Introduction
Bicornuate uterus is a mullerian anomaly which is almost always associated with problems during pregnancy continuation rather than problems to conceive. Here we had a case of bicornuate uterus which developed haematometra, endometriosis and consequently infertility. But sequential management and timely supervision resulted in a favourable outcome.

Case Report
A 19 year old married house wife since 2 years admitted with complaints of heavy bleeding per vaginum every 15 days fasting for 8 days since 4 months. She attained menarche at 15 years of age with menstrual cycle of 3-4 /30 days. She also gave a history of primary infertility since two years.

On per speculum examination, cervix was high up deviated to left, anterior fornix shown as bulge. On vaginal examination cervix was flushed with anterior and right fornix, mass around 4 x 5 cm size, nontender in right fornix noted.

Ultrasound examination, showed bicornuate uterus with 5 x 3 cm size collection in lower path of uterus and cervix. Right kidney absent with compensatory hypertrophy of left kidney. Intravenous urogram showed absent right kidney with enlarged left kidney and normal pelvicalyceal system and ureter. MRI showed absent right kidney, bicornuate uterus with 2 endometrial cavities. 5 x 4 cms size well defined mass in right horn of bicornuate uterus. Left horn of uterus displaced to left of midline.

Diagnostic laparoscopy features were suggestive of bicornuate uterus with enlarged right horn, left horn was normal. Bilateral tubes and ovaries were normal. Multiple endometriotic patches were present. On per vaginal examination bulge seen in anterior and right fornix of vagina which was also appreciated laparoscopically. A small nick was made per vaginum and chocolate coloured sticky material was drained. Nick was gradually dilated with increasing sizes of in situ for 5 days.

Ultrasound examination done after 10 days was showing no previously mentioned collection with collapsed cavity between bladder and uterus. Vaginal septum excision was done. After 4 years patient came in OPD with history of infertility since 6 years. Routine investigations were done for primary infertility. Patient conceived spontaneously. Patient followed in ANC OPD regularly. Ultra sound examination showed single live intrauterine pregnancy of 15.5 weeks in left horn of uterus. right horn was empty and size was 8 x 3.5 cms EDD given was 20.6.2004. Patient was given complete bedrest, inj Terbutaline for 15 days and injection dexamethasone. She carried through till term but developed mild IUGR. On 3.6.2004 Female baby of 2 kg, delivered by breech presentation at 10.21 am; baby cried immediately after birth with APGAR 8,9,9. Patient went home on Day 5 of LSCS with healthy baby.

Discussion
This case of mullerian anomaly had all the classic problems associated with it, such as endometriosis, haematometra and infertility. Pregnancy to occur spontaneously in such cases is unusual. During pregnancy too, she had problems which were tided over by expectant management. We had considered cerclage, but did not do so due to good cervical length midtrimester. Vaginal delivery was not an option due to breech presentation at term, with IUGR. The satisfaction on the patient's face after six years of regular follow up and conservative management was seen when she was holding her baby.

Fig. 1 : Predrainage	Fig. 2 : Postdrainage	Fig. 3 Post vaginal septum excision

Conclusion
Mullerian anomalies have various problems, but systemic supervision and management can lead to a favourable outcome. This case being a rare case with all possible complications involved in it, we had a favourable outcome.