Successful pregnancy in the blind hemicavity of Robert's uterus: a rare case report and brief literature review

Abstract

Background: Robert's uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert's uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert's uterus.

Case presentation: A 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert's uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.

Conclusions: Pregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.

Keywords: Blind hemicavity; Case report; Robert’s uterus; Successful pregnancy.

Fig. 1

Two-dimensional ultrasound images during the first trimester. A uterine septum (black arrow) divides the uterus into two hemicavities (white arrows). Pregnancy occurs in the right blind hemicavity (black arrow head)

Fig. 2

Ultrasonography for diagnosing fetal malformations. The two hemicavities (white arrows) are connected by a 10 mm hole in diameter (red double arrow) in the uterine septum (black arrow). Pregnancy occurs in the right blind hemicavity (black arrow head)

Fig. 3

Ultrasonography images show the amniotic sac stretches across two hemicavities (white arrows). The fetus (black arrow head) is located in the right hemicavity with little amniotic fluid, whereas the umbilical cord (yellow arrow) extends to the contralateral hemicavity with most amniotic fluid

Fig. 4

Magnetic resonance images. The amniotic sac lying across two hemicavities (white arrows) by a 10 mm defect (red double arrow) at the septum. The fetus (black arrow head) with little amniotic fluid (blue pentagram) in the right hemicavity and the umbilical cord (yellow arrow) with most amniotic fluid in the left hemicavity

Fig. 5

Obstetric ultrasonography after admission. There is hardly any amniotic fluid in the amniotic sac in both hemi-cavities (white arrows). The fetus curls up in the right hemicavity and the umbilical cord (yellow circle and yellow arrow) is huddled in the left side directly above the internal cervical os