Nahum G G
Department of Obstetrics and Gynecology, Good Samaritan Hospital of Santa Clara Valley, San Jose, California, USA.
J Reprod Med. 1997 Aug;42(8):525-32.
Surviving twins were born to a woman with a unicornuate uterus having a noncommunicating rudimentary uterine horn; this was the first such case reported. Further, it is the first report on a multiple gestation with one twin delivered successfully by cesarean section and the second vaginally at a later date.
The first twin in a unicornuate uterus was delivered via cesarean section at 28 2/7 weeks due to intractable preterm labor with breech presentation. The ipsilateral hypogastric and ovarian arteries were ligated intraoperatively to arrest myometrial hemorrhage. Continuing preterm contractions resulted in contralateral rudimentary uterine horn rupture eight days later, allowing successful vaginal delivery of the second twin.
Neonatal survival in rudimentary uterine horn pregnancies is poor, occurring in only 11% of cases during the past half century. The probability of attaining a favorable outcome is increased if aggressive antenatal management is instituted after establishing an early prenatal diagnosis. In the case of dual-chamber uterine anomalies, it is possible to effect surgical delivery of one fetus while maintaining a second preterm fetus in utero. This maneuver can decrease preterm morbidity for later-born siblings and enhance neonatal survival.
一名双角子宫且残角子宫无交通的女性诞下存活的双胞胎；这是首例此类报道病例。此外，这也是首例关于多胎妊娠的报道，其中一个胎儿通过剖宫产成功分娩，另一个胎儿随后经阴道分娩。
因臀位难产且早产难以控制，双角子宫中的第一个胎儿于孕28 2/7周时通过剖宫产娩出。术中结扎同侧下腹下动脉和卵巢动脉以控制子宫肌层出血。持续的早产宫缩导致八天后对侧残角子宫破裂，从而使第二个胎儿成功经阴道分娩。
残角子宫妊娠的新生儿存活率很低，在过去半个世纪中仅为11%。如果在早期产前诊断后采取积极的产前管理措施，获得良好结局的可能性会增加。对于双腔子宫异常情况，有可能在手术分娩一个胎儿的同时，使另一个早产胎儿继续留在子宫内。这种操作可以降低晚出生胎儿的早产发病率并提高新生儿存活率。
