Agarwal Isha, Tayade Surekha, Sharma Sakshi
Department of Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND.
Cureus. 2022 Sep 14;14(9):e29152. doi: 10.7759/cureus.29152. eCollection 2022 Sep.
The case report has been done to examine the possibility of normal pregnancy achieved in the case of a rare congenital anomaly, the bicornuate uterus. A bicornuate uterus is a very rare congenital anomaly of the uterus, which falls in the class 4 category according to the classification of Mullerian duct anomalies given by the American Society of Reproductive Medicine and is associated with several obstetrics complications like malpresentation, recurrent abortions, and growth restrictions. However, to have a normal pregnancy in a bicornuate uterus, close antenatal monitoring is required, and, depending on the individual, surgical unification can be done. A 30-year-old woman with G3A2 with 34.3 weeks of gestational age with in vitro fertilization (IVF) conception came with cervical stitch in situ and oligohydramnios with liquor index 7 for safe confinement. At the time of admission, amenorrhea was present for nine months. Ultrasound at 33 weeks three days showed a single uterine live fetus weighing about 2187 grams. The interpretation of the color Doppler was also normal. Fetal heart sound was heard in the Doppler. She was operated on at 36 weeks as an emergency lower-section cesarean section procedure. The indication was that it was an IVF baby, and the female had presented with oligohydramnios on performing investigations. The patient was counseled accordingly and discharged on 22 February 2022. She was advised to come back after 15 days or SOS at the time of emergency. All the measures were suggested, including adequate rest, plenty of fluids, and a good protein diet. Most cases of the bicornuate uterus do not present with any symptoms, i.e., they are asymptomatic and can be detected during routine evaluation of the patient. However, some patients can also have symptoms like menstrual problems such as dysmenorrhea and menorrhagia. Also, along with this anomaly, associated anomalies may be present, including agenesis of the kidney and ureter. The first and foremost investigation to be done is ultrasonography, which tells about the diagnosis of the bicornuate uterus. Magnetic resonance imaging is the gold standard test for its diagnosis. However, the diagnosis in the case of asymptomatic patients is relatively tricky and requires aggressive prenatal monitoring and needs to be kept in observation to make the pregnancy successful.
本病例报告旨在探讨双角子宫这种罕见先天性异常情况下实现正常妊娠的可能性。双角子宫是一种非常罕见的子宫先天性异常，根据美国生殖医学学会给出的苗勒管异常分类，它属于4类，并且与多种产科并发症相关，如胎位异常、反复流产和生长受限。然而，要在双角子宫中实现正常妊娠，需要密切的产前监测，并且根据个体情况，可以进行手术矫正。一名30岁、孕3产2、孕34.3周、通过体外受精（IVF）受孕的女性，因宫颈环扎在位且羊水过少（羊水指数7）前来待产以确保安全分娩。入院时，停经9个月。孕33周3天时的超声检查显示单活胎，胎儿体重约2187克。彩色多普勒检查结果也正常。多普勒检查可听到胎心音。她在孕36周时接受了急诊低位剖宫产手术。手术指征是这是一个IVF婴儿，且该女性在检查时出现了羊水过少。对患者进行了相应的咨询，并于2022年2月22日出院。建议她15天后复诊或在紧急情况时随时就诊。还给出了所有建议措施，包括充分休息、大量饮水和优质蛋白质饮食。大多数双角子宫病例没有任何症状，即无症状，可在对患者进行常规评估时被发现。然而，一些患者也可能有月经问题，如痛经和月经过多等症状。此外，除了这种异常情况，还可能存在相关的异常，包括肾和输尿管发育不全。首先要进行的检查是超声检查，它可以诊断双角子宫。磁共振成像（MRI）是其诊断的金标准检查。然而，无症状患者的诊断相对棘手，需要积极的产前监测，并需要持续观察以确保妊娠成功。
