Herlyn-Werner-Wunderlich syndrome and central placenta previa in a COVID-19 positive pregnant woman: a case report

Background. The Herlyn–Werner–Wunderlich syndrome (HWWS) is an uncommon congenital anomaly, characterized by uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis.
We report a unique case of association of HWWS and central placenta previa (CPP) in a COVID-19 positive pregnant woman.
Case presentation. A 39-year-old pregnant woman was admitted to our hospital for preterm labor risk at 32 gestational weeks. She referred a previous cesarean section (CS) and three miscarriages. Speculum examination allowed visualization of the left cervix, whereas the contralateral one was hidden under the obliterated vaginal septum. Ultrasound examination
showed postero-lateral CPP, double uterus, and right renal agenesis. Subsequent Magnetic Resonance Imaging confirmed the condition of uterus didelphys and right renal agenesis, associated with CPP. The patient was treated with tocolytics and progesterone and was discharged in good physical conditions. At 35 gestational weeks, the patient became COVID-19 positive with few symptoms. Elective CS was performed at 36 gestational weeks, and she delivered a small-for-gestational-age newborn in good health conditions. The left womb was particularly bleeding on the lower uterine segment and ligation of the left uterine artery was necessary. The post-operative course was uneventful.
Conclusions. We describe a unique association of HWWS and CPP in a COVID-19 positive pregnant woman solved by means of elective CS and uterine artery ligation. Pregnancy in women with HWWS is possible, although obstetric complications may arise. When HWWS is associated with CPP, the risk of hemorrhage is the rule. A correct management determined positive both maternal and fetal outcomes.

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