The value of hysteroscopy in the diagnostic approach to a rudimentary horn pregnancy

Esch, Edith M.G. van; Lashley, Eileen; Berning, Bennett; Kroon, Cor D. de

doi:10.1136/bcr.08.2010.3229

Cited by 4 publications

(5 citation statements)

References 6 publications

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“…Subsequently, other authors have attempted, through short series of cases, to develop specific USS criteria to facilitate preoperative diagnosis [8]. A recent literature review showed that only 5 % of the reported RHPs were diagnosed pre-operatively [9], whereas our search of laparoscopically managed RHP revealed that 9/20 (45 %) were confidently diagnosed pre-operatively. Jihong et al reported that their case was misdiagnosed by USS as missed miscarriage at 5, 7 and 8 weeks of gestational age.…”

Section: Discussionmentioning

confidence: 92%

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Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

2014

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Pregnancy in a uterine rudimentary horn carries a high risk of uterine rupture with severe and potentially lethal intra-abdominal haemorrhage. There is now growing evidence that this condition can be safely managed by minimally invasive surgery. We report a case of an unruptured 11-week rudimentary horn pregnancy that was diagnosed and treated laparoscopically. We have performed a literature review using PubMed, Embase and Cochrane Database of Systematic Reviews to identify relevant cases and draw conclusions with regards to their management. We have collated 20 published cases of rudimentary horn pregnancies that were managed by laparoscopy. The surgical technique appears consistent among these cases with few variations. In advanced gestations, feticide may need to be performed. Morcellation has been shown to be possible without compromising patient safety from trophoblast spill. The possibility of uncommon presentations such as duplicated or absent ureter should be taken into account. Extracorporeal Roeder knot can be used safely to secure unusually dilated vascular pedicles. Overall, laparoscopy appears to be as safe as and potentially superior to laparotomy for the management of rudimentary horn pregnancies.

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Section: Discussionmentioning

confidence: 92%

“…A case of a 16-week ruptured RHP was initially thought to be an intra-uterine pregnancy developing in a bicornuate uterus at laparoscopy performed at 7 weeks for abdominal pain [11]. Magnetic resonance imaging (MRI) can help differentiate between a RHP and a pregnancy in a bicornuate uterus which can be potentially viable [9].…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

2014

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“…The incidence of invasive hydatidiform moles in rudimentary horns is extremely rare. Due to the atypical characteristics of the condition, it is difficult to definitively diagnose it prior to surgery ( 18 ).…”

Section: Discussionmentioning

confidence: 99%

An unexpected invasive hydatidiform mole in a rudimentary uterine horn: A case report

Yuan

et al. 2017

Oncology Letters

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Rudimentary horns of the uterus develop as a result of a partial non-development of one Müllerian duct, a type of congenital uterine anomaly. Pregnancy in a rudimentary horn is uncommon and the outcome tends to be poor, with the majority of cases resulting in rupture between 10 and 15 gestational weeks, with significant risk of morbidity and mortality. Regardless of the availability of imagiological procedures and the advances being made in this field, the diagnosis of this type of ectopic pregnancy often only occurs during laparotomy or laparoscopy subsequent to abdominal pain and collapse. The present study describes a rare case of a uterine rudimentary horn pregnancy. The case was diagnosed by the high serum β-HCG level, imageological results and dissection of the final pathological specimen, by combined hysteroscopy and laparoscopy. An ultrasound illustrated a suspicious gestational trophoblastic disease in the rudimentary uterine horn, with a rich blood flow signal at the right side of the uterus. A pelvic magnetic resonance image indicated that there was endometrial thickening and gestational trophoblastic disease in the rudimentary uterine horn. The patient was treated with surgery, including rudimentary horn dissection and diagnostic curettage; the ipsilateral adnexa was conserved as it appeared to be normal. Due to the apparent decline of the serum β-HCG level and the reluctance for chemotherapy, the patient chose to undergo no further treatment and closed follow-up. At the time of writing, the patient is in a good condition. Only a small number of reports of a horn pregnancy with invasive hydatidiform mole are described by other studies, thereby increasing the clinical significance of this case.

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“…The continuity between the endometrium lining the gestational sac and the other uterine horn is typical for a pregnancy in a bicornuate uterus. In case of persistent doubt, hysteroscopy can easily determine the absence of a cervical channel to the uterine horn and consequently discriminate a rudimentary horn from a bicornuate uterus [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Ectopic Pregnancy in Uncommon Implantation Sites: Intramural Pregnancy and Rudimentary Horn Pregnancy

Wang

Yang

Zeng

2015

Case Reports in Obstetrics and Gynecology

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Ectopic pregnancy is commonly located in the fallopian tube. Nevertheless, two unusual types of ectopic pregnancy, intramural pregnancy and rudimentary horn pregnancy, seriously threaten maternal life. The diagnosis and treatment of these unusual implantation sites present a clinical challenge. In this study, we illustrated the two unusual types of ectopic pregnancy and summarized the current data regarding diagnosis and optimal treatment from our experience.

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The value of hysteroscopy in the diagnostic approach to a rudimentary horn pregnancy

Cited by 4 publications

References 6 publications

Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

Laparoscopic management of an 11-week rudimentary uterine horn pregnancy using extracorporeal Roeder knot to secure the dilated vascular pedicle

An unexpected invasive hydatidiform mole in a rudimentary uterine horn: A case report

Ectopic Pregnancy in Uncommon Implantation Sites: Intramural Pregnancy and Rudimentary Horn Pregnancy

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