Ruptured Rudimentary Horn Pregnancy at 25 Weeks with Previous Vaginal Delivery: A Case Report

Abstract

Unicornuate uterus with rudimentary horn occurs due to failure of complete development of one of the Mullerian ducts and incomplete fusion with the contralateral side. Pregnancy in a noncommunicating rudimentary horn is extremely rare and usually terminates in rupture during first or second trimester of pregnancy. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with prior vaginal delivery is difficult. It can be missed in routine ultrasound scan and in majority of cases it is detected after rupture. It requires a high index of suspicion. We report a case of G2PlL1 with rupture rudimentary horn pregnancy at 25 weeks of gestation which was misdiagnosed as intrauterine pregnancy with fetal demise by ultrasound, and termination was attempted and the case was later referred to our hospital after the patient developed hemoperitoneum and shock with a diagnosis of rupture uterus. Laparotomy revealed rupture of right rudimentary horn pregnancy with massive hemoperitoneum. Timely laparotomy, excision of the horn, and blood transfusion saved the patient.

Ruptured Rudimentary Horn Pregnancy Diagnosed by Preoperative Magnetic Resonance Imaging Resulting in Fetal Salvage

“…2 Common diagnostic modalities include hysterosalpingography, combined laparoscopy and hysteroscopy, ultrasonography (preferably three-dimensional) and MRI. An ultrasound scan is used as an initial imaging tool to diagnose such uterine anomalies; however, the sensitivity of this modality is only 26% and this decreases in advanced pregnancies, 3 as was found in the current case. Suggested sonographic criteria by Tsafrir et al include pseudo-patterns of an asymmetrical bicornuate uterus, a lack of visual continuity between the cervical canal and the lumen of the pregnant horn and evidence of myometrial tissue around the gestational sac.…”

“…The sensitivity of ultrasonography in the diagnosis of uterine anomalies is low, especially in advanced gestation, and can often be missed. 3 A unique case of rudimentary horn pregnancy is presented, which was diagnosed preoperatively via magnetic resonance imaging (MRI) as the ultrasonography was inconclusive. Prompt surgical intervention resulted in a good maternal and fetal outcome.…”

Full-Term Pregnancy in a Non-communicating Rudimentary Horn: A Case Report

“…USG is usually the first modality to be used; however, this particular modality has a low sensitivity of 26%, which is even lower in advanced pregnancies [10]. Typical hypervascularization seen in cases of placenta accreta may support the diagnosis.…”

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

“…During operation, she was diagnosed as a case of term rudimentary horn pregnancy with placenta percreta. Tsafrir et al suggested ultrasound criteria for early diagnosis of this condition that includes (1) a pseudo-pattern of asymmetrical bicornuate uterus, (2) absent visual continuity between the cervical canal and the lumen of the pregnant horn, and (3) the presence of myometrial tissue surrounding the gestational sac [7,8,10]. These criteria can help in differentiating the pregnancy from cornual pregnancy, intraabdominal pregnancy, and bicornuate uterus [8,10].…”

“…The natural course of a rudimentary horn pregnancy is rupture during the first or mid-second trimester with potentially life-threatening bleeding [1,5]. In the majority of cases, horn rupture occurs before 20 weeks of gestation [7]; reports of rupture varying from 5 to 37 weeks are described [1,7]. The uterine wall being thicker and more vascular, bleeding is more severe in rudimentary horn pregnancy rupture, therefore it commonly manifests with acute abdominal pain and intraperitoneal hemorrage [1,7].…”