A 22-year-old Gravida II, abortion I came to our institution on referral from a primary hospital with a referral paper and sonography showing that she had IUFD. She had a spontaneous abortion for which dilation and curettage (D&C) was performed at the primary hospital 16 months back. She had no remarkable medical and surgical histories. She had regular antenatal care follow-up at the primary hospital and had 8 months of amenorrhea.
Upon admission, the patient was clinically asymptomatic and stable, showing no uterine contractions and no cervical dilatation. On abdominal examination, the uterus was enlarged equivalent in size to 30 weeks of pregnancy.
On examination, her BP was 120/75 mm of Hg, pulse 85/minute, temperature 36.5 C, and respiratory rate 22/minute. FHS was absent
Obstetric ultrasonography revealed a singleton, intrauterine fetal demise with a gestational age of 32 weeks, estimated fetal weight of 1.3 kg, and negative fetal heartbeat. The placenta was fundal and anteriorly. The cervix was closed, uneffaced, and posterior. All laboratory investigations were normal.
Initially, she was administered 50 mcg of vaginal misoprostol at 6-hour intervals, without response after the 6th dose. Then, she was given an infusion of normal saline 0.9% with 5 IU of oxytocin, followed by increasing concentrations of the same infusion. Just then, there was no cervical dilation, despite the onset of contractions.
Cervical effacement with no dilatation was seen. Finally, a Foley catheter was used. All attempts were unsuccessful. The patient was counselled and underwent a cesarean section horizontally under spinal anaesthesia.
The intraoperative finding was intact rudimentary horn pregnancy. Clamps were applied over the fibrous band on the medial side and the fallopian tube and ovarian and round ligaments on the lateral side; the accessory horn was excised with the dead fetus; and right salpingo-oophorectomy was performed (Figures 1 and 2).
On releasing the forceps applied to the fibrous band and probing, a canal was detected between the rudimentary horn and the uterine cavity at the level of the isthmus. The round ligament, ovarian ligament, and tube were connected to the right cornua of the uterus.
The patient was advised to follow up. The patient had uneventful postoperative recovery and was discharged after 3 postoperative days.