Termination of a pregnancy located in one horn of a bicornuate uterus: challenges and solution.
ESC Congress Library. Gbolade B. May 4, 2016; 127055; A-23 Disclosure(s): Paid for organising and chairing an educational meeting by Exelgyn.
Mr. Babatunde A. Gbolade
Mr. Babatunde A. Gbolade
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Abstract
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Objective:
To report a surgical evacuation of a retained 15-week old fetus in one horn of a bicornuate uterus without resorting to laparotomy and hysterotomy, discuss the challenges faced and solution, and review the literature.

Method:
Case report, discussion of challenges faced, solution and review of the literature.

Case Report:
A 16-year-old primigravida presented for a surgical termination of pregnancy. An initial ultrasound scan revealed an intrauterine pregnancy at five weeks and six days' gestational age and an apparently normal uterus. She underwent a suction termination of pregnancy by Manual Vacuum Aspiration (MVA) under continuous intraoperative ultrasound guidance with apparent success. However, she presented two months later with an on-going pregnancy and ultrasound scan confirmed a viable single intrauterine pregnancy of 14 weeks and two days duration but without identifying the uterine anomaly. During an attempt at an electric surgical termination of pregnancy, bimanual examination suggested the presence of a uterine anomaly and a detailed repeat ultrasound scan confirmed the presence of a bicornuate uterus, with the fetus in the left uterine horn. Medical termination of pregnancy with a combination of Mifepristone and Misoprostol was only partially successful as there was retention of the fetus and placenta. The opening into the left uterine horn was at almost a right angle to the cervical canal. A surgical evacuation of the retained products of conception was undertaken with a malleable threaded cannula, using a combination of hysteroscopy and continuous ultrasound-guided dilation of the opening into the left uterine horn, The procedure was completed without any complications. The patient remains well.

Conclusion:
A combination of very early pregnancy and unknown uterine anomaly pose a significant risk of failure to terminate the pregnancy. Medical abortion may not always be successful, and recourse may need to be made to surgical termination. Intraoperative real-time ultrasound guidance and surgical versatility are required to avoid laparotomy and hysterotomy and decrease the incidence of retained products of conception in these relatively rare situations.

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