Rudimentary horn pregnancy: Pre-rupture diagnosis and management

Abstract

SUMMARYRudimentary horn pregnancy is a rare obstetric entity and the diagnosis and management may pose some problems especially in a low-resource center. We report our experience in diagnosing and managing a case of fetal death in a rudimentary horn.Keywords: rudimentary horn, pre-rupture, pregnancy, tourniquet CASE REPORTMadam CA was a 28 years old gravida 6 para 5. She presented to Korle Bu Teaching hospital with a complaint of vaginal bleeding of two days duration. She did not remember the exact date of her last menstrual period but she believed she was six months pregnant. The vaginal bleeding was associated with lower abdominal pain. She had not booked for antenatal care in this pregnancy. All her previous deliveries were spontaneous vaginal deliveries at term.On examination, she looked well with a pulse rate of 88 beats per minute and a blood pressure of 130/70mmHg. There was a mass arising from the pelvis corresponding to the size of a 16-week pregnancy. The surface was smooth, mildly tender and not mobile. The cervix was firm, 2.5cm long, posterior and the os was closed. There were no adnexal masses felt and the mass was not displaced to either side. There was no active vaginal bleeding. A speculum examination did not reveal any cervical or vaginal pathology. A clinical impression of threatened abortion was formed.A transabdominal ultrasound scan was performed and the findings were as follows: single intrauterine pregnancy, no fetal heart activity, reduced liquor volume, femur length 2.2cm and gestation age 16weeks. Her haemoglobin was 11.2g/dl, platelet count was 320 x 10 9 /L, and the clotting profile was normal.Labour was induced with 200mcg of misoprostol in the posterior vaginal fornix, 6 hourly for a total of four doses. This was however, unsuccessful on two different occasions, 48 hours apart. There were no complications associated with the attempts at induction of labour. Based on the two failed attempts at induction of labour, extrauterine pregnancy was suspected. A repeat transabdominal ultrasound scan could not conclusively confirm or rule out an extrauterine pregnancy. Transvaginal ultrasound scan, MRI and CT scan were not readily available for further investigation of the patient. A size 18 Foley catheter was passed into the uterine cavity and the balloon inflated with 10mls of normal saline. The bladder was also filled with about 250mls of normal saline. Trans-abdominal ultrasound scan examination was then repeated. On this occasion, the fetus was seen to be outside the uterine cavity and the diagnosis of extrauterine pregnancy was confirmed. Madam CA was counselled and prepared for laparotomy which was performed under general anaesthesia.

Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو

“…The incidence in the general population is estimated to be 4.3%. 1 A unicornuate uterus with a rudimentary horn is the rarest anomaly and results from the failure of one of the Müllerian ducts to develop completely and an incomplete fusion with the contralateral side. 2 The incidence of this anomaly is approximately 0.4%.…”

Term Pregnancy with a Live Fetus in Non-communicating Rudimentary Horn with Placenta Percreta

“…The sensitivity of USG as a late gestation diagnostic tool is 26 % [8,9]. MRI appeared to be the ''gold standard'' for diagnosing and grouping utzerine anomalies because of its 98-100 % accuracy [2,6].…”

“…In about 84 % of these cases, a contralateral rudimentary horn exists, almost always of a non-communicating type [1,5]. The attachment of the rudimentary horn may vary from a fibromuscular band (separated variety) to an extensive fusion between the two horns where there is no external separation between them [4,6]. This was a case with an extensive fusion between the two horns.…”

Rudimentary horn pregnancies: dilemmas in diagnosis

“…Buntungu et al reported a rudimentary horn pregnancy in a 6th gravida with all previous normal deliveries with a diagnosis of intrauterine fetal demise in this pregnancy where induction with misoprostol failed leading to the suspicion of ectopic pregnancy. 13 They placed a Foley catheter into the uterine cavity prior to performing a transabdominal ultrasound scan, which obviously is not a preferred method of diagnosing an extrauterine pregnancy, but it proved to be a useful and cheap way of excluding an intrauterine pregnancy. This method has been used by others also to confirm an extrauterine pregnancy which proved to be a rudimentary horn pregnancy at laparotomy.…”