Novel Management of Ectopic Pregnancy in a Noncommunicating Rudimentary Horn of a Unicornuate Uterus

Pregnancy implanted in the rudimentary horn of unicornuate uterus is very rare with an incidence of 1 in 75,000 to 1 in 150,000 pregnancies. Both prerupture and postrupture diagnosis of ectopic pregnancy in the rudimentary horn of a unicornuate uterus is difficult. Here is a case of a 21-year-old gravida 5 para 3 abortion 1 mother presented with abdominal pain of 2 days duration following a falling accident. The patient was severely anemic and was in hypovolemic shock at the time of presentation. She had diffused lower abdominal tenderness with hemoperitonium. After clinical and ultrasound evaluation, emergency laparotomy was decided for preop diagnosis of ruptured cornual ectopic pregnancy to rule out uterine rupture at gestational age of 16 weeks. Intraoperatively, ruptured ectopic pregnancy in noncommunicating rudimentary horn was diagnosed. Resection of rudimentary horn and ipsilateral salpingectomy was done. She was transfused with 5 units of compatible blood. It is better to increase awareness about pregnancy occurring in this rare uterine anomaly, so as to have a high index of suspicion as early detection before it gets ruptured is difficult.

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A case report on ruptured rudimentary horn ectopic pregnancy

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20212204 ◽

2021 ◽

Vol 10 (6) ◽

pp. 2504

Author(s):

Milan R. Shingala ◽

Bhavesh B. Airao

Keyword(s):

Ectopic Pregnancy ◽

Rare Condition ◽

First Trimester ◽

Normal Pregnancy ◽

Incomplete Fusion ◽

Lateral Side ◽

Rudimentary Horn ◽

Unicornuate Uterus ◽

Wide Range ◽

Laparoscopic Excision

Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. This malformation results from the defective fusion of the duct with the contra-lateral side. This rudimentary horn may or may not have functional cavity. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. IT is a rare condition that can lead to a catastrophic outcome when it rupture. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. Pregnant rudimentary horn can present with wide range of symptoms that may be similar to ectopic pregnancy or may remain silent with features of normal pregnancy.1-2 We report a case of ruptured non-communicating rudimentary horn at 19 weeks in pregnant lady. In our opinion, routine excision of rudimentary horn should be undertaken during non-pregnant state laparoscopically. However, those women who refuse should be adequately counselled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.

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Ruptured Ectopic Pregnancy in Rudimentary Horn of Unicornuate Uterus

Indian Journal of Obstetrics and Gynecology ◽

10.21088/ijog.2321.1636.6418.17 ◽

2018 ◽

Vol 6 (4) ◽

pp. 432-434

Author(s):

Indrani Roy ◽

Keyword(s):

Ectopic Pregnancy ◽

Rudimentary Horn ◽

Unicornuate Uterus

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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

BMC Pregnancy and Childbirth ◽

10.1186/s12884-021-04195-5 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Makiko Ueda ◽

Kuniaki Ota ◽

Toshifumi Takahashi ◽

Satoshi Suzuki ◽

Daisuke Suzuki ◽

...

Keyword(s):

Blood Flow ◽

Laparoscopic Surgery ◽

Ectopic Pregnancy ◽

Uterine Horn ◽

Elective Cesarean Section ◽

Rudimentary Horn ◽

Unicornuate Uterus ◽

Rudimentary Uterine Horn ◽

Gestational Sac ◽

The Right

Abstract Background Pregnancy 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 presentation The 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. Conclusion Combined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.

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Ectopic pregnancy within a rudimentary horn in a case of unicornuate uterus

European Radiology ◽

10.1007/s003300100939 ◽

2001 ◽

Vol 12 (1) ◽

pp. 121-124 ◽

Cited By ~ 23

Author(s):

D. Smolders ◽

F. Deckers ◽

M. Pouillon ◽

T. Vanderheyden ◽

J. Vanderheyden ◽

...

Keyword(s):

Ectopic Pregnancy ◽

Rudimentary Horn ◽

Unicornuate Uterus

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Ruptured ectopic pregnancy in a non-communicating rudimentary horn of a unicornuate uterus: A case report

Journal of Chitwan Medical College ◽

10.3126/jcmc.v5i4.16559 ◽

2017 ◽

Vol 5 (4) ◽

pp. 78-80

Author(s):

S Kaudel

Keyword(s):

Case Report ◽

Ectopic Pregnancy ◽

Uterine Rupture ◽

Second Trimester ◽

Mullerian Anomalies ◽

Rudimentary Horn ◽

Müllerian Anomalies ◽

Unicornuate Uterus ◽

Scarred Uterus

Uterine rupture in first and second trimester in a non-scarred uterus is usually associated with Mullerian anomalies like rudimentary horn pregnancy. Such rudimentary horn pregnancy is difficult to diagnose antenatally but it carries grave consequences for the mother and fetus. Here is a case of undiagnosed ruptured rudimentary horn pregnancy in unicornuate uterus in Gravida 2 Para 0+1 lady at 18 week gestation who was admitted in Emergency with Shock and diagnosis was confirmed at laparotomy.

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Rupture of non-communicating rudimentary horn ectopic pregnancy of a unicornuate uterus in first trimester

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20150460 ◽

2015 ◽

pp. 1211-1213

Author(s):

Tsering Wangdi ◽

Dubori Deka

Keyword(s):

Ectopic Pregnancy ◽

First Trimester ◽

Rudimentary Horn ◽

Unicornuate Uterus

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CHALLENGES OF DIFFERENTIAL DIAGNOSIS OF CONGENITAL UTERINE MALFORMATIONS

INTERNATIONAL ACADEMY JOURNAL Web of Scholar ◽

10.31435/rsglobal_wos/31082019/6653 ◽

2019 ◽

Vol 1 (8(38)) ◽

pp. 28-31

Author(s):

Nataliya Veresnyuk

Keyword(s):

Differential Diagnosis ◽

Ectopic Pregnancy ◽

Clinical Manifestation ◽

Pregnancy Outcomes ◽

Obstetric Complications ◽

Successful Pregnancy ◽

Rudimentary Horn ◽

Unicornuate Uterus ◽

Uterine Malformations

A unicornuate uterus varies from 2.4 to 13% among Müllerian anomalies and most of them have rudimentary (functional) cavity. Patients with rudimentary horns that contain functional endometrium are at the risk of gynecological and obstetric complications such as ectopic pregnancy, hematometra, endometriosis and poor pregnancy outcomes. These reports describe two cases. One of them regards of a successful pregnancy in non- communicating rudimentary horn of unicornuate uterus and postpartum clinical manifestation of it and another one describes adenomyosis in rudimentary horn. In both cases were difficulties of differential diagnosis of uterus anomalies.

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Unicornuate Uterus with NonCommunicating Non-Cavitated Rudimentary Uterine Horn: An Unusual Case with Adenomyosis Managed with Total Hysterectomy

Medical & Clinical Research ◽

10.33140/mcr.01.01.04 ◽

2015 ◽

Vol 1 (1) ◽

Keyword(s):

Medical Treatment ◽

Unusual Case ◽

Uterine Bleeding ◽

Uterine Horn ◽

Rudimentary Horn ◽

Total Hysterectomy ◽

Unicornuate Uterus ◽

Ultrasound Evaluation ◽

Rudimentary Uterine Horn

A 45-year-old woman admitted to our hospital complaining of perimenopausal uterine bleeding not responding to medical treatment. Ultrasound evaluation revealed unicornuate uterus with adenomyosis and it was so difficult to see the distant small left rudimentary horn on ultrasound. The patient underwent laparotomy with total hysterectomy for both horns and was sent to pathologist that indicated adenomyosis and non-communicating non-cavitated left rudimentary horn.

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