Sonographic Dilemma in Bicornuate Uterus- Transabdominal or Transvaginal

Dhanaraj Thuraisamy, Suhnaina Kaur, Normaliza Muhamad, Norhana Mohd Kasim

Department of Obstetrics and Gynaecology, Hospital Cyberjaya, Malaysia

OBJECTIVE:

Spontaneous twin pregnancy in bicornuate uterus is rare and estimated to be as low as 1 in 1,00,00,000. In a patient presenting with nausea and vomitting in early pregnancy, transabdominal sonographic detection of twin pregnancies are important for further management of these pregnancies. In our case, we present a case of bicornuate uterus with pregnancies in both horns conceived spontaneously.

 

CASE REPORT:

A 34 year old G2P1 with spontaneous conception presented with nausea and vomitting for 1 week. She was amenorrheic for 7 weeks. She gave a past history of cesarean section done for singleton with malpresentation at term with bicornuate uterus. During examination, the uterus was bulky. Speculum examination revealed no presence of any vaginal septum with a single cervix. Initial transvaginal sonography revealed a single viable intrauterine pregnancy. Transabdominal sonography was repeated and revealed two gestational sacs, one in each horn of bicornuate uterus. One sac was had a viable pregnancy wherelese the other sac was irregular and empty. She was discharged with antiemetics and in order to safeguard the healthy pregnancy, we avoid a D&C and followed up the patient regularly.

 

DISCUSSION:

Association of pregnancy with congenital uterine abnormalities such as bicornuate uterus are low between 0.003% to 0.033%. Our case belongs to this rare category of pregnancies. In patients presenting with vomitting in early pregnancies, a sonographic evaluation is important to exclude multiple pregnancies. A sonographic evaluation by transabdominal route would reveal a global view of the uterus and adnexa as compared to Transvaginal route. It is more likely to pick up a congenital abnormality via transabdominal sonography. Early ultrasound is a contributing factors in detecting abnormal uterus in pregnancies. High incidence of spontaneous abortion in pregnancies with congenital abnormalities makes them high risk pregnancies. D&C should be avoided in order to protect the viable pregnancy.

 

CONCLUSION:

Based on our experience with this case, a Transabdominal Sonography gives a global view of the uterus. This helps clinicians to reveal congenital abnormalities as well as the presence of a second pregnancy. It avoids unnecessary D&C and helps safeguard the viable pregnancy.

 

REFERENCES:

1. Amit Suri L, Satija L. BICORNUATE UTERUS WITH BILATERAL PREGNANCY PRESENTING AS THREATENED ABORTION: A Report on Two Cases. Med J Armed Forces India. 2000 Jul;56(3):233-234

 

2. Nhan VU, Huisjes HJ. Double uterus with pregnancy in each horn. Obstet Gynaecol. 1983;61:115–117.