Ultrasound-Guided Hysteroscopic Uterine Evacuation for Early Missed Abortion in a Patient With Uterus Didelphys: Overcoming Anatomical Challenges.

OBJECTIVE

To demonstrate the use of ultrasound-guided hysteroscopic technique for the successful surgical management of a missed abortion in a patient with uterus didelphys and complex cervical anatomy.

SETTING

The case was managed in a tertiary referral center with a multidisciplinary team.

PARTICIPANTS

A 36-year-old woman, gravida 4 para 3, with a known Müllerian anomaly and right renal agenesis, presented with a missed abortion at 9 weeks of gestation. Although the anomaly was previously suspected, the exact diagnosis-whether bicornuate uterus or didelphys uterus-remained unclear due to the presence of a single identifiable cervix. In this case, ultrasound identified the pregnancy within the right uterine horn.

INTERVENTIONS: Under general anesthesia, a thorough speculum examination revealed a potential opening to the right uterine horn. Ultrasound-guided cervical dilation was attempted but proved unsuccessful due to the tortuous nature of the canal. Therefore, ultrasound-guided hysteroscopic approach was employed with a multidisciplinary team including gynecology, anesthesia, and sonography specialists. Surgical hysteroscopy facilitated precise navigation and evacuation of the gestational sac from the right uterine horn under ultrasound guidance. The procedure was completed without complications. Hysteroscopic and sonographic follow-up after 2 months demonstrated a normal endometrial lining and no retained products of conception.

CONCLUSION

This case underscores the importance of adapting surgical strategies to complex anatomical variations in patients with Müllerian anomalies. Ultrasound-guided hysteroscopy offers a safe and effective solution when standard methods such as D&C fail due to obstructive cervical anatomy. Its direct visualization capabilities allow for precise intervention, minimize procedural risks, and improve patient outcomes. Incorporating advanced hysteroscopic techniques into clinical practice is essential for managing challenging uterine malformations. VIDEO ABSTRACT.