Asymptomatic uterine rupture of a cornual pregnancy in the third trimester - A case report

BACKGROUND: Reports of cornual pregnancy persisting until fetal viability and of ultrasound diagnosis of asymptomatic uterine rupture are rare. CASE: A 24-year-old woman, gravida 6, para 5, presented for initial ultrasound evaluation at 28517 weeks' gestation after registering late for prenatal care. Her history included 2 prior cesarean deliveries. Obstetric ultrasound evaluation revealed a clinically silent uterine rupture with a live fetus. The site of rupture was suspected to be the prior uterine scar. After completion of a course of antenatal corticosteroids, the patient underwent exploratory laparotomy, abdominal delivery of a live, male neonate, hysterectomy and appendectomy. The patient experienced an unremarkable postoperative course and was discharged on postoperative day 4. The infant was discharged on hospital day 83 with chronic lung disease, stage 1 retinopathy of prematurity, atrial septal defect and a right clubfoot; there were no additional findings at the 4-month follow-up. Pathologic examination demonstrated cornual implantation with subsequent uterine rupture. CONCLUSION: This case demonstrates the importance Of maintaining a suspicion for ectopic pregnancy at advanced gestational ages and for uterine rupture even in the absence of symptoms. The case also illustrates that fetal survival can occur in cornual pregnancy.