2083 Hemihysterectomy of Non-Communicating Rudimentary Horn Following a Missed Abortion

Abstract

Video Objective The objectives of this film are to demonstrate the surgical management of a missed abortion in a non-communicating rudimentary horn. The majority of these pregnancies present with uterine rupture in the second trimester, making them difficult to manage and often hard to detect early in gestation. In this case presentation, the patient had previously failed medical management and suction dilation and curettage (D&C) prior to presenting to our clinic. The viewer should be able to understand the management of pregnancies in association with mullerian anomalies. Setting The film describes the case of a previously healthy 40 y/o G2P1 who presents to outpatient clinic after failing medical management and suction D&C for a missed abortion. Interventions An ultrasound (U/S) at the outlying provider's office confirmed a 5 week 5 day pregnancy in the right horn with uncertain cardiac activity. A follow-up U/S confirmed a missed abortion in the right horn. She underwent two doses of misoprostol with no resolution. A curette was unable to be passed during D&C. Upon referral, hysteroscopy was performed and a communication between the horns was unable to be visualized. She was immediately scheduled for a right hemi-hysterectomy and right salpingectomy the following day. The procedure was performed paying careful attention to the ureters, as mullerian anomalies are commonly associated with genitourinary anomalies as well. Conclusion To our knowledge, no report of a similar case exists in the literature. Our video highlights the surgical techniques and methods used to evaluate and treat a missed abortion within a non-communicating rudimentary horn. We intend to increase awareness regarding mullerian anomalies and the ways in which they can present. Careful attention must be paid to patients presenting with pregnancies in association with mullerian anomalies. The high risk of uterine rupture necessitates immediate surgical management.