Uterine rupture in a primigravid patient with an unscarred bicornuate uterus at term

Abstract

BackgroundUterine rupture of an unscarred primigravid uterus is an exceedingly rare event. Cases of spontaneous rupture of an unscarred bicornuate uterus have been reported, but typically occur in the first or second trimester.CaseA 28-year-old primigravida at 37 weeks gestation with a known bicornuate uterus and no prior surgery underwent an emergent cesarean section after presenting with severe abdominal pain and signs of fetal compromise. She was found to have a uterine rupture with the fetus free in the abdomen accompanied by a large hemoperitoneum. Both mother and baby did well postoperatively.ConclusionBicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid patients and at any gestation.

The impact of congenital uterine abnormalities on pregnancy and fertility: a literature review

“…Similar to uterus didelphys, bicornuate uterus derives from deficient fusion of Müllerian ducts during fetal development; in this case, the two cavities are entirely or partially unified by caudal fusion ( Doruk et al ., 2013 ) . Both endometrial cavities frequently open to a single vagina via a single uterine cervix (unicollis) or via separate uterine cervices in rare cases (bicollis) ( Chan et al ., 2011b ; Gasim & Al Jama, 2013 ; Nitzsche et al , 2017 ) . Bicornuate uterus competes with arcuate uterus for the place of third most frequent congenital Müllerian malformation in unselected populations (0.4%) ( Dohbit et al ., 2017 ; Kowalik et al ., 2011 ) .…”

“…The rate of the Premature Rupture of Membranes (PROM), preterm separation of the placenta, miscarriage, premature delivery, and Intrauterine Growth Restriction (IUGR) is higher in cases of bicornuate uterus ( Mastrolia et al ., 2017 ) . Bicornuate uterus significantly contributes to uterine ruptures in first pregnancy patients and at any gestational age ( Nitzsche et al ., 2017 ) , as well as cervical incompetence, which can significantly increase the perception of birth risk ( Mastrolia et al ., 2017 ) . However, there are several reports of successful gestations involving bicornuate uterus patients.…”

Case Report: Spontaneous perforation of a bicornuate uterus with concomitant sarcoma

“…The bicornuate uterus often has unusually thick and strong round ligaments along with a thick vesicorectal fold running between them 12 . This fibrous band in the form of a rectovesical ligament has a restrictive effect on the expansion of the pregnant horn of a bicornuate uterus, thereby weakening the medial aspect of the horn 13 . Rupture of a bicornuate uterus during a growing pregnancy occurs due to inability of the malformed uterus to expand as a normal uterus would 4 .…”

Uterine rupture in patients with a history of laparoscopy or hysteroscopy procedures

“…Several factors may be responsible for rupture of the uterus, including advanced maternal age, overdue pregnancy, macrosomia, a shorter interval of deliveries, single-layer uterine closure, multiple previous cesarean deliveries, trial of labor after cesarean section, [4] bicornuate uterus, [5] laparoscopic or abdominal myomectomy or adenomyomectomy, [6–8] and hysteroscopic surgery. [1] As we have previously reported, interstitial pregnancy treated with uncomplicated laparoscopic cornual wedge resection and laparoscopic salpingectomy can also lead to UR.…”