Favorable pregnancy outcome for a patient with Robert's uterus, bicornuate uterus, and ipsilateral renal agenesis

Abstract

Fibroids are the most common benign tumor of the female reproductive tract. Elective services have been suspended due to the COVID-19 pandemic, resulting in a backlog of patients awaiting surgery. When the curve was flattened in the UK, the second phase of the National Health Service's plan to tackle the pandemic was announced with the reintroduction of elective surgery. Guidance emerged on how to prioritize patients based on urgency, taking into account the risk of surgery during the pandemic. 1 Most women needing surgery for fibroids fell into P3 or P4 categories, 2 defined as procedures that could wait for 3 months. The majority were from ethnic minorities due to greater prevalence of fibroids among black women. East London has a diverse patient population: many women are from black, Asian and minority ethnic (BAME) backgrounds. BAME women are over four times more likely to contract, and be adversely affected by, SARS-CoV-2 than their white counterparts. 3 Women whose fibroid surgery was postponed as a result of COVID-19 were identified using electronic patient records (n=22). Verbal consent was obtained for participation in the study at the time of completing the questionnaire, as written consent was not possible/appropriate amid the pandemic. Pre-COVID-19, women completed 'Uterine Fibroid Symptoms and Health-related Quality of Life Questionnaires' (UFS-QOL), a validated tool for assessing patients'

Robert’s uterus with delayed diagnosis and potential consequences: a case report

“…Rare complications of Robert’s uterus, such as pregnancy in the blind cavity (considered as one type of ectopic pregnancy), unique ipsilateral renal agenesis, and a bicornuate uterus, have been reported. 4 In contrast to the classical symptoms, Robert’s uterus in the present patient did not show prominent symptoms related to hematometra as previously reported. 5 Therefore, diagnosis and treatment were delayed and the function of the salpinx and pelvic environment were severely damaged.…”

Inappropriate surgery in a patient with misdiagnosed Robert’s uterus

“…Robert’s uterus is difficult to diagnose pre-operatively [ 4 , 7 – 12 ], especially because abdominal pain is also caused by the more common endometriomas and hematosalpinx, resulting in its misdiagnosis. US and MRI are the modalities used for diagnosing Robert’s uterus with corresponding hysterosalpingography, hysteroscopy, and laparoscopy becoming useful, especially in cases where infertility is an issue.…”

“…However, the outer fundal contour of a bicornuate uterus presents with a larger or wider concavity at > 10 mm [ 3 , 4 ]. Considering how rare Robert’s uterus is as well as the limitations of relevant imaging and standards, preoperative diagnosis is often wrong and the condition tends to be misdiagnosed as uterine adnexal diseases or appendicitis with right lower abdominal pain, leading to unsuccessful surgeries and treatment plans [ 4 , 7 – 12 ]. Additionally, Robert’s uterus may be misdiagnosed as another uterine malformation disease, so uteroplasty may be performed incorrectly.…”

“…Regarding fertility in patients with Robert’s uterus, recurrent pregnancy loss and infertility are the main clinical problems. Case reports of post-operative childbirth are limited [ 7 , 9 , 13 , 21 , 22 ], and the effect on pregnancy remains unclear. There are also a few reports of a rare complication of Robert’s uterus manifesting with pregnancy in a blind cavity, resulting in stillbirth associated with transperitoneal migration of sperms to the contralateral tube [ 23 , 24 ].…”

Successful pregnancy in the blind hemicavity of Robert’s uterus: a rare case report and brief literature review

“…Up to now, minimally invasive ultrasound-guided hysteroscopic metroplasty is considered the best way to correct this malformation as it has the potential to normalize the uterine morphology and function [ 2 ]. There is no shortage of successful cases in which the patients were able to conceive naturally after surgery and deliver healthy newborns[ 5 ], indicating early diagnosis and timely remodeling are essential for cases where infertility is an issue.…”