Uterine Rupture Associated with Placenta Accreta in a Communicating Pseudo-unicornus: A Case Report and Review of the Literature

Abstract

Introduction: Uterine malformations are abnormalities of the development of the Müllerian ducts and represent 1 to 4% in terms of prevalence in the population. Pregnancy constitutes a circumstance of discovery of this congenital anomaly with an increased risk of obstetrical complications, the most dreaded of which are ectopic pregnancy and uterine rupture. Case Presentation: We report in our observation a case of uterine malformation associated with pregnancy. This was a 20 years old female patient with a 34 SA pregnancy who presented with abdomino-pelvic pain. On clinical examination a threat of preterm delivery was suspected. Obstetrical ultrasound revealed a prævia mass suggesting adnexal torsion or a prævia myoma. A laparotomy was carried out, which revealed a communicating pseudo-unicornuate uterus (AFS class II type 3) with the pregnancy located in the communicating part. A subserous uterine rupture associated with a placenta accreta was noted at this level. Fetal extraction was performed followed by a hemostasis hysterectomy. The postoperative course was unremarkable with a healthy live infant.  Conclusion: These rare cases require a good prenatal follow-up with early ultrasound. This is often difficult in rural areas where the low socio-economic level favors a delay in diagnosis and management and the mode of discovery remains during an obstetrical complication.