Ultrasound diagnosis of rudimentary uterine horn pregnancy in fourteen weeks of gestation: a case report (original) (raw)
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Rudimentary Uterine Horn Pregnancy; Pre-rupture Diagnosis and Management: Case Report
2019
Introduction: Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in a rudimentary horn is rare. The Diagnosis of the rudimentary horn pregnancy is very difficult and needs high index of suspicion. Case: We present a case of pregnancy in a non-communicating rudimentary horn that was difficult to diagnosis in the 1 st presentation. The diagnosis was suspected when the case did not respond to the medical termination of pregnancy by misoprostol; and also by mechanical methods. Following that a suspicion of an abnormally located pregnancy was made and confirmed by radiology modalities. Patient had surgical resection of the rudimentary horn. Conclusion: Despite recent advances in ultrasound, the diagnosis of pregnancy in the rudimentary horn remains difficult, and high index of suspicion is needed in these cases.
2009
reported to be 1/100.000 to 1/140.000 pregnancies.1,2 Despite the recent advances in the ultrasound, the diagnosis of this condition is difficult. It can be misdiagnosed or diagnosed at lapratomy due to rupture of the pregnancy. The majority of the cases are reported to occur at the noncommunicating horn of the uterus.3 A rudimentary horn results from an arrest in the development of one of the mullerian ducts with the inappropriate fusion with the contra lateral side. Connection of horn with the uterus may be fibrous or fibro muscular. There is no communication between two cavities at 70-90% of the cases.3 Because of the variable musculature of the uterine horn duration of pregnancy may differ to end at second
Rupture of a Rudimentary Uterine Horn: A Case Report
Pregnancy in an abnormal uterus is a high-risk situation in obstetrics. Uterus bicornis unicollis with a rudimentary horn is often discovered incidentally. The aim of this report is to warn obstetricians about recurrent abdominal pain in the second trimester of pregnancy without any cause identified. Pregnancy can proceed in the rudimentary horn. We presented a case of a rupture of the rudimentary horn which occurred at 25 weeks of amenorrhea in an unmarried 19-year-old primigravida. The rudimentary horn was removed after performing an emergency laparotomy for an intraperitoneal hemorrhage with signs of shock. This abnormality is often revealed by uterine rupture, which usually occurs in the second trimester of pregnancy. Conclusion: We emphasize the importance of early diagnosis of this uterine abnormality, before pregnancy if possible. Undiagnosed, this condition evolves towards uterine rupture during pregnancy and requires emergency surgery with excision of the rudimentary horn.
Rudimentary uterine horn pregnancy: a mystery diagnosis
Fertility and Sterility, 2009
Objective: To emphasize the importance of complete ultrasonographic evaluation during the first trimester of pregnancy. Design: Case report. Setting: Obstetric unit in a training and research hospital. Patient(s): A 27-year-old primigravida woman who reached 37 weeks' gestation with a noncommunicating rudimentary horn pregnancy. Intervention(s): The accurate diagnosis of a noncommunicating rudimentary horn pregnancy was made after cesarean section at 37 weeks' gestation. Rudimentary horn excision and ipsilateral salpingectomy were performed during exploration. Main Outcome Measure(s): Early diagnosis using sonography to prevent maternal morbidity and mortality. Result(s): A female baby with a 7/10 apgar score was delivered successfully. The patient and her baby were both discharged in good health. Conclusion(s): Rudimentary uterine horn pregnancy should always be considered as a differential diagnosis of intrauterine pregnancy in a bicornuate uterus. A thorough ultrasonographic examination should be performed on the aspects of the pregnancy and the pelvic anatomy. Lack of knowledge of and experience with m€ ullerian anomalies still makes these anomalies difficult to recognize even with laparoscopy. (Fertil Steril Ò 2009;92:2037.e1-e3.
Abstract: Pregnancy in non-communicating rudimentary horn of unicornuate uterus is an uncommon form of ectopic pregnancy usually resulting in rupture during second trimester with grave consequences for the mother and fetus. We report a case of ruptured non-communicating rudimentary horn at 28 weeks of gestation in woman with previous Caesarean section in unicornuate uterus. She presented to emergency with pain abdomen since four days. Laparotomy was done and the rudimentary horn excised. Post-operative recovery was uneventful. High index of suspicion of uterine anomaly and its early diagnosis in cases of second trimester rupture is required to save this catastrophic event. Keywords: unicornuate uterus; non-comunicating rudimentary horn; ectopic pregnancy; rupture.
Ruptured rudimentary horn pregnancy with a history of an uneventful vaginal delivery
Journal of Medical Ultrasonics, 2014
Pregnancy in a rudimentary uterine horn is a rare event with an estimated incidence of 1 in 76,000 to 1 in 1,40,000 pregnancies. Unicornuate uterus with a rudimentary horn has a high incidence of obstetric and gynecological complications. Ruptured ectopic pregnancy in the rudimentary horn is one of the most dreaded complications, which can have grave consequences for both mother and fetus. In the majority of the cases, it is detected after rupture of the horn, usually during the first or second trimester of pregnancy. An ultrasonographic diagnosis made prior to rupture of the rudimentary horn may prevent this catastrophic outcome. We report a case of a G2 P1 L1 with a ruptured left rudimentary horn pregnancy at 16 weeks of gestation that was misdiagnosed as a pregnancy in the left uterine horn of a bicornuate uterus on prior prenatal ultrasound. The patient presented to our hospital with abdominal pain and vaginal bleeding. A diagnosis of ruptured left rudimentary horn pregnancy was made on the basis of emergency ultrasound and was later confirmed on laparotomy. The left rudimentary horn along with the ipsilateral fallopian tube was excised.
Rudimentary Horn Pregnancy Mimicking Ruptured Uterus
Journal of Gynecologic Surgery, 2014
Background: Pregnancy in a noncommunicating rudimentary horn is extremely rare and usually terminates by rupture in second trimester of pregnancy. Thus, excision of the rudimentary horn is advised when it is diagnosed. Case: A 25-year-old woman, gravida 2, para 1 + 0, presented as a case of an acute abdomen. She had a rare case of an intact pregnancy that had reached 26 weeks of gestation in a noncommunicating rudimentary horn, and this was misdiagnosed by ultrasound as a case of a ruptured uterus. The rudimentary horn, with the pregnancy in situ, the right tube, and the right ovary were excised. The fetus was not alive by the time of this surgery. Results: The patient's postoperative period was uneventful, and she was discharged to go home 3 days after her surgery had occurred. Conclusions: Despite being rare, rudimentary-horn pregnancy should be suspected regardless of the fetus' gestational age. Rudimentary-horn pregnancy should also be considered as an unusual presentation of a ruptured uterus. Excision of the rudimentary horn remains the ''gold standard'' method for treating these patients. (J GYNECOL SURG 30:162
Prerupture diagnosis of a pregnant rudimentary uterine horn
Radiology Case Reports, 2021
This clinical case reports prerupture diagnosis of a rudimentary horn pregnancy in a 27-year-old formerly healthy woman presented with moderate to severe suprapubic abdominal pain at the gestational age of 12 + 0 weeks. The suspected diagnosis of this pregnant rudimentary horn via transvaginal ultrasound was acknowledged during an emergency exploratory laparotomy. The simple transvaginal ultrasound criteria suggested by the present study would help clinicians avoid time-consuming inefficient investigative procedure and rule out this rare life-threatening condition by taking into account the rudimentary horn pregnancy as a differential diagnosis in patients presenting with abdominal pain.
Rupture of Rudimentary Horn Pregnancy at 16 Weeks of Gestation
Case Reports in Obstetrics and Gynecology, 2021
Pregnancy in the rudimentary horn is rare and a life-threatening. Rupture of pregnant rudimentary horn in the second trimester is a usual presentation. Early diagnosis and fast management are necessary to decrease the mortality and the morbidity of this pathological entity. This report confirms the diagnostic and therapeutic difficulties of the pregnant rudimentary horn. An emergency laparotomy was taken, and ruptured right rudimentary horn was diagnosed. A hemi-hysterectomy was carried out. The patient’s postoperative follow-up was uneventful, and she left the hospital 5 days after.