Complete Septate Uterus presenting as recurrent mid-trimester stillbirth and Placenta Previa: An incidental Intraoperative Diagnosis

Abstract

Background: A complete septate uterus is the most common Müllerian anomaly and is strongly associated with recurrent pregnancy loss and adverse obstetric outcomes. However, antenatal diagnosis may be missed, and incidental intraoperative detection during Caesarean section is rare. Case Presentation: A 35-year-old gravida 4 para 3 living 1 abortion 0 woman at 30 weeks of gestation was referred with antepartum haemorrhage secondary to placenta previa. She had a history of two previous stillbirths at 26 and 28 weeks of gestation. In her third pregnancy, McDonald's cervical cerclage resulted in preterm vaginal delivery at 35 weeks of a healthy 2.5 kg neonate. In the present pregnancy, prophylactic cerclage was placed at 14 weeks. Due to recurrent bleeding, an emergency Caesarean section was performed. Intraoperatively, two completely separate uterine cavities were visualized with a septum extending from the fundus to the internal cervical os. The external uterine contour was smooth with no fundal indentation, confirming a complete septate uterus. Septal resection was deferred. Postoperative recovery was uneventful. Conclusion: This case underscores the importance of evaluating congenital uterine anomalies in women with recurrent mid-trimester loss. Accurate intraoperative differentiation between a septate and bicornuate uterus is essential, as management strategies differ significantly.