Placenta Percreta in a Gravid Bicornuate Unicollis Uterus

Abstract

Background Identifying bicornuate uterus can be challenging especially as a cause of early pregnancy bleeding. On ultrasonographic examination, it is difficult to misdiagnose pregnancy in a bicornuate uterus as an ectopic pregnancy due to the continuity of the endometrium. A rudimentary horn of a bicornuate uterus in early pregnancy can occasionally be misdiagnosed for an ectopic pregnancy especially when compounded by severe abdominal pains and supportive sonographic evidence. Myometrial invasive grading of placenta may be necessary for emergency preparedness and consenting. Hemihysterectomy is lifesaving when percreta has caused severe postpartum haemorrhage. Case Presentation We present a 24-year-old primigravida who presented to the maternity department with severe abdominal pains at 35 weeks. She was pale on clinical examination and haemodynamically unstable. She underwent emergency caesarean section with a preoperative diagnosis of concealed abruptio placentae. Intraoperatively we encountered a bicornuate uterus, delivered a fresh stillbirth, and noted a placenta percreta. A hemihysterectomy was done and she recovered after transfusion without complications. Conclusion A gravid horn of a bicornuate uterus may present as an ectopic pregnancy; careful assessment at laparotomy or laparoscopy is required to prevent inadvertent surgical termination of pregnancy. Placental myometrial invasive assessment is important for delivery emergency preparedness.

Pregnancy With a Bicornuate Uterus Complicated by Placenta Percreta and Intraperitoneal Hemorrhage

“…The condition may become an incidental finding intraoperatively or after developing related obstetric complications such as uterine rupture or complications during labor leading to a cesarean section. The complications have a risk of hysterectomy [ 6 ], as seen in our case.…”

“…However, rupture of scar pregnancy could be considered a differential diagnosis. Other complications include menstrual irregularities, infertility, and abnormal uterine bleeding [ 6 ].…”

Placenta percreta after Strassman metroplasty of complete bicornuate uterus: a case report

“…The abnormal uterus, endometriosis, and pelvic adhesions contributed to infertility and recurrent failed assisted reproductive technology. Abortion in the first trimester was probably caused by inadequate trophoblast blood vessel formation, which was related to the reduced muscle tissue and abnormal vasculature in the process of implantation [ 16 ], which might also have led to the lethal placenta percreta [ 17 ]. Alternatively, the placenta previa and percreta might have been caused by scar tissue, which formed during metroplasty and curettage.…”

Management of Interstitial Ectopic Pregnancy in a Bicornuate Uterus Simulating an Incomplete Abortion

“…The probability of misdiagnosis to an ectopic pregnancy is real. There are sonographical similarities between a pregnant horn of a bicornuate uterus and an ectopic pregnancy [ 3 ].…”