Bicornuate Uterus with Third Trimester Fetal Demise in a Non-Communicating Rudimentary Uterine Horn: A Case Report

Bicornuate uterus is a rare congenital uterine anomaly that occurs due to incomplete fusion of the mullerian ducts during fetal development, resulting in a single cervix and two uterine horns with partial to complete separation with or without communication between the cavities. Pregnancy in a rudimentary non-communicating uterine horn of a bicornuate uterus is an even rare occurrence, usually due to transperitoneal migration of sperms or zygote, and it is often associated with fetal demise and uterine rupture. We report a case of a bicornuate uterus unicollis with a third-trimester fetal demise in a non-communicating rudimentary uterine horn with focus on diagnosis, investigations and management in a low resource setting.

The patient was a 24-year-old Ugandan, gravida 2 para 0+1 at 29 weeks of gestation who presented with abdominal pain for 3 days. She had a history of dyspareunia, dysmenorrhea, and a first-trimester miscarriage four years ago. Laparotomy for an abdominal ectopic pregnancy revealed a bicornuate uterus with a gravid non-communicating rudimentary uterine horn containing a dead fetus. Resection of the right non-communicating uterine horn was done with preservation of the right ovary.

Despite the rarity and difficulty in the diagnosis of uterine anomalies in low-resource settings, it is important for clinicians, especially obstetricians and gynecologists, to be aware of a bicornuate uterus with a non-communicating rudimentary horn pregnancy that can lead to fetal demise and uterine rupture. Early antenatal diagnosis by ultrasonography is crucial in prevention of future obstetric complications in low resource settings.