Breech Presentation in a Primigravida with Previously Unrecognized Bicornuate Uterus: A Case Report from a Resource-Limited Area
Keywords:
diagnostic challenges, rural area, bicornuate uterus, breech presentationAbstract
Background: Congenital uterine anomalies (CUAs) are structural malformations of the uterus that occur during embryogenesis, and their prevalence in the general population ranges from 0.1% to 5.5%, depending on the population studied and the diagnostic modalities used. However, in rural or resource-limited settings, access to such modalities is often restricted, and antenatal evaluation is limited to basic obstetric ultrasonography; diagnostic challenges may delay recognition of this condition.
Case Presentation: An 18-year-old primigravida with 36 weeks of gestation from a rural area who presented with a breech pregnancy. Antenatal care was conducted in a primary healthcare facility with limited ultrasonography capabilities, and no uterine anomaly was detected. Cesarean section was performed due to breech presentation and developed into a premature rupture of membranes. Intraoperatively, a bicornuate uterus was identified, with the pregnancy located in one uterine horn.
Conclusion: This case highlights the diagnostic limitations in rural healthcare settings and emphasizes the importance of maintaining clinical suspicion for uterine anomalies in cases of malpresentation, particularly in primigravida patients.
References
Campo MC, Milán FP, Roig MC, Bartolomé EM, Arroyo JD, Zambrano JA, Pacheco LA, Carugno J. Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis. Facts, Views & Vision in ObGyn. 2024 Mar 28;16(1):9.
Akhtar MA, Saravelos SH, Li TC, Jayaprakasan K, on behalf of the Royal College of Obstetricians and Gynaecologists. Reproductive Implications and Management of Congenital Uterine Anomalies (Scientific Impact Paper No. 62), 2024 Second Edition. BJOG Int J Obstet Gynaecol. 2025;132:e86–e97.
Dixit R, Duggireddy CS, Pradhan GS. Mullerian anomalies: revisiting imaging and classification. Insights into Imaging. 2025 Feb 17;16(1):40.
Mandelbaum RS, Anderson ZS, Masjedi AD, Violette CJ, McGough AM, Doody KA, Guner JZ, Quinn MM, Paulson RJ, Ouzounian JG, Matsuo K. Obstetric outcomes of women with congenital uterine anomalies in the United States. American Journal of Obstetrics & Gynecology MFM. 2024 Aug 1;6(8):101396.
Kim MA, Kim HS, Kim YH. Reproductive, obstetric and neonatal outcomes in women with congenital uterine anomalies: a systematic review and meta-analysis. Journal of Clinical Medicine. 2021 Oct 20;10(21):4797.
Xydias EM, Liasidi PN, Papageorgouli D, Tsakos E, Gouliopoulos N, Thanasas I, et al. Three-dimensional transvaginal ultrasound versus MRI in the diagnosis and classification of congenital uterine anomalies: a systematic review and meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2025;312:114560.
Dunah AA, Abubakar IS, Icha IM. Bicornuate Uterus with Successful Term Pregnancy: A Rare Occurrence. Int J Med Sci Dent Health. 2025;11(09):47–51.
Jayaprakasan K, Ojha K. Diagnosis of congenital uterine abnormalities: practical considerations. J Clin Med. 2022;11(5):1251.
He L, Chen S, Sun Y, Zheng Z, Li Y, Chu C, Li L. The Genetic Landscape of Müllerian Duct Anomalies: A Comprehensive Review. Reproductive Medicine and Biology. 2025 Jan;24(1):e12692.
Rogers RE, Chai S, Pask AJ, Mattiske DM. Prenatal exposure to diethylstilbestrol has long-lasting, transgenerational impacts on fertility and reproductive development. Toxicological Sciences. 2023 Sep 1;195(1):53-60.
Abe J, Nasu T, Noro A, Tsubaki J. An unusual case of severe asphyxia with the fetal position unexpectedly inverted in a malformed uterus: a case report. Journal of Medical Case Reports. 2024 Apr 26;18(1):209.
Yavuz O, Akdöner A, Mankan KA, Gündoğan K, Okyay RE, Doğan ÖE. Evaluation of the incidence of congenital uterine anomalies in polycystic ovarian syndrome: tertiary center experience. Frontiers in Medicine. 2025 May 22;12:1582100.
Soni S, Bansal A, Srivastava A, Srivastava AK. Ultrasonographic assessment of uterine and ovarian structural changes during the menstrual cycle in relation to hormonal variations. J Pharm Bioallied Sci. 2025;17(Suppl 2):S1622–S1624.
Ginsburg AS, Liddy Z, Khazaneh P, May S, Pervaiz F. A survey of barriers and facilitators to ultrasound use in low- and middle-income countries. Sci Rep. 2023;13:3322
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Denaya Nindita, Aniq Fauziah Haningtyas, Afriyah, Gayuh Tunggal Rachmadhini (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors publishing here keep copyright but grant the journal first publication rights, under a Creative Commons Attribution-NonCommercial 4.0 License. They can distribute their work non-exclusively elsewhere with an acknowledgment of its first publication in this journal. Posting the work online before and during submission for earlier and greater citation is encouraged, reflecting Open Access benefits.
