Pregnancy in unicornuate uterus without rudimentary horn: a case report (original) (raw)
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A Case Report of Successful Pregnancy Outcome in Unicornuate Uterus with Rudimentary Horn
Journal of Evolution of Medical and Dental Sciences, 2015
Unicornuate uterus with rudimentary horn is developmental anomaly which occurs due to abnormal or failed development of one of the paired mullerian duct or fusion of the ducts. Rudimentary horn can be communicating or non-communicating. Non communicating rudimentary horn (90%) is more common type. Women with unicornuate uterus have increased incidence of obstetric complications like spontaneous abortions, preterm delivery and intrauterine foetal demise and Gynaecological complications like infertility, endometriosis and dysmenorrhoea. We here present a case of 25yrs, G2P1D1 on admission 32 weeks 3days by LMP and 31weeks 0 days by USG of 7weeks with Rh negative pregnancy with HBsAg reactive status with severe oligohydramnios (AFI-5cm) with symmetric IUGR admitted for observation. Emergency LSCS was done on day 15 of admission i/v/o colour Doppler s/o placental insufficiency and intraoperatively patient was found to have unicornuate uterus with rudimentary horn and baby was male 1.4kg cried immediately after birth. CONCLUSION: If pregnancy with unicornuate uterus with rudimentary horn managed well it can result in favourable obstetric outcome.
Pregnancy in a unicornuate uterus: a case report
Journal of Medical Case Reports, 2014
Introduction: A unicornuate uterus accounts for 2.4 to 13% of all Müllerian anomalies. A unicornuate uterus with a non-communicating rudimentary horn may be associated with gynecological and obstetric complications such as infertility, endometriosis, hematometra, urinary tract anomalies, abortions, and preterm deliveries. It has a poor reproductive outcome and pregnancy management is still unclear. Case presentation: We report a case of a 26-year-old Caucasian woman presenting with a unicornuate uterus with a non-communicating rudimentary horn. The diagnosis of the anomaly was based on two-dimensional and three-dimensional sonography. The excision of her symptomatic rudimentary horn and her ipsilateral fallopian tube was performed laparoscopically. The growth of the fetus was normal. At 20 weeks' pregnancy, her cervix started shortening and a tocolytic therapy was started. A cesarean delivery was successfully performed at 39 weeks and 4 days' gestation. Conclusions: Although the reproductive outcome of women with unicornuate uterus is poor, a successful pregnancy is possible. Routine excision of the rudimentary horn should be undertaken during non-pregnant state laparoscopically, and it would be necessary to screen such pregnancies for the development of intrauterine growth retardation with serial ultrasound assessments of the estimated fetal weight and the cervix length.
Unicornuate uterus and pregnancy outcome: a case report
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2016
Mullerian duct anomalies (MDAs) are congenital defects of the female genital tract that arise from abnormal embryological development of the Mullerian ducts. Unicornuate uterus with or without rudimentary horn is developmental anomaly which occurs due to abnormal or failed development of one of the paired mullerian duct or fusion of the ducts. Women with unicornuate uterus have increased incidence of obstetric complications like spontaneous abortions, preterm delivery and intrauterine foetal demise and gynaecological complications like infertility, endometriosis and dysmenorrhoea. A 25 years old, primigravida was admitted at 38 weeks 3 days gestational age with complaints of leaking per vaginum. She was induced with PGE2 gel under antibiotic coverage to prevent chorioamnionitis. She underwent emergency caesarean section for failure to progress and intra-operatively she was incidentally found to have unicornuate uterus with contralateral fallopian tube directly getting attached to the ovary. The baby cried immediately after birth, though it was growth retarded (IUGR). If pregnancy with unicornuate uterus is managed well, it can result in favourable obstetric outcome.
Objective: The aim of this study was to analyze gynecologic and obstetrical morbidities associated with unicornuate uterus with rudimentary horn and to plan future management strategies for patients with this condition. Materials and Methods: This was a retrospective study of 38 patients with unicornuate uterus with rudimentary horn found on laparotomy. The research was carried out at the Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India, from April 2007 to March 2012. The patients' clinical details were reviewed and management of the cases was analyzed. Results: Of 38 patients, 4 were adolescents who presented with dysmenorrhea and had hematometra in a noncommunicating rudimentary horn on laparotomy. Eighteen patients had rudimentary horn pregnancy and 17 presented in the second trimester. All patients underwent laparotomy, 12 for hemoperitoneum and 5 for failed induction. Preoperative diagnosis was suspected clinically in 13/18 cases. Sixteen patients had pregnancy in the semiuterus, and diagnosis of unicornuate uterus with rudimentary horn was made incidentally during cesarean section. In all cases, excision of the rudimentary horn along with ipsilateral salpingectomy was performed. Conclusions: Unicornuate uterus with rudimentary horn is a rare clinical entity associated with many gynecologic and obstetrical morbidities. Early diagnosis and timely treatment is the key to better management. ( J GYNECOL SURG 30:87)
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Unicornuate uterus is an anomaly arising from defective lateral fusion of incompletely developed mullerian duct or paramesonephric duct with the contralateral duct. Pregnancy in non-communicating rudimentary horn can result in I and II trimester pregnancy losses along with maternal morbidity and mortality. Here we describe three such cases of unicornuate uterus with non-communicating rudimentary horn pregnancy, who presented to our hospital with pain in lower abdomen. Two of them with II trimester pregnancy landed in haemorrhagic shock owing to rupture of pregnant horn, though were revived by immediate intervention. Third patient who came with a definitive diagnosis of I trimester rudimentary horn pregnancy was managed electively by hemi-hysterectomy. Rupture of pregnant uterus can occur in II trimester when associated with uterine anomaly. Early sonographic diagnosis has a major offering in workup, management and prevention of mother from grave life threatening consequences.
Pregnancy in rudimentary horn of unicornuate uterus: a rare case
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Congenital malformations of the female genital tract result from embryological maldevelopment of Mullerian or paramesonephric ducts. Mullerian duct anomalies (MDAs) are due to agenesis, defective fusion or resorption during embryological development. Unicornuate uterus results due to defective lateral fusion of Mullerian duct. This report discussed a case of pregnancy in rudimentary horn of unicornuate uterus which resulted in rupture of the horn. A patient 35 year old G2A1 with spontaneous conception with 4 months pregnancy came to emergency room with complaints of pain in abdomen and giddiness. On examination her general condition was moderate with pulse rate of 128 bpm, blood pressure of 90/60 mmHg, pallor was present. On per abdomen examination guarding, rigidity and diffuse tenderness was present. On per vaginum examination, uterus size could not be appreciated. Her haemoglobin level was 6 gm%. Ultrasonography of abdomen showed presence of unicornuate uterus with ruptured right...
Diagnostic and Laparoscopic Management of Unicornuate Uterus with Rudimentary Horn
Case Reports in Clinical Medicine, 2014
We describe here a case report of a female patient with a unicornuate uterus with noncommunicating left rudimentary horn. The patient presented herself to us due to persistent lower abdominal pains, primarily dysmenorrhea and suspected internal genital endometriosis. Further to additional diagnosis and imaging by vaginal and abdominal ultrasound and abdominal MRI, a suspected rare congenital malformation of the genital tract was established. A normal vagina with cervical system without pathological findings was presented during the operation. The diagnostic hysteroscopy and laparoscopy indicated an intact right unicornuate uterus with a regular tube and ovary. A left rudimentary horn, noncommunicating with cervix and vagina was also presented, also together with a regular tube and ovary. The chromopertubation carried out proved the patency of the right tube. The decision was taken intraoperatively to remove the left rudimentary horn with ipsilateral tube. The surgery could be carried out without complications. We are reporting a patient with persistent lower abdominal pain, who desires to have children, to conceive with a unicornuate uterus and left rudimentary horn with retrograde menstruation and proliferative endometrium. Surgical minimal invasive treatment by laparoscopically removing of the left rudimentary horn and tube took place.
Pregnancy in Non-Communicating Unicornuate Uterus: Diagnosis Difficulty and Outcomes - a Case Report
Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia, 2017
Approximately 1 in every 76,000 pregnancies develops within a unicornuate uterus with a rudimentary horn. Müllerian uterus anomalies are often asymptomatic, thus, the diagnosis is a challenge, and it is usually made during the gestation or due to its complications, such as uterine rupture, pregnancy-induced hypertension, antepartum, postpartum bleeding and intrauterine growth restriction (IUGR). In order to avoid unnecessary cesarean sections and the risks they involve, the physicians should consider the several approaches and for how long it is feasible to perform labor induction in suspected cases of pregnancy in a unicornuate uterus with a rudimentary horn, despite the rarity of the anomaly. This report describes a case of a unicornuate uterus in which a pregnancy developed in the non-communicating rudimentary horn and the consequences of the delayed diagnosis.
International Journal of Reproduction, Contraception, Obstetrics and Gynecology
Unicornuate uterus with a rudimentary horn is an anomaly of the mullerian duct and is an extremely rare condition. This condition results when one of the paired mullerian ducts fails to fuse completely. Its incidence is estimated to be one in 76,000 pregnancies.Pregnancy in the rudimentary horn of the unicornuate uterus is difficult to diagnose on ultrasound and can be easily missed out. Hence the pregnancy usually gets detected after rupture when the mother presents with the complaint of severe abdominal pain. This is a case report of a 24 year old G2P1A0L1 female who presented to us with complaints of tenderness in the left iliac fossa and mild abdominal distention. Clinical examinations, radiological investigations, and exploratory laparotomy revealed a unicornuate uterus with an unruptured left rudimentary horn pregnancy at 14 weeks with mild hemoperitoneum. Following the exploratory laparotomy, excision of the left rudimentary horn and thorough peritoneal lavage was performed.