A CASE OF BREECH PRESENTATION IN A PRIMIGRAVIDA WITH BICORNUATE UTERUS AND PLACENTA ACCRETA

Abstract

A 20-year-old primigravida at 38 weeks of gestation presented in active labor with breech presentation. Clinical assessment suggested a bicornuate uterus with a noncommunicating rudimentary horn. An emergency cesarean section was undertaken, resulting in the delivery of a breech neonate. Intraoperatively, placenta accreta was identified with partial adherence to the uterine wall, complicating placental separation. The majority of placental tissue was manually removed, though a portion remained adherent. Importantly, no active postpartum hemorrhage was observed. Hemostasis was achieved, and the surgical site was secured. Postoperatively, the patient was closely monitored, and ultrasonography was utilized to evaluate retained products of conception. Scheduled follow-up visits were arranged to ensure early detection and management of potential complications.This case highlights the critical importance of early antenatal recognition of müllerian anomalies and placental pathology. A bicornuate uterus with a rudimentary horn significantly increases obstetric risks, including uterine rupture and abnormal placentation. The coexistence of placenta accreta further exacerbates peripartum morbidity, demanding meticulous surgical management and heightened intraoperative vigilance. Timely operative intervention, precise intraoperative evaluation, and rigorous postoperative surveillance are imperative to optimize outcomes. Early and accurate diagnosis remains essential for reducing maternal and neonatal morbidity in such high-risk pregnancies.