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| Atypical Obstruction Praevia: A Case Report and Review of the Literature
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Mohamed Mahmoud Emed ,Ahmedna Elbechir , Karam Mohammed Saoud, Nisrine Mamouni, Sanae Errarhay, Chahrazed Bouchikhi, Abdelaziz Banani
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Abstract:
A didelphic uterus is a congenital anomaly due to the lack of fusion of the mullerian ducts, resulting in the development of two uterine bodies, each with its own cervix, fallopian tubes and often a septal vagina; To draw the attention of clinicians, we report the case of a 21-year-old parturient, without any notable pathological history, primigravida primiparous woman referred from a birthing center for pelvic pain on a full-term pregnancy. On admission, the patient was algic with a uterus that was contracted on palpation. On vaginal touch, the cervix is lateralized to the left and dilated to one finger, the presentation is mobile cephalic. The water sac is intact with a sensation of a bulging mass at the level of the Douglas lateralized to the right. The emergency ultrasound noted a pregnancy of 37-38 weeks with a retro-cervical mass lateralized to the right of 10 cm × 8cm, enclosed in the cul-de-sac of Douglas whose echo structure favors a normal myometrium. An emergency caesarean section allowed the extraction of a male newborn, Apgar 10/10 and weight 3100 grams, on the basis of the information provided by the ultrasound, the surgeon decided to further explore the pelvic cavity after total exteriorization of the uterine mass. This procedure revealed a second non-gravid uterus that was enclosed in the cul-de-sac of Douglas which corresponded to the Pr?via mass seen on ultrasound. Clinicians must have a high index of suspicion for uterine abnormality to make an early diagnosis of Didelphe uterus. A pregnancy in a Didelphic uterus deserves early diagnosis of the anomaly, and meticulous care during pregnancy and delivery to avoid the associated negative consequences.
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