Non-communicating Rudimentary Horn Research Articles

Ruptured Ectopic Pregnancy in Non-Communicating Right Rudimentary Horn: A Case Report

Abstract Rudimentary horn is a developmental anomaly of the uterus, and pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures. As the fetus enlarges in the rudimentary horn, the chances of rupture in the first or second trimester are increased. Catastrophic hemorrhage results in increased maternal and perinatal mortality and morbidity. To date, management of such cases remains a challenge due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management are lifesaving in such cases. A case of undiagnosed rudimentary horn pregnancy presented to our department in shock with features of acute abdomen, and the diagnosis was confirmed at laparotomy that revealed ruptured rudimentary horn pregnancy. And excision of the accessory horn was done.

Asymptomatic Rupture of Term Non-communicating Rudimentary Horn of Uterus: A Case Report

A Rudimentary horn is a rare form of congenital uterine anomaly, resulting from an arrest in the development of one of the Mullerian ducts with inappropriate fusion with the other side. In most of the cases no direct communicating channel exists between the two parts of the uterus. Pregnancy in the rudimentary horn represents a rare form of ectopic gestation and is thought to result from transperitoneal migration of spermatozoa or the fertilized ovum. Most patients with rudimentary horn pregnancy present in second trimester with hemorrhagic shock due to rupture of horn. Diagnosis of the rudimentary horn may be done with magnetic resonance imaging or 3D, 4D ultrasonography but confirmation of diagnosis is usually surgical at laparoscopy or laparotomy. We report a case with provisional diagnosis of a case of primigravida with 40+ weeks pregnancy with transverse lie along with placenta praevia and intrauterine fetal death. But at laparotomy it revealed a ruptured pregnant non-communicating horn of uterus.Bangladesh J Obstet Gynaecol, 2015; Vol. 30(1) : 53-55

Robotic-Assisted Laparoscopy for Resection of a Non-Communicating Rudimentary Horn

Robotic-Assisted Laparoscopy for Resection of a Non-Communicating Rudimentary 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...

The Importance of Initial Evaluation by Trans Vaginal Sonography in Rudimentary Horn Pregnancy: A Case Report and Literature Review

Rudimentary horn pregnancy (RHP) as a rare incidence has been estimated at 1:76,000- 1:150,000 pregnancies. It has been also reported that 80-90% of RHP lead to uterine rupture in second trimester. Early diagnosis with the use of 3-dimentional ultrasonography (3-DUS) that is followed by laparoscopic resection of RH and ipsilateral fallopian tube is likely to be considered as the best management strategy that prevents maternal morbidity and mortality. We present a case of 9-week pregnancy in a non-communicating rudimentary horn with positive fetal heart rate (FHR) that was diagnosed by 3-DUS and successfully treated with laparoscopic resection.

A near miss case of ruptured non-communicating rudimentary horn pregnancy in primigravida

Abstract Rudimentary horn pregnancy is a rare site of ectopic pregnancy. Diagnosis of rudimentary horn pregnancy requires a high index of suspicion as it can be easily missed during routine ultrasound scan. Rupture of rudimentary horn pregnancy can lead to catastrophic intraperitoneal hemorrhage with consequent maternal morbidity and mortality. Here, we report a case of ruptured non-communicating rudimentary horn pregnancy at 21 weeks of gestation in a 19 years old nulliparous woman which was initially missed during ultrasound scan and misdiagnosed as a case of anemia with pregnancy. The patient was managed immediately with excision of the horn through urgent exploratory laparotomy. High index of suspicion and early referral from the discrete hospitals is needed before exact time is lost; thus reducing the morbidity and mortality of the pregnant women.

Robotic Assisted Resection of a Non-Communicating Uterine Horn Ectopic Pregnancy

Abstract Background: Anomalies of the female reproductive tract have been associated with poor pregnancy outcomes. In the case of an ectopic pregnancy, these risks are especially high. Case: A 29-year-old, gravida 1 female with a pregnancy at 9 weeks' gestational age, who presented for care, was found to have a uterine-horn ectopic pregnancy. Imaging confirmed the presence of a unicornuate uterus with the pregnancy located in a noncommunicating uterine horn. Excision of the ectopic pregnancy was recommended, and the patient underwent a robotic assisted resection of the noncommunicating rudimentary uterine horn and the pregnancy. Results: There were no postoperative complications. The patient's pathology was consistent with a tubal/cornual ectopic pregnancy. She stated that she would like to conceive in the future. Any future pregnancies in this patient will need to be monitored closely because of her risk of a higher complication rate. Conclusions: This is the first reported case describing a robotic appr...

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.

Spontaneous Rupture Of Noncommunicating Rudimentary Horn Pregnancy Presenting As Medical Emergency

Pregnancy in a noncommunicating rudimentary horn of the uterus is extremely rare and usually terminates in rupture during first or second trimester of pregnancy.Diagnosis of such cases with prior vaginal delivery is difficult. It can be missed in routine ultrasonograms and in majority is detected after rupture. 30 year old P3L1S2 presented to the Emergency Medical Ward with an acute abdomen and shock. Surgical and gynaecological advice was seeked, a provisional diagnosis of ruptured ectopic pregnancy made as the patient gave history of over the counter consumption of abortion pills a month ago. At laprotomy a unicornuate uterus with ruptured noncommunicating rudimentary horn was seen with massive hemoperitoneum. The need for high index of suspicion is recognized in such cases.The incidence is estimated at 1 per 100000 to140000 pregnancies.There are no definitive clinical criteria to detect this life threatening condition specially when it mimics other medical and surgical emergencies.

Full-Term Pregnancy in a Non-communicating Rudimentary Horn: A Case Report

Unicornuate uterus with a rudimentary horn is a rare anomaly of the female genital system resulting from inco mplete development of one of the mullerian ducts. It might end in grave obstetrical and gynecological complications in the absence of early diagnosis and proper management. A rare case of a full-term pregnancy in a non-communicating rudimentary horn is presented in this paper. A 24-year-old pregnant woman carrying the preliminary diagnosis of placenta percreta was referred to our clinic by reason of vaginal bleeding at a gestational age of 38 weeks. She underwent emergency cesarean section in our clinic, which led to the finding that her condition was not placenta percreta, but a full-term pregnancy in a non-communicating rudimentary horn. The need for a high index of suspicion as well as the use of ultrasonography plays a key role in the early diagnosis of this rare condition. Rudimentary horn pregnancy must be suspected in patients referred with the preliminary diagnosis of placenta percreta.

Successful in vitro fertilization pregnancy in a case of unicornuate uterus with diminished ovarian reserve: A case report

The occurrence of Mullerian anomalies with concomitant gonadal abnormalities is very rare. Very limited number of case reports are published in the literature, and the exact incidence is not known. In this report, we present a case of unicornuate uterus with non-communicating rudimentary horn along with absence of adnexa on one side and smaller ovary on other side, leading to diminished ovarian reserve. The patient conceived with in vitro fertilization (IVF) with oocyte donation and delivered a healthy child at 38th week of gestation. Establishing an accurate diagnosis and management by IVF followed by adequate supervision of resulting pregnancy may lead to successful obstetric outcome in women with unicornuate uterus with diminished ovarian reserve.

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A Case of Recurrent Rudimentary Horn Ectopic Pregnancies Managed by Methotrexate Therapy and Laparoscopic Excision of the Rudimentary Horn.

This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn.

The Unchartered Waters of Obstetrics - Rupture of Noncommunicating Rudimentary Horn Pregnancy (Rnhp) in a Bicornuate Uterus

Background: Mullerian duct anomalies in female result from failure of complete development of one duct and incomplete fusion of other duct during embryonic life. Bicornuate uterus with rudimentary horn (BURH) is the rarest uterine anomaly. Pregnancy in rudimentary horn is even rarer, i.e. 1:1,40,000 pregnancies. Case description: A 24-year-old primigravida presented with acute pain abdomen and amenorrhoea for 16 weeks. She was severely pale and was in hypovolemic shock, with diffuse tenderness, guarding and rigidity of abdomen. Per vaginal examination revealed a bulky uterus with motion tenderness and full fornices. On laparotomy there was hemoperitoneum along with rupture of left horn of the bicornuate uterus. The placenta was inside the rudimentary horn, and the horn was non-communicating with the body of the uterus. It was excised completely. An abortus of 16 weeks size was lying within intact membranes, and was found free within the abdominal cavity. Conclusion: A second trimester pregnancy with features of ruptured ectopic should be screened for the associated uterine anomalies. Rupture of the rudimentary horn of the uterus is one of the important but rare causes of acute abdomen. A high index of suspicion is warranted in cases of advanced gestation presenting with acute abdomen, especially in developing countries like India, where the possibility of early detection before rupture is unlikely, culminating in maternal demise.

A Case of Unicornuate Uterus Accidentally Discovered During Patient’s Fourth Delivery

Unicornuate uterus with non-communicating rudimentary horn is a rare congenital uterine malformation. It may lead to a variety of infertility and obstetric complications. A 32-year-old woman - para III gravida IV - presented at the third stage of pregnancy with acute onset of severe right abdominal pain. Cesarean delivery with abdominal exploration were performed. During cesarean section a unicornuate uterus with a rudimentary horn was accidentally observed. This is a rare and interesting clinical example of patient who had four healthy babies as results of four uneventful pregnancies despite having a unicornuate uterus which carries a significant risk of infertility and advers pregnancy outcomes.

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INTRODUCTION: Pregnancy in a rudimentary horn of a unicornuate uterus is rare.1 An incidence of 1 in 76,000-150,000 pregnancies is reported in the literature.2,3 We present a case report of rupture of a 25 weeks pregnancy in the non-communicating rudimentary horn of a unicornuate uterus. Congenital malformations of the uterus, also known as Mullerian duct anomalies, are rare in general population (Approx. 1%). These abnormalities result from arrested development, abnormal formation or incomplete fusion of mesonephric ducts. Unicornuate uterus results from unilateral arrested mullerian duct development. Rarely unicornuate uterus may also have a rudimentary horn, more on the right than on the left side. The incidence of unicornuate uterus is estimated to be 1:250 and its occurrence with rudimentary horn is 1:100,000. Such anomalies are reported to result in increased rate of miscarriages, recurrent pregnancy losses, preterm labor, infertility and other obstetric complications. Conception in rudimentary horn arises either from a small communication with the uterine cavity (Communicating) or by Trans peritoneal migration of the fertilized ovum from the contra-lateral side (Non-communicating). The proportion of non-communicating rudimentary horns is 70-90%. The frequency of pregnancy in rudimentary horn is reported to be 1:76000. The clinical presentations vary from being asymptomatic to vague complaints of mild lower abdominal pain with gastrointestinal upset to its severest form of acute abdomen with hemorrhagic shock. The most significant threat of a rudimentary horn pregnancy is the risk of rupture because of poorly developed musculature. In view of the paucity of literature on rare observation of pregnancy in rudimentary horn of uterus, the case reported here is of crucial importance.

Embarazo en cuerno rudimentario no comunicante de útero unicorne

Se comunica un caso de embarazo de 20 semanas en el cuerno rudimentario no comunicante de un útero unicorne evidenciado por laparoscopía y confirmado por estudio anatomopatológico. Se revisa la literatura.

Case Report of Surgical Excision of Non-Communicating Rudimentary Horn of Uterus Present in Adolescent with Dysmenorrhea

Unicornuate uterus with a rudimentary horn is a rare type of mullerian duct malformation. It leads to many obstetrical and gynecological complications. The mean age of presentation was the mid 20 s [1]. It is one of the differential diagnosis of dysmenorrhea in adolescent. A 19-year-old single was present with progressive severe dysmenorrhea and chronic pelvic pain after history right ovarian torsion treated by right salpinoophrectomy. Exploratory laparotomy was performed found unicornuate uterus with right non-communication rudimentary horn. Excised of right rudimentary horn was done. Remove of non-communication rudimentary horn will reduce symptoms of dysmenorrhea and chronic pelvic pain. Proper diagnosis and management will prevent misdiagnosis and good outcome to the patient.

Term Pregnancy with a Live Fetus in Non-communicating Rudimentary Horn with Placenta Percreta.

Abnormalities of embryogenesis of mullerian duct system resulting in congenital anomalies of female genital tract are relatively common [1]. The prevalence of congenital uterine anomalies in the general population is 6.7 % [2]. In women with a history of repeated pregnancy loss, the rate of mullerian anomalies increases to 3–25 % [2, 3]. Unicornuate uterus accounts for 5 % of all mullerian anomalies. Unicornuate uterus is thought to occur in general population at a rate of 1:4,020 [1]. Unicornuate uterus is a type II mullerian anomaly according to the American Fertility Society classification system [1, 4] that occurs due to a complete or partial failure of development of one mullerian duct and incomplete fusion with contralateral side [1]. The failed mullerian duct fusion leads to the formation of an isolated hemiuterus without a contralateral structure (in complete failure) to various degrees of a rudimentary horn (in partial failure) [1]. This rudimentary horn is subclassified into communicating or non-communicating with uterine cavity and a horn with no cavity [1]. In about 84 % of these cases, a contralateral rudimentary horn exists, almost always of a non-communicating type [1, 5]. The attachment of the rudimentary horn may vary from a fibromuscular band (separated variety) to an extensive fusion between the two horns where there is no external separation between them [4, 6]. This was a case with an extensive fusion between the two horns. Pregnancy in such a rudimentary horn is extremely rare, tenfold less common than an abdominal pregnancy [1, 2, 4]. The natural course of a rudimentary horn pregnancy is rupture during the first or mid-second trimester with potentially life-threatening bleeding [1, 5]. In the majority of cases, horn rupture occurs before 20 weeks of gestation [7]; reports of rupture varying from 5 to 37 weeks are described [1, 7]. The uterine wall being thicker and more vascular, bleeding is more severe in rudimentary horn pregnancy rupture, therefore it commonly manifests with acute abdominal pain and intraperitoneal hemorrage [1, 7].

Unembriyonic pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: a case report

This is a case report of an unembriyonic pregnancy in the non-communicating rudimentary horn of a unicornuate uterus with the contralateral ovary carrying a corpus luteum. A 24-year-old nullipara was admitted to our outpatient clinic with the complaint of primary infertility for 3 years. Her hysterosalpingographic and laparoscopic evaluation revealed a mullerian anomaly; non-communicating rudimentary uterine horn. One year later, the patient was admitted with a 10-week amenorrhea. The examination showed unembriyonic pregnancy in the left uterine rudimentary horn and corpus luteum on the contralateral ovary. The case at hand is an evidence of transperitoneal migration of both the sperm and the ovum, so the belief that unicornuate uterus with a non-communicating rudimentary horn goes asymptomatic without causing any trouble is not true. In such cases, the rudimentary horn should be removed.