Management Of Rudimentary Horn Pregnancy Research Articles

Rudimentary horn pregnancy - ten years of experience.

This study aimed to evaluate data on early diagnosis and therapeutic management of rudimentary horn pregnancy (RHP). Patients diagnosed with RHP at a tertiary center between for two periods of 2008-2012 and 2013-2018 were analysed retrospectively. We obtained information of patients from hospital electronic archive registration system. Data on demographic characteristics, clinical presentation, gestational age at presentation, presenting symptoms, diagnostic methods, and therapeutic management were noted and analysed by descriptive statistical method. Demographic datas, the complaint of patient's admission to hospital, history of cesarean section, preliminary diagnosis and intraoperative diagnosis were compared between periods of 2008-2012 and 2013-2018. A total of 14 RHP patients were included. Eight (57.1%) of these patients were diagnosed between 2008-2012 (Group 1), whereas six patients (42.9%) were diagnosed between 2013-2018 (Group 2). Rudimentary horn was non-communicating in 13 patients (92.8%). Communicated form was observed in 1 patient in group 1. RHP was diagnosed on the left side in nine patients (64.2%). Six of these patients were observed in group 1 and 3 were in group 2. The pre-rupture diagnosis was made in 10 (71.4%) patients. Six (100%) of 10 patients were in group 2. In addition, in group 1, four patients (50%) experienced intraoperative RHP rupture. RHP was diagnosed before rupture in 2 (33.3%) patients in group 2. It is an indication of advanced ultrasonographic technology as well as increased carefulness on the physician side and raised alertness on the patient side that today both RHP and preoperative rupture of RHP are less frequent. Still, further awareness is required among physicians of the necessity of excision of a rudimentary horn that is detected at the time of C-section.

Conservative surgical management of a ruptured non–communicating rudimentary horn of pregnancy at 13 weeks period of gestation in previous caesarean delivery – A Rare Case Report

Introduction: Unicornuate uterus with Non– communicating rudimentary horn occurs due to failure of complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. Pre rupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult and missed frequently (sensitivity 30%). Many times it is diagnosed during laparotomy. The standard treatment is excision of the ruptured horn. However, this is technically difficult due to distorted anatomy, time-consuming and can lead to more blood loss. In this case, the ruptured horn was repaired and the surgery was coupled with bilateral tubectomy. This is a new conservative approach to rupture the non-communicating horn of pregnancy. Case Report: A 27-year-old woman presented to us with a history of amenorrhea of 13 weeks and abdominal pain. Her obstetric score was Gravida 3 Para 2 Living 2. She had undergone 2 cesarean sections which were uneventful. On ultrasonography, the gestational sac was seen outside the uterus, hence a diagnosis of ruptured ectopic was made. As she was hemodynamically unstable and she had completed her family and consented for tubectomy, a decision to repair the horn was made. Conclusion: Diagnosis and management of rudimentary horn pregnancy remain a challenge. A high index of suspicion during a prenatal ultrasound can result in early diagnosis, and thereby resulting in decreased maternal morbidity and mortality. A Conservative surgical approach coupled with tubectomy in women who have completed their families can decrease operative time, blood loss and potential complications due to distorted anatomy.

Cornual Ectopic Pregnancy, Which Had Continued to Full Term; Deliver a Healthy Fetus

Rudimentary horn pregnancy is a rare ectopic pregnancy in uterine horn caused by abnormal or failed development of one Müllerian duct with a healthy fetus. A significant number of cases reported an incidence of 1 in 76,000 and 1 in 150,000 and some cases are not detected. Timely management of rudimentary horn pregnancy is pivotal in reducing mortality and morbidity. This study is designed to present a case of live 36-week primary horn ectopic pregnancy diagnosis using Ultrasound. Serum B-HCG levels normalized on postoperative first month. Keywords: Cornual ectopic pregnancy, Healthy fetus, Müllerian duct anomaly Rudimentary horn.

Cornual Ectopic Pregnancy, Which Had Continued to Full Term; Deliver a Healthy Fetus

Rudimentary horn pregnancy is a rare ectopic pregnancy in uterine horn caused by abnormal or failed development of one Müllerian duct with a healthy fetus. A significant number of cases reported an incidence of 1 in 76,000 and 1 in 150,000 and some cases are not detected. Timely management of rudimentary horn pregnancy is pivotal in reducing mortality and morbidity. This study is designed to present a case of live 36-week primary horn ectopic pregnancy diagnosis using Ultrasound. Serum B-HCG levels normalized on postoperative first month.

32. An Underdeveloped Structure With Fully-matured Learning Points: A Case of a Rudimentary Horn Pregnancy

Rudimentary horn pregnancy (RHP) is a rare diagnosis with life-threatening maternal consequences. We describe the diagnosis and management of RHP in a medically complex patient. This case highlights three challenging aspects of RHP, which we review in detail: 1) Accurate classification and risk-stratification of rudimentary horn pregnancy, 2) Radiologic assessment for intrapartum diagnosis, and 3) Prenatal identification and management of patients with rudimentary uterine horn.

Laparoscopic Management of Rudimentary Horn Pregnancy: A Case Report and Review of the Literature

Abstract Background: Rudimentary horn pregnancy is a rare but important cause of gynecologic morbidity and mortality. As the available literature is limited, the optimal surgical approach and techniques have not been defined clearly. Case: This report describes a case of a multiparous woman who presented with painless vaginal spotting. Her history included a previous preterm vaginal birth at 35 weeks' gestation and a subsequent cesarean section for breech presentation. At the current presentation, she was otherwise asymptomatic and had no abnormal examination findings. A transvaginal ultrasound revealed a 3-cm cystic structure in the right adnexa with a thick echogenic wall containing a yolk sac, and a left unicornuate uterus. Diagnostic laparoscopy revealed a unicornuate uterus with a bulging noncommunicating right rudimentary horn measuring 4 cm. Excision of the rudimentary horn and an ipsilateral salpingectomy were performed. Upon excision, it was confirmed that there was no communication between the r...

Pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: Prerupture diagnosis and management

ObjectiveThe estimated incidence of rudimentary horn pregnancy is one in 76,000. It is a life-threatening entity with a 50% risk of uterine rupture. With advances in prenatal ultrasound in recent decades, there may be an opportunity to detect rudimentary horn pregnancy earlier, resulting in a lower incidence of maternal morbidity and mortality. Management is typically resection of the rudimentary horn and the ipsilateral fallopian tube by either laparotomy or laparoscopy. Case ReportHere, we present the case of a 22-year-old woman with a suspected ectopic pregnancy of 12 weeks' gestation. Ultrasound and magnetic resonance imaging were performed as preoperative evaluations. A definitive diagnosis was made during laparotomy, and resection of the rudimentary horn pregnancy was performed. ConclusionDiagnosis and management of rudimentary horn pregnancy remain a challenge. We should be alert to prenatal ultrasound with the intention of making an earlier diagnosis, thereby resulting in decreased maternal morbidity and mortality.

Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

Pregnancy in a uterine rudimentary horn carries a high risk of uterine rupture with severe and potentially lethal intra-abdominal haemorrhage. There is now growing evidence that this condition can be safely managed by minimally invasive surgery. We report a case of an unruptured 11-week rudimentary horn pregnancy that was diagnosed and treated laparoscopically. We have performed a literature review using PubMed, Embase and Cochrane Database of Systematic Reviews to identify relevant cases and draw conclusions with regards to their management. We have collated 20 published cases of rudimentary horn pregnancies that were managed by laparoscopy. The surgical technique appears consistent among these cases with few variations. In advanced gestations, feticide may need to be performed. Morcellation has been shown to be possible without compromising patient safety from trophoblast spill. The possibility of uncommon presentations such as duplicated or absent ureter should be taken into account. Extracorporeal Roeder knot can be used safely to secure unusually dilated vascular pedicles. Overall, laparoscopy appears to be as safe as and potentially superior to laparotomy for the management of rudimentary horn pregnancies.

Prerupture Sonographic Diagnosis and Management of Rudimentary Horn Pregnancy: A Rare Presentation

Background: Rudimentary horn pregnancy is a rare form of ectopic pregnancy, and rupture of the pregnant rudimentary horn in the second trimester is the usual presentation. Most cases are diagnosed at laparotomy for hemorrhagic shock, with increased maternal morbidity and, at times, mortality. Although the diagnosis prior to rupture is difficult, early detection is essential for timely management. Among various investigative methods, such as ultrasound scanning, computed tomography scanning, magnetic resonance imaging, and laparoscopy, ultrasonography plays an important role in early diagnosis of this condition and in planning management. Case: A 23-year-old woman, gravida two, para one, A0, in the fifth month of her pregnancy was referred by a private practitioner after routine ultrasonography revealed a live extrauterine pregnancy. Her general condition was good. A repeat ultrasound at the Postgraduate Institute of Medical Sciences, Rohtak, Haryana, India, showed a rudimentary-horn pregnancy of 15 weeks gestation and a normal uterus on her right side. Laparotomy, followed by excision of the rudimentary horn was performed. Results: The patient's postoperative period was uneventful. Conclusions: Although diagnosis prior to rupture is difficult, early detection of rudimentary-horn pregnancy is essential to avoid a fatal outcome. One should suspect this rare entity if a patient is complaining of lower abdominal pain in early pregnancy. Early ultrasonography in such cases should be performed, because it plays an important role in diagnosing rudimentary-horn pregnancy especially in the prerupture state, as was seen in this case. our case. (J GYNECOL SURG 29:140)

Pre-rupture diagnosis and management of rudimentary horn pregnancy in the first trimester

A case of pregnancy in the rudimentary horn of a unicornuate uterus, suspected on routine pelvic examination and confirmed by sonography as early as at 8 weeks of gestation is presented. Ultrasonographic findings of the case and surgical management of ipsilateral adnexa at the time of excision of rudimentary horn are discussed.