Pregnancy In Non-communicating Rudimentary Horn Research Articles

Successful pregnancy outcome via in-vitro fertilization and laparoscopic resection of non-communicating rudimentary horn pregnancy containing early pregnancy: a case report

BackgroundNon-communicating rudimentary horn pregnancy (NCRHP) lead to life-threatening condition for both mother and fetus. Early diagnosis of NCRHP and laparoscopic resection is important to prevent catastrophic conditions. However, delayed diagnosis until the second or third trimester makes it difficult to accurately diagnose between NCRHP and bicornuate uterine pregnancy, as both conditions present uterine rupture and massive hemoperitoneum. Furthermore, these rare cases are challenging in pregnancy trials and associated with adverse outcomes in subsequent pregnancies.Case presentationA 31-year-old gravida 1 para 0 Korean woman visited our infertility center with a confirmed positive urine pregnancy test after timed intercourse. Before she was scheduled to have timed intercourse, a unicornuate uterus with a non-communicating right uterine horn was suspected based on an ultrasound scan and hysterosalpingography during the initial infertility workup. A gestational sac was observed in the right non-communicating rudimentary horn at 5 weeks of gestation. Serum beta-human chorionic gonadotropin (b-hCG) level was 2052.0mIU/mL. An elective laparoscopic resection of the right rudimentary horn containing a gestational sac, along with ipsilateral salpingectomy, was performed with no adverse event. After 3-month of recovery period and three cycles of conceptional trials involving timed intercourse and intrauterine insemination, in-vitro fertilization (IVF) was performed using the antagonist protocol, and successful pregnancy was confirmed. The patient had been hospitalized from 21 + 6 weeks to 35 + 6 weeks of gestation, underwent cerclage placement and tocolytics with corticosteroid treatment. She delivered an early-term male baby by cesarean section.ConclusionIn this rare case, the successful pregnancy achieved through IVF following the appropriate management of NCRHP under laparoscopy underscores the critical importance of early diagnosis and intervention in cases of NCRHP. Timely identification and management of NCRHP are vital to prevent the occurrence of catastrophic conditions and to enhance the prognosis of a successful pregnancy through assisted reproductive technology (ART). Therefore, a high index of suspicion for NCRHP is important and employs a range of diagnostic modalities.

Factors associated with caesarean section in women referred for preinduction - a nested case-control study in dinoprostone and misoprostol groups.

Induction of labour is a beneficial perinatal procedure, but may be associated with some risks. The aim of this study was to identify factors associated with the need for Caesarean section in women referred for preinduction with dinoprostone and misoprostol. It was a retrospective cohort study of 560 pregnant women who underwent labour induction for medical reasons. Analyses were performed separately in the dinoprostone and misoprostol group. Above other characteristics, the diameters of the pelvis and abdominal circumference of pregnant women were analysed. There were some mothers' characteristics like age, weight, BMI, presence of hypothyroidism or diabetes, which were not associated with Caesarean section deliveries. Women in the misoprostol group with gestational age less than 38 weeks had an increased risk of Caesarean section (OR 2.189; p = 0.041). The analyses of combined effect of mothers age and parity history showed 6.7 (in dinoprostone group) and over 10 times (in misoprostol group) increased the risk of Caesarean section in nulliparous women over 35 years of age. The increased risk of Caesarean delivery in the dinoprostone group was combined with the intertrochanteric dimensions such as the mother's height measuring less than 165 cm, nulliparity and hypertension. In the misoprostol group, strong risk factors for Caesarean delivery were mothers aged 35 years or more, gestational age less than 38 weeks and nulliparity and hypertension as in dinoprostone group. The oxytocin infusion had increased the risk of Caesarean section only in the combined dinoprostone and misoprostol group. Further high-quality studies are warranted.

Non-communicating rudimentary horn pregnancy presenting as sudden unexpected maternal death: an autopsy diagnosis.

Pregnancy on a rudimentary uterine horn is a rare condition that can lead to a catastrophic outcome when it ruptures. The majority of cases are diagnosed late, after the rupture has occurred. We present the case of a 29-year-old female G2 P1 who complained of abdominal pain. She consulted a medical practitioner who prescribed her analgesics. In the next day, she was found dead in her bedroom. The pregnancy was undiagnosed as she was not aware that she was in a gravid state. At autopsy, there was massive haemoperitoneum and a 24-week gestation foetus lying outside the uterus. The uterus revealed an anomaly in keeping with a non- communicating rudimentary horn. Forensic pathologists do encounter undiagnosed ectopic pregnancies in practice. However, abdominal ectopic pregnancy with a uterine anomaly remains uncommon. These cases are often associated with a high maternal and foetal mortality.

Pregnancy in Non-communicating Rudimentary Horn of Unicornuate Uterus: A Case Report

A unicornuate uterus with a non-communicating rudimentary horn has always been a notorious uterine malformation threatening normal pregnancy continuation. Pregnancy in the rudimentary horn of the uterus is rare, but it plays an essential role in maternal morbidity and mortality. Early detection of rudimentary horn pregnancy is vital because poor musculature can lead to the dangerous complication of uterine rupture. When a Rudimentary horn pregnancy is diagnosed, surgical treatment to excision the horn with ipsilateral salpingectomy is recommended because of its high risk of rupture in the second trimester. We present a case of non-communicating rudimentary horn pregnancy that was terminated, and the rudimentary horn was resected.

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review.

Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.

Diagnosis and management of non-communicating rudimentary horn pregnancy.

Non-communicating rudimentary horn pregnancy is a rare condition associated with serious complications and consequences. We reported a case of a 44-day non-communicating rudimentary horn pregnancy who was diagnosed by three-dimensional ultrasound (3D-US) and pelvic magnetic resonance imaging (MRI), followed by treatment via laparoscopic resection. The 3D-US and pelvic MRI scan showed a consistent result. Serious complications and consequences were avoided. Postoperative diagnosis showed that the malformation was classified as type IIc. For such diagnosis as a unicornuate uterus with a rudimentary horn, if there are no symptoms, it cannot be treated. Once pregnancy is in the rudimentary horn, 3D-US or MRI should be conducted to determine the implantation location of the pregnancy capsule and the operation should be performed as soon as possible to avoid uterine rupture. Laparoscopic surgery can be chosen in the early stage.

Successful pregnancy and term delivery after treatment of unicornuate uterus with non-communicating rudimentary horn pregnancy with local methotrexate injection followed by laparoscopic resection: a case report and literature review

BackgroundPregnancy in a rudimentary horn is an extremely rare type of ectopic pregnancy. A rudimentary uterine horn pregnancy is associated with a risk of spontaneous rupture and bleeding during surgery due to the increased uterine blood flow. Recent advances in imaging modalities have enabled laparoscopic surgery to be performed in cases without rupture in the early stages of pregnancy. However, there are few reports of successful pregnancies and deliveries after treatment of rudimentary horn pregnancies. We report the successful management of a case of non-communicating rudimentary horn pregnancy by local injection of methotrexate followed by complete laparoscopic excision along with a review of the literature.Case presentationThe patient was a 29-year-old Japanese woman, gravida 2, nullipara. She was diagnosed with a left unicornuate uterus with a right non-communicating rudimentary horn on hysterosalpingography and magnetic resonance imaging. A gestational sac with a heartbeat was observed in the right rudimentary uterine horn at 6 weeks of gestation. A diagnosis of ectopic pregnancy in a non-communicating rudimentary horn was made. Color Doppler detected multiple blood flow signals around the gestational sac, which were clearly increased compared to the left unicornuate uterus. Her serum human chorionic gonadotropin level was 104,619 mIU/ml. A 100 mg methotrexate injection into the gestational sac was administered, and laparoscopic surgery was performed on day 48 after the methotrexate treatment. The right rudimentary horn and fallopian tube were successfully excised with minimal bleeding. A spontaneous normal pregnancy was established 6 months after the surgery. The pregnancy was uneventful, and a baby girl was born by elective cesarean section at 38w0d.ConclusionCombined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.

Rupture of Non-communicating Rudimentary Horn Pregnancy at 15 Weeks with Previous Normal Pregnancies: A Case Report

Rudimentary horn is a mullerian anomaly that is a variant of unicornuate uterus. Rudimentary horn pregnancies are rare and associated with increased maternal morbidity and mortality. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with previous vaginal delivery is challenging. Although ultrasonography is an important diagnostic tool, it has low sensitivity in making diagnosis of ruptured rudimentary horn pregnancy. Therefore, clinicians should have high index of suspicion in such cases. We report a case of G3P2L2 at 15 weeks period of gestation referred to our centre as a case of intrauterine pregnancy with acute abdomen. She underwent emergency laparotomy and was found to have ruptured rudimentary horn intraoperatively. Excision of the ruptured rudimentary horn and ipsilateral salpingectomy was done and the patient had an uneventful postoperative recovery.

A surprising presentation of a partial hydatidiform molar pregnancy in rudimentary horn of unicornuate uterus

A surprising presentation of a partial hydatidiform molar pregnancy in rudimentary horn of unicornuate uterus - IJOGR- Print ISSN No: - 2394-2746 Online ISSN No:- 2394-2754 Article DOI No:- 10.18231/j.ijogr.2019.087, Indian Journal of Obstetrics and Gynecology Research-Indian J Obstet Gynecol Res

UNICORNUATE UTERUS WITH FUNCTIONAL RUDIMENTARY HORN: CLINICAL MANIFESTATIONS AND DIAGNOSTIC PROBLEMS (CLINICAL CASE)

A unicornuate uterus ranges from 1 in 1000 to 1 in 5400 women and 74-90% of them will have rudimentary uterine horn. Patients with non-communicating uterine horns that contain functional endometrium are at an increased risk of ectopic pregnancy, hematometra, hematosalpinx, endometriosis and poor pregnancy outcomes. This report describes a case of a successful pregnancy in non-communicating rudimentary horn of unicornuate uterus and postpartum clinical manifestation of it and difficulties of differential diagnosis of uterus anomalies.

A Rare Case of Recurrent Non-Communicating Rudimentary Horn Pregnancy

Introduction: A unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side. Pregnancy in a rudimentary horn of the uterus is a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. It carries grave consequences for the mother and fetus as the diagnosis may be missed and subsequently result in an emergency due to spontaneous rupture of the enlarging rudimentary horn and massive intraabdominal bleeding. The standard treatment is the surgical excision of the rudimentary horn. The authors present a case of a rare recurrent rudimentary horn pregnancy that contained a viable pregnancy diagnosed in first trimester and managed with complete excision of the rudimentary horn along with the pregnancy in-situ.

Uterine rupture of a non-communicating rudimentary horn pregnancy with resultant successful outcome of an extremely premature baby born at 24 weeks of gestation

Abstract Mullerian anomalies occur in about 0.5% of reproductive-aged women; many remain asymptomatic only being discovered during surgery or on imaging done for unrelated reasons. These result from the abnormal formation, fusion or resorption of the mullerian duct during development. A unicornuate uterus with a rudimentary horn is one of the rarer subtypes, with such anomalies making up about 5% of all mullerian anomalies. Pregnancy in a non-communicating uterine horn (NCUH) is extremely rare, with an incidence between 1:100,000 and 1:140,000. There is a high risk of uterine rupture if pregnancy occurs in a non-communicating uterine horn. We present here a case of a non-communicating rudimentary horn pregnancy, with a successful outcome.

Non-communicating Rudimentary Horn Pregnancy—A Rare Clinical Scenario

Non-communicating Rudimentary Horn Pregnancy—A Rare Clinical Scenario

Pregnancy in Non-Communicating Rudimentary Horn of A Unicornuate Uterus.

Diagnosis and management of pre-rupture stage of the pregnant horn are difficult and usually missed on a routine ul- trasound scan. Also most cases are detected after rupture of pregnant horn. We presented a 28-year-oldG2 L1 woman with diagnosis of rudimentary horn pregnancy (RHP) at 14 weeks of gestation. We diagnosed her with a normal intrauterine pregnancy, whereas a pregnancy in a right-sided non-communicating rudimentary horn with massive he- moperitoneum was later discovered on laparotomy. RHP has a high risk of death for mother, so there must be a strong clinical suspicion for the diagnosis of RHP. Although there is a major advancement in field of diagnostic ultrasound and other imaging modalities, prenatal diagnosis has remained elusive and a laparotomy surgery is considered as a definitive diagnosis.

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.

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.

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.

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.

LAPAROSCOPIC EXCISION OF RUPTURED NON-COMMUNICATING RUDIMENTARY HORN PREGNANCY [Rüptüre Non-Komminikan Rudimenter Horn Gebeliğinin Laparoskopik Eksizyonu

Unicornuate uterus with rudimentary horn occurs due to failure of complete development of one of the mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in a non-communicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with prior vaginal delivery is difficult. It can be undiagnosed in routine ultrasound scan and in majority of cases it is detected after rupture. We report a case of G2 P1 with ruptured rudimentary horn pregnancy at 9 weeks of gestation which was misdiagnosed as tubal ectopic pregnancy. Key words: non-communicating rudimentary horn pregnancy, laparoscopy, unicornuate uterus

Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو

A unicornuate uterus with a rudimentary horn is a uterine anomaly resulting from the incomplete development of one of the Müllerian ducts and an incomplete fusion with the contralateral side. Pregnancy in a rudimentary horn of the uterus is a rare clinical condition with a reported incidence of 1 in 100,000 to 140,000 pregnancies. Usually the diagnosis is missed and may present as an emergency with haemoperitoneum. The standard treatment is the surgical excision of the horn. A gravida 2, para 1 patient presented at 23 weeks' gestation with fetal demise. Repeated failed attempts at induction of labour raised the suspicion of an abnormally located pregnancy which was confirmed by magnetic resonance imaging. She underwent a laparotomy with right rudimentary horn excision. The final diagnosis of a non-communicating rudimentary horn pregnancy was made intraoperatively and was confirmed by histopathology. This case highlights the importance of an early ultrasound in detecting uterine anomalies and the need for high clinical suspicion.