Diagnosis and laparoscopic management of a 5-week ectopic pregnancy in a rudimentary uterine horn: A case report

Monacci, Francesca; Lanfredini, Nora; Zandri, Stella; Strigini, Francesca Anna Letizia; Luchi, Carlo; Giannini, Andrea

doi:10.1016/j.crwh.2018.e00088

Cited by 6 publications

(8 citation statements)

References 10 publications

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“…5 This method improves operative morbidity and chances of intraoperative hemorrhage but delays definitive management. There are case reports in literature wherein they have removed the rudimentary pregnant horn successfully without prior medical management 16 similar to ours. We did a primary surgical excision of the uterine horn with live fetus in situ.…”

Section: Discussionsupporting

confidence: 76%

See 1 more Smart Citation

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

Dhanawat

Pape

Stuhlmann-Laeisz

et al. 2021

Clinical Case Reports

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Section: Discussionsupporting

confidence: 76%

“…There are case reports in literature wherein they have removed the rudimentary pregnant horn successfully without prior medical management 16 similar to ours. We did a primary surgical excision of the uterine horn with live fetus in situ.…”

Section: Discussionsupporting

confidence: 75%

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

Dhanawat

Pape

Stuhlmann-Laeisz

et al. 2021

Clinical Case Reports

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“…Upon diagnosis of a pregnancy in a rudimentary horn, the standard treatment involves immediate excision of the pregnant rudimentary horn for avoiding recurrence of pregnancy, removing the cause of dysmenorrhea, and preventing possible endometriosis [ 4 ]. In recent years, laparoscopic surgery has been the standard treatment for rudimentary horn pregnancy in hemodynamically stable patients [ 7 , 9 ]. During resection of a pregnant-rudimentary horn, bleeding is a major surgical risk because the pregnant uterus has abundant blood flow.…”

Section: Discussionmentioning

confidence: 99%

“…Recent advances in diagnostic imaging modalities, such as ultrasound and magnetic resource imaging (MRI), have made it possible to diagnose these pregnancies before occurrence of rupture [ 7 , 8 ]. Early diagnosis can help in performing laparoscopic surgical treatment before rupture [ 7 , 9 ].…”

Section: Introductionmentioning

confidence: 99%

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

Ueda

Ota

Takahashi

et al. 2021

BMC Pregnancy Childbirth

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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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“…[ 5 10 ] To treat these cases, emergency laparotomy is performed. Apart from detecting hypovolemic shock,[ 11 12 13 14 15 16 17 ] patients frequently have abdominal pain,[ 7 11 13 14 15 16 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 ] but some reports have indicated that only 8% of rudimentary horn pregnancies (RHPs) are diagnosed before the symptoms appear. [ 44 ] Sufficient knowledge seems necessary to detect NCRHP during early obstetric screening.…”

Section: Introductionmentioning

confidence: 99%

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery

Isono

Tsuchiya

Honda

et al. 2022

Gynecology and Minimally Invasive Therapy

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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.

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Diagnosis and laparoscopic management of a 5-week ectopic pregnancy in a rudimentary uterine horn: A case report

Cited by 6 publications

References 10 publications

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

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

Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery

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