Pregnancy in Noncommunicating Rudimentary Horn of Unicornuate Uterus: A Case Report and Review of the Literature

Abstract

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.

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

“…Emergency open surgery with multiple blood transfusions is the only option. 14,15 But with advent of better diagnostics, and more women being diagnosed in first trimester scans, medical line of management with surgical removal being done on a later date has become possible. 5 There are no fixed guidelines to manage such ectopics, but like management of other ectopic pregnancy, in early hemodynamically stable pregnancy, intrauterine or intramuscular methotrexate, or intrauterine KCL can be injected.…”

“…Earlier days, or in places where access to health care is difficult, when diagnosis is a problem, women often come with rupture of rudimentary horn with unstable hemodynamic condition. Emergency open surgery with multiple blood transfusions is the only option 14,15 . But with advent of better diagnostics, and more women being diagnosed in first trimester scans, medical line of management with surgical removal being done on a later date has become possible 5 .…”

Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice

“…However, as mentioned previously, the term cornual pregnancy has been used in clinical practice to describe pregnancies in various locations, both normally sited and ectopics, and we decided to abandon this term as suggested by Baltarowich (2017) . Rudimentary horn pregnancy is rare, with a reported incidence of 1 in 75 000–150 000 pregnancies ( Tesemma, 2019 ). If not diagnosed in early pregnancy, they can advance well into the second trimester, when they often present with severe pain and rupture ( Jayasinghe et al , 2005 ; Li et al , 2019 ).…”

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

“…[ 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.…”