Abstract
Pregnancy implanted in the rudimentary horn of unicornuate uterus is very rare with an incidence of 1 in 75,000 to 1 in 150,000 pregnancies. Both prerupture and postrupture diagnosis of ectopic pregnancy in the rudimentary horn of a unicornuate uterus is difficult. Here is a case of a 21-year-old gravida 5 para 3 abortion 1 mother presented with abdominal pain of 2 days duration following a falling accident. The patient was severely anemic and was in hypovolemic shock at the time of presentation. She had diffused lower abdominal tenderness with hemoperitonium. After clinical and ultrasound evaluation, emergency laparotomy was decided for preop diagnosis of ruptured cornual ectopic pregnancy to rule out uterine rupture at gestational age of 16 weeks. Intraoperatively, ruptured ectopic pregnancy in noncommunicating rudimentary horn was diagnosed. Resection of rudimentary horn and ipsilateral salpingectomy was done. She was transfused with 5 units of compatible blood. It is better to increase awareness about pregnancy occurring in this rare uterine anomaly, so as to have a high index of suspicion as early detection before it gets ruptured is difficult.
Highlights
A unicornuate uterus with a rudimentary horn results from incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side [1,2,3]. e incidence of pregnancy occurring in a rudimentary horn of the unicornuate uterus is very rare ranging from 1 in 75,000 to 150,000 pregnancies
There was about 2500 ml hemoperitonium, ruptured le side rudimentary horn ectopic pregnancy, dead male fetus weighing about 300 gm (Figure 1), and the placenta partly attached to the cavity of the rudimentary horn. e unicornuate uterus with a normal ovary and tube was seen. e rudimentary horn had a cavity which was noncommunicating with the unicornuate uterine cavity and it was attached to the unicornuate uterus by brous tissue. e le round ligament and the ovary are directly attached to the rudimentary horn rather than the unicornuate uterus
Mechanism of pregnancy occurrence in the noncommunicating rudimentary horn is assumed to be by transperitoneal migration of either the fertilized ovum or the spermatozoon from the contralateral tube [2, 7, 8]
Summary
A unicornuate uterus with a rudimentary horn results from incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side [1,2,3]. e incidence of pregnancy occurring in a rudimentary horn of the unicornuate uterus is very rare ranging from 1 in 75,000 to 150,000 pregnancies. About 85% of rudimentary uterine horns are noncommunicating in type [1, 5]. Ectopic pregnancy in this extremely rare anomaly ends up with rupture during all trimesters of pregnancy. Diagnosis of ectopic pregnancy in rudimentary horn is di cult, especially in a woman with a prior vaginal delivery. Ectopic pregnancy in the rudimentary horn of unicornuate uterus is associated with life threatening complications, one of which is uterine rupture with a 50% risk [4, 5]. I report a case of ectopic pregnancy in the rudimentary horn of a unicornuate uterus at gestational age of 16 weeks
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