Abstract

Background: The incidence of uterine rupture in women without previous scar is estimated to be 0.1-0.2% in the second trimester of pregnancy using mifepristone and gemeprost. Persistent failed induction necessitates further investigations to find the true nature of the pregnancy. Unicornuate uterus is a congenital uterine anomaly resulting from a non-developing Mullerian duct or agenesis of the Mullerian system. It was first classified in 1979 by Buttram and Gibbons and further revised by the American Society of Reproductive Medicine in 1988.

Case Description: A 19-year primigravida at 20 week gestation presented to the emergency with ultrasound finding of intrauterine dead fetus of 17 weeks gestation. The patient had stable vitals though she was clinically pale. The patient was stabilized with initial three units of packed red blood cell transfusion and induced with mifepristone 200 micrograms. After 48 hours of mifepristone, induction was started with P/V misoprostol 200 micrograms every eight hours. Following two doses of misoprostol, patient gave history of subsiding pains and on examination revealed a loss of contour of uterus and tenderness on deep palpitation. Emergency scan revealed rupture uterus with hemoperitoneum. On laparotomy, ruptured left non-communicating rudimentary horn of uterus with possible placenta accreta was found. 500ml of hemoperitoneum was drained. Postoperative period of the patient was satisfactory.

Conclusion: This case illustrates that in case of failure of second trimester medical abortion, differential diagnosis of pregnancy in non-communicating hornof unicornuate uterus should be kept in mind as USG can miss to diagnose mullerian anomalies.

KEYWORDS: Uterine Rupture, Placenta Accreta, Rudimentary Horn, Mullerian Anomaly.