Non-Classical Mullerian Uterine Anomaly: A Case Report

Congenital uterine anomalies are malformations that occur during female fetal development. The maturation of the paramesonephric ducts (mullerian ducts) is responsible for the formation of the uterus and other reproductive organs. It is within this developmental process that mullerian anomalies occur. Abnormalities of the uterus can be classified as arcuate, septate, bicornuate, unicornuate, and uterine didelphys. Commonly, patients with mullerian anomalies are asymptomatic, however those that are symptomatic often present with fertility difficulties. Asymptomatic anomalies are often discovered incidentally, as was the case with the patient presented in this report. The patient is a 28-year-old G2P1001 39w0d who elected to undergo a cesarean delivery after presenting to the labor and delivery unit with contractions. The standard procedure was successful with delivery of a viable fetus without any complications. Incidentally, it was discovered that the patient had a uterine anomaly consisting of an abnormally located right ovary and fallopian tube below the lower uterine segment. The tissue was viable and congruent to its left counterpart aside from the location. The anomaly was classified as a left unicornuate uterus; however, the presentation was a unique and not commonly described variant of a unicornuate uterus. Physical inspection of the uterus after delivery of the fetus did not show any other abnormal, atrophic tissue or a rudimentary horn that is characteristically present with a unicornuate uterus. This patient's findings were a unique example of a unicornuate uterus not commonly seen in literature given the vast range of defects that could be possible. The patient recovered fully after the delivery, and the newborn was healthy with no abnormal findings during assessment. Given the asymptomatic nature of the finding, and the patient’s full recovery, no plans have been made for any intervention and the patient was instructed to follow-up in the outpatient setting.