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Pregnancy in a rudimentary horn: multicenter's MRI features of a rare condition. ABDOMINAL RADIOLOGY (NEW YORK) 2022; 47:4195-4204. [PMID: 36094661 DOI: 10.1007/s00261-022-03658-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/17/2022] [Accepted: 08/18/2022] [Indexed: 01/18/2023]
Abstract
PURPOSE To describe the MRI features of rudimentary horn pregnancy (RHP) with surgical correlations. METHODS Nine women with a RHP underwent preoperative pelvic MRI. MRI protocol included T2- (n = 9), T1- (n = 7), and fat-suppressed contrast-enhanced T1-weighted sequences (n = 4). Two pelvic radiologists retrospectively analyzed MR images to assess the following MRI features: presence of a myometrium around the gestational sac (GS) and characteristics of its wall, GS surrounded by myometrium in contact with the round ligament, communication of the GS with the endometrial cavity of the main horn, continuity of the GS with the cervix, fibrous or muscular GS attachment to the main horn, lateral deviation, and endometrial thickness of the main horn. Ovaries and tubes were also assessed. MRI features were correlated with surgical findings. RESULTS Seven of the nine women [29 ± 6 SD years (range 16-37 years)] underwent surgical management. The first US diagnosed RHP in only 1/9 patients. All pregnancies were diagnosed using MRI. RHP was all located in the rudimentary horn of a unicornuate uterus. All the GS was surrounded by myometrium in contact with the round ligament. None of the RHP displayed communication with the endometrial cavity of the main horn nor with the cervix. An attachment between the RHP and the main horn was seen in 3/9 patients. All the main horns were lateralized and empty. CONCLUSION MRI diagnosed RHP in all patients by identifying the GS surrounded by myometrium in contact with the round ligament and the absence of continuity between the GS and the cervix. LEVEL OF EVIDENCE IV-retrospective study.
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2
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Isono W, Tsuchiya A, Honda M, Saito A, Tsuchiya H, Matsuyama R, Fujimoto A, Nishii O. Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review. Gynecol Minim Invasive Ther 2022; 11:7-16. [PMID: 35310117 PMCID: PMC8926057 DOI: 10.4103/gmit.gmit_157_20] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/09/2021] [Accepted: 04/22/2021] [Indexed: 11/23/2022] Open
Abstract
Pregnancy in a noncommunicating rudimentary horn is extremely rare but can cause serious clinical complications, such as uterine rupture. The standard treatment is excision of the rudimentary horn, and recently, in some cases, laparoscopic resection has been performed in the first trimester of gestation. Herein, we present a case of noncommunicating rudimentary horn pregnancy (NCRHP), which was diagnosed by magnetic resonance imaging at 6 weeks of gestation and treated by laparoscopic surgery. However, we have also found some rare cases in which patients could obtain live newborn babies. Since management is affected by the different levels of obstetric medical care and diagnostic tools, we also performed a review and analysis of NCRHP. A PubMed search yielded 103 cases reported in the English literature. Correct diagnosis and laparoscopic treatment were achieved more frequently in developed countries, especially in the first trimester of gestation. On the other hand, symptoms, including abdominal pain and hypovolemic shock, tended to occur in the second trimester of gestation. This period was also found to be a risk factor for uterine rupture. Among 18 patients at the third trimester of gestation, 13 obtained live neonatal infants. Therefore, detailed information about this disease is crucial for proper treatments.
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Oshodi O, Castaneda J. Use of the Purse-String Suture to Conservatively Manage a Cornual Ectopic Pregnancy. Cureus 2021; 13:e14249. [PMID: 33959439 PMCID: PMC8093125 DOI: 10.7759/cureus.14249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
We report the successful management of a 31-year-old female, treated by cornual wedge resection. The patient suffered from vaginal spotting and lower abdominal pain. Transvaginal ultrasonography revealed a 4-5 cm right cornual pregnancy and beta-human chorionic gonadotropin was measured to be 614.7 IU/L. This ectopic pregnancy was removed via a laparotomy with cornual wedge resection and right salpingectomy.
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Affiliation(s)
- Oluwatofunmi Oshodi
- Obstetrics and Gynecology, Florida Atlantic University Charles E. Schmidt College of Medicine, Boca Raton, USA
| | - Jose Castaneda
- Obstetrics and Gynecology, Bethesda Hospital East, Boynton Beach, USA
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Management of interstitial pregnancy in the era of laparoscopy: a meta-analysis of 855 case studies compared with traditional techniques. Obstet Gynecol Sci 2021; 64:156-173. [PMID: 33539687 PMCID: PMC7990998 DOI: 10.5468/ogs.20299] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/27/2020] [Indexed: 11/08/2022] Open
Abstract
Interstitial pregnancy is a rare, life-threatening condition that requires high clinical suspicion for diagnosis. Most cases are discovered after complications have occurred. Many authors have described laparoscopic management. Although previous systematic reviews have compared the attributes and complications associated with interstitial pregnancy, we endeavored to complete the first systematic review and meta-analysis to compare the laparoscopic treatment of interstitial pregnancy with the open approach in the modern age of laparoscopic surgery. We systematically searched PubMed, ClinicalTrials.gov, Scopus, Web of Science, and Cochrane until June 2020 using relevant keywords and screened them for eligibility. We found a statistically significant difference in blood loss between laparoscopic and open surgery (168 mL compared to 1,163 mL). Further, cumulative meta-analysis has revealed that blood loss in laparoscopy has been decreasing over time from 1991 to 2020. Laparoscopic patients took less operative time (63.2 minutes) compared to laparotomy patients (78.2 minutes). Patients in the laparoscopic group spent less time hospitalized (3.7 days) compared to laparotomy patients (5.2 days). Our findings add strength to the position that laparoscopic approaches to interstitial pregnancy can be considered first-line in most situations. The laparoscopic approach was found to have a mean blood loss of 168 mL, and this blood loss seems to decrease over time. Increased gravidity and duration of amenorrhea are positive factors that increase bleeding during the procedure. We are unable to find enough high-quality data to significantly compare successful pregnancy following surgery or risk of mortality in these populations.
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Kirkpatrick J, Upadhyay V, Mirjalili SA, Taghavi K. Side predilection in congenital anomalies of the kidney, urinary and genital tracts. J Pediatr Urol 2020; 16:751-759. [PMID: 32933872 DOI: 10.1016/j.jpurol.2020.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 04/24/2020] [Accepted: 08/02/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND There appear to be various patterns of sidedness with relation to the common urogenital malformations observed in pediatric urology. The objective of this statistical review was to synthesize this data and to assess if these patterns are significant. MATERIALS AND METHODS Eighteen urogenital conditions were investigated and for each condition the five largest studies that noted laterality were included. The sidedness of each condition was then analysed for statistical significance. RESULTS Three conditions had a statistically significant higher proportion on the right side: palpable undescended testis (63%, p = 0.0002), inguinal hernia (59%, p = 0.0001) and hydrocele (60%, p = 0.003). Three conditions were significantly more common on the left side: impalpable undescended testis (59%, p = 0.0008), renal agenesis (54%, p = 0.02) and vesico-ureteric junction obstruction (71%, p < 0.0001) while both pelvi-ureteric junction obstruction (62%, p = 0.09) and absent vas deferens (61%, p = 0.11) were trending towards significance. CONCLUSIONS Various urogenital malformations display a predilection for one side. Proximal malformations tend to be more frequently seen on the left side, where as inguinoscrotal malformations are more frequently observed on the right. There is an increasing body of literature regarding aetiological factors for these conditions. However, our current understanding of the pathophysiology of these conditions does not completely explain this pattern of observation.
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Affiliation(s)
| | - Vipul Upadhyay
- Department of Paediatric Surgery and Urology, Starship Children's Hospital, Auckland, New Zealand
| | - S Ali Mirjalili
- Department of Anatomy and Medical Imaging, Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
| | - Kiarash Taghavi
- Department of Paediatric Urology, Royal Children's Hospital, Melbourne, Australia; Department of Surgery, University of Auckland, Auckland, New Zealand
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6
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Li X, Peng P, Liu X, Chen W, Liu J, Yang J, Bian X. The pregnancy outcomes of patients with rudimentary uterine horn: A 30-year experience. PLoS One 2019; 14:e0210788. [PMID: 30682068 PMCID: PMC6347212 DOI: 10.1371/journal.pone.0210788] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Accepted: 01/02/2019] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To evaluate the presentation, assessment, treatment, and pregnancy outcomes of 22 women with a rudimentary uterine horn. METHODS We reviewed the data regarding the outcomes of patients with a rudimentary horn pregnancy (RHP) who were managed at Peking Union Medical College Hospital over the last 30 years. Twenty-two pregnant patients with a rudimentary horn have been treated at our institute over the last 30 years. All patients with RHP were divided into two groups: Type A (n = 4), a rudimentary horn with a cavity that communicated with the uterus; and Type B (n = 7), a rudimentary horn with a cavity that did not communicate with the uterus. We classified all 22 patients into communicating group or noncommunicating group according to the anatomical connection of the rudimentary horn to the contralateral hemiuterus. RESULTS The mean gestational age of Type A patients (23.5 weeks) was significantly higher (P = 0.046) than that of Type B patients (10 weeks). The rudimentary uterine horn carried 4 of 5 (80%) pregnancies in the communicating group. Three case of rudimentary horn pregnancies ruptured before a gestational age of 12 weeks, and one abortion occurred after a gestational age of 12 weeks. In the noncommunicating group, 7 of 17 (41.2%) cases were RHPs, and 3 ruptured after a gestational age of 12 weeks. CONCLUSIONS The diagnosis and management of the rudimentary uterine horn continues to be challenging. Medical and radiological personnel must maintain a high degree of alertness to prevent the morbidity associated with this condition. In particular, patients with RHP (Type A), who have a higher chance being misdiagnosed before 12 gestational weeks, have a higher risk of potential complications. If pregnancy in the rudimentary horn is diagnosed, excision of the pregnant horn is recommended, regardless of the type of unicornuate uterus.
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Affiliation(s)
- Xiaoyan Li
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Ping Peng
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
- * E-mail:
| | - Xinyan Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Weilin Chen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Juntao Liu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Jianqiu Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
| | - Xuming Bian
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Beijing, China
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7
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Abdelazim IA, Nussair B, Zhurabekova G, Svetlana S, Abu-Faza M, Naser W. Comment on An Intrauterine Gestational Sac Surrounded by Thin Myometrium at Fundus. J Med Ultrasound 2018; 26:168-169. [PMID: 30283207 PMCID: PMC6159320 DOI: 10.4103/jmu.jmu_58_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Ibrahim A. Abdelazim
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait, Department of Obstetrics and Gynecology, Ain Shams University, Cairo, Egypt
| | - Bassam Nussair
- Department of Obstetrics and Gynecology, Royal Medical Services, Amman, Jordan
| | - Gulmira Zhurabekova
- Department of Normal and Topographical Anatomy, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Shikanova Svetlana
- Department of Obstetrics and Gynecology, West Kazakhstan Marat Ospanov State Medical University, Aktobe, Kazakhstan
| | - Mohannad Abu-Faza
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait
| | - Waheeb Naser
- Department of Obstetrics and Gynecology, Ahmadi Hospital, Kuwait Oil Company, Ahmadi, Kuwait
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8
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Yassin A, Munaza S, Mohammed A. Tale of rudimentary horn pregnancy: case reports and literature review. J Matern Fetal Neonatal Med 2017; 32:671-676. [PMID: 29034759 DOI: 10.1080/14767058.2017.1387533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rudimentary horn pregnancy (RHP) is a rare form of pregnancy in a rudimentary uterine horn with a reported incidence of 1 in 76,000 and 1 in 150,000. A significant number of cases is diagnosed only following rupture of the RHP with an estimated maternal mortality rate of 0.5%. Early diagnosis can help in planning management before its rupture and allows for surgical treatment using laparoscopy.
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Affiliation(s)
- Ahmed Yassin
- a Department of Obstetrics & Gynecology , Sidra Medical and Research Center & Weill Cornell Medicine , Doha , Qatar.,b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Shahzadi Munaza
- b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Abdelbaset Mohammed
- b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar.,c Department of Obstetrics & Gynecology , Minia Univeristy , Minia , Egypt
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9
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Si M, Li P, Yuan Z, Ma H, Cui B, Kong B. An unexpected invasive hydatidiform mole in a rudimentary uterine horn: A case report. Oncol Lett 2017; 14:2808-2812. [PMID: 28927039 PMCID: PMC5588082 DOI: 10.3892/ol.2017.6493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Accepted: 01/11/2017] [Indexed: 11/19/2022] Open
Abstract
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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Affiliation(s)
- Manfei Si
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Peng Li
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Zeng Yuan
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Hui Ma
- Department of Emergency, Affiliated Hospital of Shandong Academy of Medical Science, Jinan, Shandong 250031, P.R. China
| | - Baoxia Cui
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
| | - Beihua Kong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, Shandong 250012, P.R. China
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10
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Alalade AO, Smith FJE, Kendall CE, Odejinmi F. Evidence-based management of non-tubal ectopic pregnancies. J OBSTET GYNAECOL 2017. [PMID: 28631522 DOI: 10.1080/01443615.2017.1323852] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Recent advances in ultrasonography and the use of other modalities including magnetic resonance imaging scans have led to the early and more accurate diagnosis of non-tubal ectopic pregnancies (NTE). As a result, the management of these pregnancies has evolved. This article addresses the management options currently available for NTE. While surgical management remains the mainstay of treatment for ovarian, abdominal and cornual ectopics, there is growing evidence that some of these can be managed medically. Many authors have utilised a combination of medical and surgical approaches in the management of cervical and caesarean section (CS) scar ectopic pregnancies with good outcome. The availability of dedicated early pregnancy units has further improved diagnosis and more importantly the follow-up care for these patients. The rarity of cases and the difficulty of ethically organising randomised trials for NTE remain a problem in formulating consistent pathways for optimum management of women with NTE.
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Affiliation(s)
- Aderemi Olaoluwa Alalade
- a Department of Obstetrics and Gynaecology , Wrexham Maelor Hospital, Betsi Cadwaladr University Health Board , Wrexham , UK
| | - Fredrick John Ennis Smith
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Charlotte Emma Kendall
- b Cochrane Medical Education Centre, Institute of Medical Education, Cardiff University School of Medicine, Cardiff University , Cardiff , UK
| | - Funlayo Odejinmi
- c Department of Obstetrics and Gynaecology, Barts Health NHS Trust , Whipps Cross University Hospital , London , England
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11
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Ueda J, Yoshida H, Makino H, Maruyama H, Yokoyama T, Hirakata A, Akagi I, Watanabe M, Uchida E, Uchida E. Right Inguinal Hernia Encompassing the Uterus, Right Ovary and Fallopian Tube in an Elderly Female: Case Report. J NIPPON MED SCH 2017; 83:93-6. [PMID: 27180795 DOI: 10.1272/jnms.83.93] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The uterus, ovary, and fallopian tube are rarely present in an inguinal hernia. We report on an operation to treat just such a rare condition for a right inguinal hernia. An 87-year-old Japanese woman was admitted with swelling in the right inguinal region and a purulent discharge from the vagina. Vital signs were stable, but the mobile mass was irreducible. Computed tomography of the abdomen indicated uterine tissue in a right inguinal hernia. We diagnosed an inguinal hernia with an incarcerated uterus and performed surgery on that basis. An incision approximately 6 cm long was made in the skin above the swollen area to open the inguinal sac, disclosing a tumor enveloped by a hernial sac. Opening the hernial sac revealed the prolapsed uterus, the fallopian tube, and the right ovary. Because no ischemic change was noted, the incarcerated uterus was returned to the abdominal cavity, and the hernial opening was closed with the onlay mesh technique. The posterior wall of the inguinal canal was found to have prolapsed laterally to the inferior epigastric artery, resulting in an external inguinal hernia. This case demonstrates that careful attention must be paid to inguinal hernias in female patients because the uterus, ovary, and fallopian tube may be involved.
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Affiliation(s)
- Junji Ueda
- Department of Surgery, Nippon Medical School Tama Nagayama Hospital
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12
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Blancafort C, Graupera B, Pascual MÀ, Hereter L, Browne JL, Cusidó MT. Diagnosis and laparoscopic management of a rudimentary horn pregnancy: Role of three-dimensional ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:112-115. [PMID: 27612443 DOI: 10.1002/jcu.22393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2016] [Accepted: 08/06/2016] [Indexed: 06/06/2023]
Abstract
Rudimentary horn pregnancy occurs in 1 in 76,000-150,000 pregnancies and causes uterine rupture in about 80% of cases. The use of three-dimensional transvaginal ultrasound seems to be useful for its early detection. We present a case of an 8-week pregnancy in a rudimentary horn, managed by laparoscopic excision. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:112-115, 2017.
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Affiliation(s)
- Claudia Blancafort
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Betlem Graupera
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Maria Àngela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Lourdes Hereter
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Jean Laurent Browne
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Maria Teresa Cusidó
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
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13
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Elagwany AS, Elgamal HH, Abdeldayem TM. Ruptured ectopic pregnancy in non-communicating right rudimentary horn: A case report. APOLLO MEDICINE 2016. [DOI: 10.1016/j.apme.2013.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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14
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Ng ZY, Tan TY, Aggarwal IM. Laparoscopic Management of Rudimentary Horn Pregnancy: A Case Report and Review of the Literature. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zheng Yuan Ng
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tse Yeun Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ieera Madan Aggarwal
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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15
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Mishra N, Yadav N, Koshiya D, Jhanwar V. Ruptured rudimentary horn pregnancy with a history of an uneventful vaginal delivery. J Med Ultrason (2001) 2015; 42:117-20. [PMID: 26578500 DOI: 10.1007/s10396-014-0582-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 07/04/2014] [Indexed: 11/28/2022]
Abstract
Pregnancy in a rudimentary uterine horn is a rare event with an estimated incidence of 1 in 76,000 to 1 in 1,40,000 pregnancies. Unicornuate uterus with a rudimentary horn has a high incidence of obstetric and gynecological complications. Ruptured ectopic pregnancy in the rudimentary horn is one of the most dreaded complications, which can have grave consequences for both mother and fetus. In the majority of the cases, it is detected after rupture of the horn, usually during the first or second trimester of pregnancy. An ultrasonographic diagnosis made prior to rupture of the rudimentary horn may prevent this catastrophic outcome. We report a case of a G2 P1 L1 with a ruptured left rudimentary horn pregnancy at 16 weeks of gestation that was misdiagnosed as a pregnancy in the left uterine horn of a bicornuate uterus on prior prenatal ultrasound. The patient presented to our hospital with abdominal pain and vaginal bleeding. A diagnosis of ruptured left rudimentary horn pregnancy was made on the basis of emergency ultrasound and was later confirmed on laparotomy. The left rudimentary horn along with the ipsilateral fallopian tube was excised.
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Affiliation(s)
- Nitin Mishra
- Department of Radio-diagnosis, SMS Medical College and Hospitals, 65-A, Lane No. 3, Keshav Nagar, Civil Lines, Jaipur, Rajasthan, 302006, India.
| | - Nitin Yadav
- Department of Radio-diagnosis, SMS Medical College and Hospitals, 65-A, Lane No. 3, Keshav Nagar, Civil Lines, Jaipur, Rajasthan, 302006, India.
| | - Darshan Koshiya
- Department of Radio-diagnosis, SMS Medical College and Hospitals, 65-A, Lane No. 3, Keshav Nagar, Civil Lines, Jaipur, Rajasthan, 302006, India.
| | - Vikas Jhanwar
- Department of Radio-diagnosis, SMS Medical College and Hospitals, 65-A, Lane No. 3, Keshav Nagar, Civil Lines, Jaipur, Rajasthan, 302006, India.
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16
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Cheng C, Tang W, Zhang L, Luo M, Huang M, Wu X, Wan G. Unruptured pregnancy in a noncommunicating rudimentary horn at 37 weeks with a live fetus: a case report. J Biomed Res 2015; 29:83-6. [PMID: 25745480 PMCID: PMC4342440 DOI: 10.7555/jbr.29.20130089] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 08/15/2013] [Accepted: 12/04/2013] [Indexed: 11/29/2022] Open
Abstract
We report an extremely rare case of an unruptured non-communicating rudimentary horn full-term pregnancy. A woman who had a uterine malformation was misdiagnosed as uterus didelphys and gave birth to a live, healthy fetus. The correct diagnosis was not made until cesarean section at 37 4/7 weeks. The case suggests that women who are pregnant in a rudimentary horn could obtain a full-term delivery and give birth to a live and healthy baby.
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Affiliation(s)
- Chen Cheng
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Weiwei Tang
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Lei Zhang
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Mei Luo
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Meihua Huang
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Xiuling Wu
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
| | - Guiping Wan
- Laboratory of Gynecological Oncology, Jiangsu Province Hospital on Integration of Chinese and Western Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Nanjing, Jiangsu 210028, China
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Lennox G, Pantazi S, Keunen J, Van Mieghem T, Allen L. Minimally invasive surgical management of a second trimester pregnancy in a rudimentary uterine horn. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2013; 35:468-472. [PMID: 23756278 DOI: 10.1016/s1701-2163(15)30938-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Pregnancy in a rudimentary uterine horn is a rare form of ectopic pregnancy with a high risk of rupture. Management usually involves excision of the rudimentary horn. If diagnosed after the first trimester, it has been managed in the past by laparotomy. CASE A primigravid woman was found on routine ultrasound to have a rudimentary horn pregnancy. The diagnosis was confirmed on MRI, and a thin uterine wall was demonstrated. Management comprised fetal injection of potassium chloride followed by complete laparoscopic excision of the rudimentary horn at 16 weeks' gestation. CONCLUSION Laparoscopic management of a mid-trimester rudimentary horn pregnancy is feasible, but expert radiological characterization is required for optimal surgical planning.
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Affiliation(s)
- Genevieve Lennox
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON
| | - Sophia Pantazi
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Medical Imaging, Mount Sinai Hospital, Toronto ON
| | - Johannes Keunen
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
| | - Tim Van Mieghem
- Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
| | - Lisa Allen
- Department of Obstetrics and Gynaecology, University of Toronto, Toronto ON; Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto ON
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18
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An unexpected near term pregnancy in a rudimentary uterine horn. Case Rep Obstet Gynecol 2013; 2013:307828. [PMID: 23710390 PMCID: PMC3655492 DOI: 10.1155/2013/307828] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 04/09/2013] [Indexed: 11/21/2022] Open
Abstract
Unicornuate uterus occurs due to a complete or partial nondevelopment of one Mullerian duct; sometimes it is associated with a rudimentary horn, which can communicate or not with uterine cavity or contain functional endometrium.
Pregnancy in a rudimentary horn is rare and the outcome almost always unfavorable, usually ending in rupture during the first or second trimester with significant morbidity and mortality. Despite the availability and advances on imagiologic procedures, recognition of this ectopic pregnancy is frequently made at laparotomy after abdominal pain and collapse. The authors describe a case of a primigravida with 34 weeks of gestation admitted with a preeclampsia with severity criteria. A cesarean for fetal malpresentation was done and, unexpectedly, a rudimentary horn pregnancy was found with a live newborn. In the literature, few reports of a horn pregnancy reaching the viability with a live newborn are described, enhancing the clinical importance of this case. A review of literature concerning the epidemics, clinical presentation, and appropriate management of uterine horn pregnancies is made.
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19
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Hirose I, Harada K, Kuroda R, Ishii Y, Nakajima M, Kamei Y, Takazawa Y, Yoshida KI. An autopsy report on a ruptured rudimentary horn (uterine anomaly) with ectopic pregnancy. Forensic Sci Int 2013; 224:e4-6. [PMID: 23265443 DOI: 10.1016/j.forsciint.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/17/2012] [Accepted: 10/08/2012] [Indexed: 11/26/2022]
Abstract
The rudimentary horn is a rare developmental anomaly of the Müllerian duct. Ectopic pregnancy in the rudimentary horn is estimated to occur in one out of 76,000-150,000 pregnancies. A 30-year-old primigravida suddenly collapsed after 3 days of continuous abdominal pain. Emergency laparotomy revealed a massive intraperitoneal hemorrhage and fetal demise. The growth of the fetus after 19 weeks of gestation is believed to have caused the rudimentary horn rupture, thereby rapidly leading to hemorrhagic shock in the mother and ischemic death in the fetus. This is the first autopsy report on maternal death due to the rudimentary horn or other Müllerian duct anomalies, which emphasizes the need for forensic pathologists to consider this condition as a possible cause of unexpected death in fertile women. In addition, it is very important for clinicians to detect Müllerian duct anomalies by sonography during routine obstetric examinations, and promptly diagnose anomaly related ectopic pregnancies in women displaying symptoms of an acute abdomen, intraperitoneal hemorrhage, or shock in the emergency practice.
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Affiliation(s)
- Izumi Hirose
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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20
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Abstract
Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures. A case of undiagnosed rudimentary horn pregnancy at 22 weeks presented to Nizwa regional referral hospital in shock with features of acute abdomen. Chances of rupture in first or second trimester are increased with catastrophic haemorrhage leading to increased maternal and perinatal morbidity and mortality. Management of such cases is a challenge till today due to diagnostic dilemma. Expertise in ultrasonography and early resort to surgical management is life saving in such cases.
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Affiliation(s)
- Hansa Dhar
- Department of Obstetrics and Gynecology, Nizwa Hospital, Oman
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21
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Siwatch S, Mehra R, Pandher DK, Huria A. Rudimentary horn pregnancy: a 10-year experience and review of literature. Arch Gynecol Obstet 2012. [PMID: 23183713 DOI: 10.1007/s00404-012-2625-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Rudimentary horn pregnancy is rare, but can cause considerable morbidity and mortality. We discuss five cases presented to our hospital in the last 10 years and systematically review the 10-year literature of rudimentary horn pregnancies diagnosed antenatally pre-rupture. OBJECTIVES OF THE REVIEW The aim of the review was to find radiologic investigations/criteria to diagnose rudimentary horn pregnancy antenatally pre-rupture. SEARCH METHODS A systematic literature review was carried out in Pubmed search for rudimentary horn pregnancies. The radiologic findings of the cases diagnosed before rupture were analyzed. RESULTS Ultrasound is the most commonly used technique, though MRI seems to delineate details better. Non-continuity of the lumen of the cervix with the pregnant uterine horn is an important imaging finding. High clinical suspicion and radiologic skill for diagnosis are emphasized. CONCLUSIONS The review presents the existing imaging criteria to diagnose rudimentary horn pregnancy and suggests future research to enhance the limited evidence.
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Affiliation(s)
- Sujata Siwatch
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Sector-32, Chandigarh 160032, India.
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22
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Ruptured noncommunicating rudimentary horn pregnancy at 19 weeks with previous cesarean delivery: a case report. Case Rep Obstet Gynecol 2012; 2012:308476. [PMID: 23119197 PMCID: PMC3483705 DOI: 10.1155/2012/308476] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2012] [Accepted: 09/19/2012] [Indexed: 11/22/2022] Open
Abstract
Unicornuate uterus with noncommunicating rudimentary horn occurs due to incomplete fusion of mullerian ducts. Pregnancy in this horn is a rare phenomenon usually resulting in rupture during second trimester of pregnancy. Prerupture diagnosis of pregnancy in rudimentary horn with ultrasonography is technically difficult, with sensitivity of 30%. We report a case of ruptured non-communicating rudimentary horn at 19 weeks in a woman with previous Cesarean delivery. She had a routine malformation scan in which diagnosis was missed. Later she presented to emergency in shock, with massive hemoperitoneum and ruptured horn. So a high index of suspicion is required to save this catastrophic event and associated maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during nonpregnant state laparoscopically. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.
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23
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Veena P, Habeebullah S, Chaturvedula L. A review of 93 cases of ruptured uterus over a period of 2 years in a tertiary care hospital in South India. J OBSTET GYNAECOL 2012; 32:260-3. [PMID: 22369400 DOI: 10.3109/01443615.2011.638091] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This was a retrospective descriptive study carried out on cases in JIPMER between July 2008 and June 2010 among 32,080 deliveries. The study sample included 93 women who had a ruptured uterus. Outcome variables included maternal characteristics, risk factors, management and complications of ruptured uterus. The incidence of ruptured uterus was 0.28%. Most of these women were multiparous (95%), between 20 and 30 years (82%). The majority had a scarred uterus (77%) and 83% were at term gestation. Among women with a scarred uterus, 57 women (79%) had an unknown uterine scar type and 46 women (64%) had < 18 months' duration from the last caesarean section. A total of 37 women (39.7%) presented with ruptured uterus and a dead fetus. Out of 71 women with previous caesarean section, 46 women (49.4%) were allowed trial of scar and developed a ruptured uterus in hospital. Among women with unscarred uterus, 14 presented with rupture and seven of these women were induced in hospital. Out of the 93 cases, 87% were managed with uterine repair and 12 women underwent hysterectomy. A total of 31 babies were born with good Apgar scores; 48 babies were stillborn. We conclude that the strongest association of ruptured uterus was with previous scarred uterus, multiparity and < 18 months' duration from the last caesarean section. There were no maternal deaths. Maternal morbidity was seen in 17% of cases. Perinatal mortality was 60.6%. As a result of the study, we have implemented changes to improve patients' care.
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Affiliation(s)
- P Veena
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
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24
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Hassan CHC, Karim AKA, Ismail NAM, Omar MH. Case report of ruptured non-communicating right rudimentary horn pregnancy: an acute emergency. ACTA MEDICA (HRADEC KRÁLOVÉ) 2012; 54:125-6. [PMID: 22250483 DOI: 10.14712/18059694.2016.34] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Ruptured pregnancy in the rudimentary horn of women who have had a vaginal delivery is rare and unpredictable. However, when undiagnosed, this condition could lead to maternal morbidity and mortality. We report a pregnancy at 19 weeks gestation presented with acute abdomen and hypovolemic shock. She was initially thought to have an intrauterine pregnancy with the provisional diagnosis of a ruptured uterus. Intraoperatively, a ruptured non-communicating right rudimentary horn with ex utero pregnancy was discovered.
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Affiliation(s)
- Che Hasnura Che Hassan
- Department of Obstetrics & Gynaecology, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia
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25
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26
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van Esch EMG, Lashley EELO, Berning B, de Kroon CD. The value of hysteroscopy in the diagnostic approach to a rudimentary horn pregnancy. BMJ Case Rep 2010; 2010:2010/dec17_1/bcr0820103229. [PMID: 22802375 DOI: 10.1136/bcr.08.2010.3229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old woman presented with an ectopic pregnancy without any complaints. Laparoscopy was performed since a tubal pregnancy was expected. However, both fallopian tubes appeared normal and it was not possible to differentiate accurately between a pregnancy in a non-communicating horn and a pregnancy in a bicornuate uterus. We therefore performed MRI which showed a thin myometrium around the pregnancy. In order to differentiate between a communicating and a non-communicating uterine horn the authors performed a hysteroscopy. Since there was only one cervical os, and an entrance to the second uterine cavity was not seen along the cervical canal, it was concluded that this pregnancy was situated in a non-communicating rudimentary horn. The non-communicating uterine horn, with the pregnancy in situ, was completely removed. Since a pregnancy in a bicornuate uterus is viable in contrast to a pregnancy in a non-communicating horn, accurate diagnosis is important.
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Affiliation(s)
- E M G van Esch
- Department of Gynecology, Bronovo Hospital, The Hague, The Netherlands
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27
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Siristatidis C, Chrelias C, Kassanos D. Rudimentary-horn pregnancy: some points to review. Arch Gynecol Obstet 2010; 283:917-8. [PMID: 20830482 DOI: 10.1007/s00404-010-1658-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Accepted: 08/16/2010] [Indexed: 10/19/2022]
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28
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Walid MS, Heaton RL. Diagnosis and laparoscopic treatment of cornual ectopic pregnancy. GERMAN MEDICAL SCIENCE : GMS E-JOURNAL 2010; 8. [PMID: 20725587 PMCID: PMC2921813 DOI: 10.3205/000105] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Revised: 05/29/2010] [Indexed: 11/30/2022]
Abstract
Cornual (interstitial) ectopic pregnancy is an uncommon variant of ectopic pregnancy which often poses a diagnostic and therapeutic challenge with a significant risk of rupturing and bleeding. We present a ruptured right cornual pregnancy and explain how to deal with such a case laparoscopically.
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Affiliation(s)
- M Sami Walid
- Medical Center of Central Georgia, Macon, GA 31201, USA.
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29
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Rudimentary horn pregnancy with herniation into the main uterine cavity. Am J Obstet Gynecol 2010; 202:e5-6. [PMID: 20207232 DOI: 10.1016/j.ajog.2009.12.011] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 12/07/2009] [Indexed: 11/23/2022]
Abstract
We report a case of a rudimentary horn pregnancy with herniation of a fetal arm and umbilical cord into the main uterine cavity that presented as an incidental finding on a routine second-trimester ultrasound scan. We also review the literature that guides the diagnosis and management of these rare complicated pregnancies.
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30
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Failure of prostaglandin induction labor in a Müllerian abnormality. Arch Gynecol Obstet 2010; 282:143-7. [PMID: 20182737 DOI: 10.1007/s00404-010-1361-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2009] [Accepted: 01/07/2010] [Indexed: 10/19/2022]
Abstract
Rudimentary-horn pregnancy (RHP) is a rare condition which is usually presented as a rupture of the pregnant horn during the second or third trimester, resulting in life-threatening bleeding. The authors report two cases of RHP which were diagnosed at the time of labor induction following fetal death diagnosis. Although the failure of prostaglandin induction to initiate labor could suggest that an additional obstructive Müllerian uterine anomaly is present, a directed investigation of such anomaly is more acceptable in cases of antepartum fetal death or atypical mid-trimester abdominal pain. Therefore, a high index of suspicion combined with clinical and imagiological findings are important to establish a correct diagnosis of pre-rupture RHP.
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