Pregnancy in a unicornuate uterus: a case report

Abstract

IntroductionA 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 presentationWe 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.ConclusionsAlthough 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.

Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn

“…After reviewing all articles, 4 reports of 10 cases were further analyzed. The results of our literature review are summarized in Table …”

“…Similar cases were reported by Adolph et al . and Caserta et al ., and in both cases, healthy babies were delivered at term by CD . Pados et al .…”

Rupture of a rudimentary uterine horn at the 19th week of pregancy subsequent to an earlier normal vaginal delivery

“…They are relatively common, the incidence is 0.5-1.8% [3]. Urinary system malformations may also accompany Müllerian duct anomalies [4]. Pregnancy in a non-communicating rudimentary horn occurs through transperitoneal migration of sperm or fertilized ovum, and it is associated with a high rate of spontaneous abortion, preterm labour, intrauterine growth retardation, intraperitoneal haemorrhage and uterine rupture [5].…”

Еctopic pregnancy in a rudimentary uterine horn (сase report)

“…В зависимости от размеров маточного рудимента и его полости, а также степени активности эндометрия может происходить образо-вание гематометры, гематосальпинкса, а также фор-мирование наружного генитального эндометриоза [2,3]. В данном клиническом случае у больной не на-блюдались вышеуказанные симптомы, и не был свое-временно поставлен диагноз порока развития.…”

“…Однако даже в случаях удаления рудиментарного рога пациентки с данным пороком развития остают-ся в группе высокого риска акушерских осложнений: потери беременности в I и II триместре, преждевре-менных родов, внутриутробной задержки роста пло-да, антенатальной гибели плода, что связано с анато-мо-функциональной неполноценностью матки (не-большие размеры полости матки, особенности кро-воснабжения маточного рога, нарушение маточно-плацентарного кровотока, истмико-цервикальная недостаточность) [3].…”