Rupture of a noncommunicating rudimentary uterine horn pregnancy with a combined intrauterine pregnancy

Abstract

The second known case is documented of a combined intrauterine pregnancy and ruptured noncommunicating rudimentary uterine horn pregnancy. the patient was a 37-year old gravida 2 para 1 with unremarkable obstetric history except for preterm delivery of her previous pregnancy. At her first visit at 13 weeks gestation the ultrasound scan showed a twin pregnancy compatible with dates in 2 separated uterine cavities and a left ovarian cyst 4 cm in diameter. Hematocrit was 35.7%. She was followed in the high risk antenatal clinic. At 15 weeks she had severe pelvic pain and epigastric distress. On exam she was restless and markedly pale with cold extremities a blood pressure of 60/p and pulse of 120. Her abdomen was markedly distended with guarding and rigidity. Her cervix was normal her uterus was not palpable and the cul-de-sac was bulging. Hematocrit was 24%. On laparotomy the peritoneum contained 4000 ml fluid and a ruptured right noncommunicating rudimentary uterine born pregnancy of 6 x 6 cm was attached to the right hemi-uterus by a pedicle. A 90 gm fetus was free in the abdominal cavity. She also had bilateral ovarian endometriomas of 3 and 4 cm in diameter. After hysterectomy and bilateral ovarian cystectomy she recovered uneventfully. Rupture of a blind uterine born usually occurs in the second trimester causing fetal death and high maternal morbidity or mortality if not extirpated immediately.