Pregnancy In Non-communicating Rudimentary Uterine Horn Research Articles

Non-communicating Rudimentary Uterine Horn Pregnancy

Pregnancy in a non-communicating rudimentary horn is an extremely rare form of ectopic gestation. The rudimentary horn may or may not communicate with the uterine cavity with the majority of cases being non-communicating. The patient exhibits features of acute abdomen and carries a high risk of maternal death. Even modern scans remain elusive whereas laparatomy remains the confirmatory procedure for the diagnosis. Because of the varied muscular constitution in the thickness and distensibility of the wall of the rudimentary horn, pregnancy is accommodated for a variable period of gestation. Here, we report three cases of pregnancy in a non-communicating rudimentary horn of the uterus in different periods of gestation, their outcome and a review of the available literature.

A Case Report of Preoperative Diagnosis and Laparoscopic Resection of a Non-communicating Rudimentary Uterine Horn Pregnancy

A unicornate uterus with a rudimentary horn is a rare Mullerian duct abnormality. This uterine anomaly may cause variable gynecologic complications, including hematometra, endometriosis leading to acute pelvic pain, infertility, and obstetric complications, including miscarriage, preterm delivery, and rupture of the uterus, especially when the pregnancy implants in the rudimentary horn. To date, the standard treatment for the latter condition has been laparotomy, as patients usually experience massive abdominal hemorrhage or pregnancies too large to attempt laparoscopic removal. We report a case of a non-communicating rudimentary uterine horn pregnancy which was preoperatively diagnosed by ultrasonography, hysterofiberscopy, and magnetic resonance imaging, and then subsequently resected laparoscopically.

Rupture of noncommunicating rudimentary uterine horn pregnancy

BACKGROUND: We present a rare case of pregnancy in a noncommunicating rudimentary horn that ruptured at 20 weeks. CASE: A 30-year-old woman presented with a history of two spontaneous abortions. An ultrasound scan showed a bicornuate uterus, with one normal and one hypoplastic horn. Hysterosalpingography revealed a single uterine cavity with only one tube, suggesting a unicornuate uterus. Hysteroscopy and laparoscopy were recommended but declined. She presented again 2 months later at 7 weeks’ gestation. A single intrauterine pregnancy in the hypoplastic right horn was diagnosed. A transvaginal scan showed a single cervical canal in continuity with the left uterine horn, which led to the suspicion of a pregnancy in a rudimentary horn. The option of pregnancy termination was offered. A laparoscopy was repeatedly suggested but declined. Excision of a ruptured noncommunicating rudimentary horn and ipsilateral salpingectomy were performed after an emergency laparotomy at 20 weeks because of the sudden onset of abdominal pain and signs of shock. CONCLUSION: Although a rudimentary horn pregnancy had been suspected before the laparotomy, the patient presented as a clinical emergency. This report, like others, indicates that prompt diagnosis and immediate removal of the rudimentary horn is lifesaving.

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

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.