A rare case of first-trimester ruptured bicornuate uterus in a primigravida

Bicornuate uterus (BU) is a rare uterine anomaly result from incomplete fusion of the two Müllerian ducts during embryogenesis. BU very rarely can lead to rupture of the uterus during the early pregnancy with high mortality and morbidity rates.

A primigravida in the first trimester (9 weeks) presented complaining of epigastric pain and vomiting for one day. Ultrasound scan was performed at the 7th week of pregnancy and showed a BU with single intrauterine gestational sac in the right horn. On presentation, the patient was pale and irritable. Urgent ultrasound scan showed viable fetus in the right horn, free fluids in Morrison's pouch. Laparotomy showed BU with pregnancy in the ruptured right horn. The defect in the uterus was repaired. Postoperatively, the patient was advised to use contraceptive pills for one year.

Our patient has a sonographic diagnosis of BU at the 7th gestational week. At that stage, nothing was done except close follow up of the pregnancy. When she developed severe epigastric pain, initially, we thought of peptic ulcer disease complications. Even after deterioration of the patients' condition, the diagnosis was not clear as the urgent ultrasound showed a viable fetus. Blood and fluid replacement therapy, and exploratory laparotomy were essential to save the patient's life.

This case highlights the fact that uterine rupture can occur in early pregnancy when associated with uterine anomaly. Early sonographic diagnosis has a major contribution in evaluation and management.