Authors: Harshit Terala, St. Barnabas Hospital Allen Gold, St. Barnabas
A bicornuate uterus is a rare maternal anatomical variant that results from the partial fusion of the Mullerian ducts, forming a heart-shaped uterus. Patients are most often asymptomatic until they are pregnant. A bicornuate uterus is associated with an increased risk of structural fetal anomalies, such as a fetal pericardial effusion.
Here, a 31-year-old female with a history of polysubstance abuse presented with lower abdominal pain and bizarre behavior. The patient was worked up for acute altered mental status and was found to have a UTI and a concern for drug abuse. The patient was also noted to be pregnant with an elevated B-HCG level. Transvaginal ultrasound displayed a single, viable, intrauterine pregnancy in the left anterior horn of the bicornuate uterus. Additionally, the fetus displayed a stable pericardial effusion measuring approximately 3.88mm with grossly normal fetal movements and heart rate.
Isolated fetal pericardial effusions are rare findings with an estimated incidence rate of 0.6-2.0%. Risk factors include infection, maternal substance abuse, and congenital anomalies. Effusion may also be due to the abnormal fetal growth secondary to the bicornuate uterus. The patient was ultimately discharged after sober re-evaluation, UTI antibiotics, and follow up with MFM clinic.