Ngichabe Sammy, Sura Mandeep
Nairobi Women's Hospital, Nairobi, Kenya.
University of Nairobi, Nairobi, Kenya.
Case Rep Obstet Gynecol. 2017;2017:4082182. doi: 10.1155/2017/4082182. Epub 2017 Jun 11.
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.
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.
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.
识别双子宫可能具有挑战性，尤其是作为早期妊娠出血的原因时。在超声检查中，由于子宫内膜的连续性，很难将双子宫内的妊娠误诊为异位妊娠。妊娠早期双子宫的残角偶尔可能被误诊为异位妊娠，尤其是当伴有严重腹痛和支持性超声证据时。胎盘的肌层浸润分级对于应急准备和知情同意可能是必要的。当穿透性胎盘导致严重产后出血时，半子宫切除术可挽救生命。
我们报告一名24岁初产妇，35周时因严重腹痛到产科就诊。临床检查时她面色苍白，血流动力学不稳定。她接受了急诊剖宫产，术前诊断为隐性胎盘早剥。术中我们发现是双子宫，娩出一个新鲜死产儿，并注意到穿透性胎盘。进行了半子宫切除术，输血后她康复且无并发症。
双子宫的妊娠角可能表现为异位妊娠；剖腹手术或腹腔镜检查时需要仔细评估，以防止意外终止妊娠手术。胎盘肌层浸润评估对分娩应急准备很重要。
