ABSTRACT
Uterine anomalies are congenital malformations arising due to embryological mal-development of mullerian ducts. The European society of Human Reproduction and Embryology (ESHRE) classifies these anomalies into 6 classes. Hemi-uterus is one such class of formation defect of mullerian duct with unilateral uterine development; the contralateral part could be either incompletely formed or absent. In a rare form of ectopic pregnancy, implantation can occur in the cavity of a rudimentary horn of the hemi-uterus. Authors report a case of 22-year G2P1L1 with 12 weeks gestation who presented with acute abdomen. Ultrasound showed hemoperitoneum with suspicion of ectopic pregnancy. Laparotomy confirmed the diagnosis of ruptured right rudimentary horn with fetus and placenta in the peritoneal cavity. Immediate laparotomy and excision of the horn with transfusion of blood and blood products saved the patient in the nick of time.
ABSTRACT
Background: 2-5% of the pregnancies are complicated by antepartum haemorrhage. About one third of them are due to placenta previa thus contributing to a significant amount of maternal and perinatal morbidity and mortality. In the present times with liberally increasing caesarean section rates, there is a changing trend in the incidence and complications of placenta previa. The objective of this study was to evaluate the obstetrical characteristics and maternal and perinatal outcome of cases of placenta previa.Methods: This was a prospective observational study conducted in the Department of Obstetrics and Gynaecology of JSS Medical College and Hospital, Mysore during the period January 2017 to June 2018.Results: Out of total 13,150 deliveries during this period, placenta previa was observed in 131 cases with an incidence of 1%. Majority belonged to the age group 25-29 years (48.8%). 66% of the cases presented with painless vaginal bleeding as their chief complaint. The major risk factor was previous caesarean delivery seen in 29.8% cases followed by history of abortion in 18.3%. 67% cases had major degree placenta previa. Remaining 33% cases had minor degree. One case was complicated by placenta accrete. Peripartum hysterectomy was performed in 3.1%. Preterm deliveries amounted to 29.8%. Maternal and perinatal mortality were 0.76% and 3.05% respectively. 10.7% cases had Postpartum haemorrhage and 3.8% required ICU admission. 25% neonates required NICU admissions and 10% had RDS.Conclusions: Placenta previa is a prime contributor to substantial maternal and perinatal morbidity and mortality. Early referral to tertiary care centres, anticipation of clinical complications and appropriate measures can avoid grave consequences. Such cases must always be managed at a higher centre with good NICU services and round the clock operation theatre and blood bank facility.