Cornual Placental Implantation in an Unscarred Uterus

Cornual implantation of the placenta is an extremely rare and potentially life-threatening form of abnormal placental location, associated with localized progressive myometrial thinning and a significant risk of uterine rupture and massive hemorrhage. Unlike classical placenta accreta spectrum, it may occur in unscarred uteri, present with subtle clinical features, and thereby pose diagnostic challenges. We report the case of a 22-year-old multigravida woman (G2P1L1) who presented in the early second trimester with intermittent lower abdominal pain and spotting per vaginum. She had no history of prior uterine surgery or identifiable risk factors for abnormal placentation. Ultrasonography revealed a single live intrauterine fetus with eccentric placental implantation in the uterine cornual region and marked thinning of the adjacent myometrium, raising a strong suspicion of abnormal cornual placental adherence. Although the patient was hemodynamically stable at presentation, the imaging findings indicated a high risk of impending uterine rupture and catastrophic hemorrhage. In view of the potential for sudden clinical deterioration, prompt surgical intervention was undertaken with appropriate preparedness for hemorrhage. Intraoperatively, cornual placental implantation with significant myometrial attenuation was confirmed. Local carboprost administration at the placental implantation site achieved good uterine tone and satisfactory hemostasis. Cornual implantation of the placenta is a rare and potentially life-threatening condition, even in an unscarred uterus. A high index of suspicion, targeted ultrasonographic evaluation, and timely surgical management are crucial to prevent catastrophic hemorrhage and optimize maternal outcomes.