Consultant Obstetrician and Gynaecologist, Head of Department of Obstetrics and Gynaecology, Mpilo Central Hospital, Vera Road; Founder and Chief Executive Officer Royal Women’s Clinic, 52A Cecil Avenue, Hillside, Bulawayo, Matabeleland, ZimbabweZimbabwe
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A 32 year-old P1G2 went into spontaneous labour at 37 weeks gestation. Precipitate labour progressed to a normal vaginal delivery (NVD) of a baby boy within 2 hours of onset. She had a retained placenta. The patient was taken to theatre for an examination under anaesthesia and manual removal of placenta. It was discovered that she had uterine anomaly. A calcified accretic placenta was manually removed. The patient was kept on an oxytocin infusion overnight and given intravenous broad spectrum antibiotics. She made a good recovery and was discharged home after 3 days on oral antibiotics.
Keywords: Retained placenta; Uterine anomalies; Life-threatening; Catastrophic haemorrhage; Reproductive outcomes; Maternal mortality
Retained placenta poses great danger to maternal health as it can lead to catastrophic haemorrhage, the risk is even higher with an adherent placenta. Prenatal diagnosis of abnormal placentation allows anticipation of multidisciplinary team4 management that prevents adverse outcomes. It is important that it is recognized early and prompt steps taken to have it manually removed under anaesthesia. An association of a retained placenta and uterine anomaly has not been described in the literature hence this case is to highlight this association. Uterine morphology can be ascertained outside pregnancy by hysterosalpingography and
laparoscopy. Magnetic resonance imaging (MRI) can also be a useful tool to diagnosis. Some uterine anomalies may permit
normal obstetric outcomes.
Women with congenital uterine malformations usually have higher incidence of subfertility and complications during
pregnancy and delivery. The risks include preterm pre-labour rupture of membranes, small for gestational age babies and pre- 7,8 term delivery.7,8 There are also risks of malpresentation and caesarean section (C-section) delivery, and rupture of rudimentary uterine horn. The complication of a retained placenta in uterine horn is not described in the literature. Uterine anomalies are as-
sociated with both normal and adverse reproductive outcomes.
This case reminds clinicians of rare clinical associations that lurk underneath the surface undetected and yet pose significant danger to maternal health. When faced with unusual clinical findings, clinicians must explore other areas that may lead to the discovery of unexpected pathology. This can be life-saving.