Abstract
Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 19 weeks in a woman with previous Cesarean delivery. She had a routine malformation scan in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during nonpregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.
Highlights
Unicornuate uterus with a rudimentary horn is a rare mullerian anomaly that has a high incidence of obstetric complications that include ectopic pregnancy in the rudimentary horn [1]
A unicornuate uterus with rupture of noncommunicating rudimentary horn was confirmed and a dead fetus was found in peritoneal cavity with four liters of hemoperitoneum (Figures 4 and 5)
Mariceau and Vassal published the first description of a rudimentary horn pregnancy in 1669, and 600 cases have since been described [3]
Summary
Unicornuate uterus with a rudimentary horn is a rare mullerian anomaly that has a high incidence of obstetric complications that include ectopic pregnancy in the rudimentary horn [1]. Pregnancy in noncommunicating rudimentary horn is possible by trans-peritoneal migration of sperm or fertilized ovum. It occurs in approximately 1 of every 76,000 pregnancies. The risk of uterine rupture is 50–90%, with most ruptures (approximately 80%) occurring by the end of the second trimester [1, 2]. We report a case of second trimester rupture of noncommunicating rudimentary horn which was missed on routine malformation scan
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