Herlyn-Werner-Wunderlich Syndrome: A Rare Congenital Uterine Anomaly

Introduction: Herlyn-Werner-Wunderlich Syndrome is a rare anomaly and exact incidence is not known. It is usually diagnosed in young girls who present with cyclical abdominal pain along with cyclical menstruation. Case Report: We present case of two girls who had this syndrome. An ultrasound was performed in both patients. In first patient, it revealed uterus didelphys with hematocolpos on right side. In the second patient, a large hematometra of size 9.8×12.2 cm, along with hematocolpos was present on the left side. Both the patients underwent examination under anaesthesia and excision of septum. They remained asymptomatic during one year follow-up. Conclusion: Treatment of such cases is excision of septum and to maintain the patency of the outflow tract and prevent stricture formation later. A good follow-up in immediate post-operative period is necessary.

Clinical Aspects of Adolescent Endometriosis

Early diagnosis and long-term management of endometriosis is important in adolescent girls considering their potential for future pregnancy and need for preventing disease progression. However, symptoms and clinical findings of adolescent endometriosis may differ from those of typical adult endometriosis, making diagnosis difficult. In adolescents, menstrual pain may present as acyclic and unresponsive to commonly used medication. Typical imaging findings in adult endometriosis, such as ovarian endometriotic cysts and fibrotic scars, are less common in adolescents. Peritoneal lesions, characteristic of early-stage endometriosis, are commonly found in this age group. It should be noted that endometriosis may also be found in adolescents before menarche, because of premenarcheal endometriosis or congenital uterine anomaly and outflow obstruction; the latter requiring surgical correction. Although surgery is reported to be effective for pain, postsurgical recurrence rate is high, and the effect of hormonal treatment is controversial. The optimal timing for surgical intervention also remains to be determined. Here, we aim to identify the unique characteristics of endometriosis in adolescents to achieve early diagnosis and optimal management for this group of patients.

Uterine Rupture - Risk Factors and Pregnancy Outcome in Bundelkhand Region

BACKGROUND Uterine rupture is defined as the tearing of the muscular wall of the uterus during pregnancy or labour.1 Often it occurs from the tearing of previous caesarean scar during labour.2 The other known risk factors for uterine rupture include, maternal age, height, body mass index (BMI), education, birth weight, gestational age, induction of labour, instrumental vaginal delivery, interpregnancy interval, congenital uterine anomaly, grand multiparity, previous uterine surgery, fetal macrosomia, fetal malposition, obstructed labour, uterine instrumentation, attempted forceps delivery, external version, and uterine trauma. 2-6This study was done to find out the prevailing risk factors associated with this grave condition in Bundelkhand region, so that mortality and morbidity associated with it could be prevented. METHODS We have studied 37 cases of uterine rupture, operated in our institution from Jan. 2018 to Oct. 2019. During this period a total of 2986 Caesarean sections (CS) were performed. Of these 37 cases, 5 were Nullipara (13.51 %), 16 primipara (31.25 %) and 16 were grand multipara (31.25 %). 24 cases (64.86 %) had previous uterine scar while 13 (35.13 %) had no scar. RESULTS In our study major risk factors for uterine rupture were found to be previous scars (64.68 %). Obstructive labour (23.07 %), malpresentation (7.69 %), grand multiparity (38.46 %) and prolong labour (30.76 %), were responsible for rupture in unscarred uterus. In all cases we first tried to repair the tear and only 9 (24.32 %) needed hysterectomy. In our study 28 patients (75.67 %) required only repair whereas 24.32 % cases needed hysterectomy. Maternal death was just 1 case (2.7 %) and (51.35 %) babies survived. CONCLUSIONS Majority of uterine rupture cases were found in women who had previous CS. So, first CS should be performed after very careful understanding of its indications. 2.7 % maternal mortality and 51.35 % delivery of live birth babies in our study proves that early detection and proper managing of the case can reduce maternal and fetal mortality in uterine rupture cases. KEY WORDS Uterine Rupture, Previous Scar, Inter-Pregnancy Interval

Herlyn-Werner-Wunderlich Syndrome: A Case Report on a Congenital Uterine Anomaly With Literature Review

During fetal development, abnormalities during Mullerian duct formation can lead to varied types of uterine, cervical, or vaginal anomalies. Herlyn-Werner-Wunderlich Syndrome (HWWS) is a rare, congenital Mullerian duct anomaly characterized by the triad of uterine didelphys, obstructed hemi-vagina, and ipsilateral renal agenesis. If the diagnosis is delayed or missed, permanent sequalae such as chronic pain, infection, and infertility can result. This is a case of a 16-year-old woman with heavy vaginal bleeding and menstrual cramping in which sonography was used in the diagnosis of HWWS. Sonography plays a vital role in this diagnosis, as it is the most common initial imaging examination. For this reason, it is important that the characteristics of uterine anomalies, like HWWS, be recognized with sonography. It is important that this diagnosis is made early and treatment can be initiated to prevent irreversible complications.

Asymptomatic Rupture of Term Non-communicating Rudimentary Horn of Uterus: A Case Report

A Rudimentary horn is a rare form of congenital uterine anomaly, resulting from an arrest in the development of one of the Mullerian ducts with inappropriate fusion with the other side. In most of the cases no direct communicating channel exists between the two parts of the uterus. Pregnancy in the rudimentary horn represents a rare form of ectopic gestation and is thought to result from transperitoneal migration of spermatozoa or the fertilized ovum. Most patients with rudimentary horn pregnancy present in second trimester with hemorrhagic shock due to rupture of horn. Diagnosis of the rudimentary horn may be done with magnetic resonance imaging or 3D, 4D ultrasonography but confirmation of diagnosis is usually surgical at laparoscopy or laparotomy. We report a case with provisional diagnosis of a case of primigravida with 40+ weeks pregnancy with transverse lie along with placenta praevia and intrauterine fetal death. But at laparotomy it revealed a ruptured pregnant non-communicating horn of uterus.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 53-55

Rotura Uterina às 18 Semanas de Gravidez no Contexto de Útero Malformado

Birth defects of the female genital tract are relatively common and often asymptomatic. Despite the pregnancy outcome can be favorable, adverse obstetric outcomes are described in women with uterine malformations. The authors report the case of an obstetric emergency which enhances the possibility of a very adverse and rare outcome of uterine rupture in a left hemi-cavity of a bicornuate uterus away from the term, at 18 weeks of pregnancy, in a pregnant woman with history of caesarean in the right hemi-cavity and with placenta increta. A malformed uterus with a primitive type cavity has lower distensibility of the wall with the progression of the pregnancy and facilitates the development of abnormal placentation forms, increasing the risk of uterine rupture in the first and second trimesters. The knowledge of the existence of a congenital uterine anomaly in the preconceptional period is of primary importance.

Case 10.8

20-year-old woman with a congenital uterine anomaly Axial (Figure 10.8.1) and coronal (Figure 10.8.2) FSE T2-weighted images reveal 2 separate uterine horns and separate cervices. Note also 2 distinct vaginal canals, both distended with fluid. Uterine didelphys with vaginal septum...