Surviving 27 weeks fetus expelled out of the ruptured rudimentary horn and detected a month later as a secondary abdominal pregnancy

Abstract

A pregnant woman, gravida 3 with two living children, who frequently experienced syncope from 23(+5) weeks of pregnancy onwards and recurring every week for a period of 3 weeks, was repeatedly treated in line for a case of acid peptic disease/appendicitis in various peripheral hospitals of Nepal, until ultrasonogram/magnetic resonance imaging diagnosis of an (undisturbed) live 27(+5) weeks abdominal pregnancy was made at our hospital. On laparotomy, this materialized to be secondary to the rupture of a left rudimentary horn pregnancy (evidenced from its sealed margin) which still retained a complete placenta, from where an umbilical cord was seen, traversing across towards the right side of the abdominal cavity just below the liver, securing its attachment to the surviving fetus and enclosed in an intact amniotic sac. Excision of the rudimentary horn containing the placenta was accomplished, after the delivery of a live baby weighing 650 g who unfortunately died on the third day of life.

Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More

“…Placenta accreta and thinned myometrium predispose to uterine rupture [64], although varying amounts of myometrium in the rudimentary horn can accommodate the growing fetus often into the second and sometimes even the third trimester. When diagnosis is delayed, ruptured rudimentary horn pregnancies can present as abdominal ectopic pregnancies [70]. Rarely, an undiagnosed and unruptured rudimentary horn pregnancy continues to term and is delivered by cesarean section [71].…”

Full-term pregnancy in a rudimentary horn with a live fetus

“…A total of 61% and 6% of uterine ruptures occur in the second and third trimesters, respectively. [ 7 ] Bhandary Amrithan [ 8 ] and Ashma Rana [ 9 ] reported two cases of abdominal pregnancies secondary to rudimentary horn pregnancy fractures. The formal gravida ended with 40 weeks of gestation through a cesarean section, and her female baby weighed 3 kg and had a good condition.…”

Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review

“… [95] 2014 1 Not reported Left cornual region 30 wk 4 d Left cornual perforation; Viable fetus Rana et al. [96] 2008 1 Not reported Left rudimentary horn 27 wk 5 d Ruptured rudimentary horn and extrusion of fetus into abdomen and survival for 1 mo; ex uterine nonviability; excision of the horn. Gaber-patel & Smith [97] 2009 1 Not reported Right cornua of the uterus 13 wk Right cornual wedge resection; a nonviable fetus.…”