Fetal Head Entrapment During Caesarean Delivery Due to Undiagnosed Bicornuate Uterus
Keywords:Bicornuate uterus, pre-term labour, malpresentation.
Objective: Fetal head entrapment during a caesarean delivery due to breech presentation is an emergency which should act promptly and appropriately. This is can be happened as a result of pre-maturity due to larger head compare to the trunk or due to uterine anomalies. Uterine anomalies may be congenital or acquired. Bicornuate uterus is a common congenital uterine anomaly while fibroid uterus is the commonest acquired uterine anomaly. This is a case of head entrapment during the delivery of the baby during caesarean section due to undiagnosed bicornuate uterus. Case: 19-year-old primi mother in the 34th week of pregnancy presented in active labour. Examination confirmed the pre-term labour with fully dilated cervix with breech presentation. Emergency caesarean delivery was planned due to risk of entrapment of after coming head. Fetal head entrapment occurred following the delivery of fetal trunk during the caesarean section. Transverse uterine incision had to be extended as an inverted “T’’ incision to complete the delivery of the fetus. Inspection following the delivery revealed the presence of bicornuate uterus. Routine uterine incision suturing done and she had an uneventful recovery. Discussion: Bicornuate uterus is one of the commonest congenital uterine anomalies occur due to incomplete fusion of the Mullerian ducts which usually diagnosed during a uterine surgery or during the course of investigation for recurrent pregnancy losses, subfertility or dysmenorrhoea. Even though current evidence not suggest to offer routine emergency caesarean delivery for all pre-term breech comes with pre-term labour, emergency caesarean delivery will reduce the risk of after coming head entrapment during vaginal breech delivery which need more difficult interventions. Making an inverted “T’’ incision is the recommended method to overcome the head entrapment during caesarean delivery. Patient should be counselled regarding the possible consequences of future pregnancies and she should be screened for renal anomalies as uterine anomalies associate with renal anomalies. Conclusion: Bicornuate uterus is associated with multiple obstetrics complications which need proper investigations and management to reduce the maternal morbidity and mortality while reducing the poor neonatal outcomes.
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