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Zheng X, Zhou Y, Sun Z, Yan T, Yang Y, Wang R. Abdominal pregnancy secondary to uterine horn pregnancy: a case report. BMC Pregnancy Childbirth 2023; 23:412. [PMID: 37270533 DOI: 10.1186/s12884-023-05704-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/15/2023] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND Pregnancy begins with a fertilized ovum that normally attaches to the uterine endometrium. However, an ectopic pregnancy can occur when a fertilized egg implants and grows outside the uterine cavity. Tubal ectopic pregnancy is the most common type (over 95%), with ovarian, abdominal, cervical, broad ligament, and uterine cornual pregnancy being less common. As more cases of ectopic pregnancy are diagnosed and treated in the early stages, the survival rate and fertility retention significantly improve. However, complications of abdominal pregnancy can sometimes be life-threatening and have severe consequences. CASE PRESENTATION We present a case of intraperitoneal ectopic pregnancy with fetal survival. Ultrasound and magnetic resonance imaging showed a right cornual pregnancy with a secondary abdominal pregnancy. In September 2021, we performed an emergency laparotomy, along with additional procedures such as transurethral ureteroscopy, double J-stent placement, abdominal fetal removal, placentectomy, repair of the right uterine horn, and pelvic adhesiolysis, in the 29th week of pregnancy. During laparotomy, we diagnosed abdominal pregnancy secondary to a rudimentary uterine horn. The mother and her baby were discharged eight days and 41 days, respectively, after surgery. CONCLUSIONS Abdominal pregnancy is a rare condition. The variable nature of ectopic pregnancy can cause delays in timely diagnosis, resulting in increased morbidity and mortality, especially in areas with inadequate medical and social services. A high index of suspicion, coupled with appropriate imaging studies, can help facilitate its diagnosis in any suspected case.
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Affiliation(s)
- Xingju Zheng
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yao Zhou
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Zhucheng Sun
- Department of Vascular Surgery, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Ting Yan
- Department of Gynecology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Yan Yang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Rongpin Wang
- Department of Radiology, Guizhou Provincial People's Hospital, Guiyang, 550002, China.
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Sarikaya S, Aybay MN. Uterine rupture of a patient with rudimentary horn pregnancy at 26th gestational weeks. Int J Surg Case Rep 2022; 94:107003. [PMID: 35405513 PMCID: PMC9006326 DOI: 10.1016/j.ijscr.2022.107003] [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: 01/13/2022] [Revised: 03/27/2022] [Accepted: 03/27/2022] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Pregnancy of Rudimentary Horn is a type of ectopic pregnancy, that is recognized almost always during surgical treatment of a rupture of the rudimentary horn. This is an obstetric case diagnosed preoperatively by magnetic resonance imaging (MRI). Case presentation We report the case of a 19-years-old primigravida patient with rupture of rudimentary horn in 26th gestational week. The patient presented with sudden onset severe abdominal pain in the emergency room. Intraabdominal free fluid is detected. To evaluate the etiology of free fluid and location of the gestational sac, an abdominal magnetic resonance imaging (MRI) scan was planned. The decision of emergent laparotomy is made because of sonographic detection of abdominal excessive -concentrated- free fluid, abdominal tenderness, and 2 points decrease of hemoglobin value in the control hemogram. A rudimentary horn pregnancy and fundal rupture of the rudimentary part of the uterus are diagnosed during the surgical procedure. A baby -live- weighing 450 g was delivered. The ruptured rudimentary horn and same-sided tuba uterina were surgically removed. Clinical discussion Rudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Identifying both cornuas systematically in all patients increases the detection rate. The absence of continuity between the gestational sac's lumen and the cervical canal on imaging is an important finding. Conclusion Due to the serious maternal and fetal complications, its detection at an early week may be life-saving. The unicornuate uterus is formed as a result of failure in development and elongation of müllerian duct during embryogenesis. Pregnancy in rudimentary horns can reach different gestational weeks in patients, depending on the muscular structures of the rudimentary horns. MR allows accurate classification of unicornuate uterus. At MR imaging, the small, curved unicornuate uterus is typically displaced off midline. Rudimentary horn pregnancy is a rare ectopic pregnancy. Diagnosis is difficult clinically, even with diagnostic imaging modalities. Due to the serious maternal and fetal complications, its detection at an early week may be life-saving.
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Affiliation(s)
- Sevcan Sarikaya
- Department of Obstetrics and Gynecology, Mardin State Hospital, Mardin, Turkey.
| | - Muhsin Nuh Aybay
- Department of Radiology, Private Doruk Yildirim Hospital, Bursa, Turkey
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3
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Gitas G, Eckhoff K, Rody A, Ertan AK, Baum S, Hoffmans E, Alkatout I. An unprecedented occult non-communicating rudimentary uterine horn treated with laparoscopic excision and preservation of both fallopian tubes: a case report and review of the literature. J Med Case Rep 2021; 15:51. [PMID: 33536066 PMCID: PMC7860579 DOI: 10.1186/s13256-020-02636-x] [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] [Received: 12/27/2019] [Accepted: 12/15/2020] [Indexed: 11/10/2022] Open
Abstract
Background Müllerian duct anomalies are congenital malformations of the female genital tract and may be of various types. For decades they have been classified according to the American Society of Reproductive Medicine, which mentions unicornuate uterine malformations as the second subgroup. They result from the arrested development of one of the Müllerian ducts and appear in approximately 1/1000 women. These anomalies are usually diagnosed in the second decade of life, because they tend to remain asymptomatic until adolescence and their initial symptoms may vary. Patients present with symptoms such as dysmenorrhea, infertility, and chronic or acute abdominal pain. Case presentation We report on a 21-year-old Caucasian German patient who suffered from dysmenorrhea for 7 years. After a transvaginal ultrasound and magnetic resonance tomography of the pelvis was performed, the patient underwent a diagnostic hysteroscopy and operative laparoscopy, and was finally diagnosed with a Müllerian duct anomaly presenting with a non-communicating rudimentary uterine horn. The left tube arose directly in orthotopic location from the cornua of uterus, with no connection to the rudimentary uterine horn or structure. Conclusion The anatomic features of this case have not been reported previously and were not consistent with any existing classification. More cases are needed in order to confirm our hypothesis. Gynecologists should always consider Müllerian anomalies as an important differential diagnosis in young patients with abdominal pain.
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Affiliation(s)
- G Gitas
- Department of Obstetrics and Gynecology, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany.
| | - K Eckhoff
- Department of Obstetrics and Gynecology, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - A Rody
- Department of Obstetrics and Gynecology, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - A K Ertan
- Department of Obstetrics and Gynecology, Leverkusen Municipality Hospital, Leverkusen, Germany
| | - S Baum
- Department of Obstetrics and Gynecology, University Hospitals Schleswig Holstein, Campus Luebeck, Ratzeburger Allee 160, Haus A, 23538, Luebeck, Germany
| | - E Hoffmans
- Department of Obstetrics and Gynecology, Leverkusen Municipality Hospital, Leverkusen, Germany
| | - I Alkatout
- Department of Obstetrics and Gynecology, University Hospitals Schleswig Holstein, Campus Kiel, Kiel, Germany
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4
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Chatziioannidou K, Fehlmann A, Dubuisson J. Case Report: Laparoscopic Management of an Ectopic Pregnancy in a Rudimentary Non-communicating Uterine Horn. Front Surg 2020; 7:582954. [PMID: 33240926 PMCID: PMC7667194 DOI: 10.3389/fsurg.2020.582954] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 09/22/2020] [Indexed: 11/17/2022] Open
Abstract
Introduction: Ectopic pregnancy in a non-communicating rudimentary uterine horn is a rare gynecological condition associated with a high risk of uterine rupture and important maternal mortality and morbidity. A surgical excision of the rudimentary horn is the standard treatment, usually performed by laparotomy in the second trimester. Methods: A 36-year-old woman, secundigravida and nulliparous, was admitted to the emergency obstetric unit with acute pelvic pain. The ultrasound found an ectopic pregnancy at 15 weeks gestational age with fetal cardiac activity. As her hemodynamic status was stable, a diagnostic laparoscopy was performed and confirmed the development of the pregnancy in a left rudimentary uterine horn. Results: We report a total laparoscopic removal of a pre-ruptured rudimentary uterine horn containing a second trimester ectopic pregnancy, using a vessel-sealer device. To our knowledge, only three other cases of successful laparoscopic treatment of second trimester rudimentary horn pregnancies have been reported in the literature. Conclusion: Laparoscopy is an efficient and safe surgical option for treating rudimentary horn second trimester pregnancy in patients with hemodynamic stability.
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Affiliation(s)
- Kyriaki Chatziioannidou
- Department of Paediatrics, Gynaecology, and Obstetrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Aurore Fehlmann
- Department of Paediatrics, Gynaecology, and Obstetrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Jean Dubuisson
- Department of Paediatrics, Gynaecology, and Obstetrics, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Bruand M, Thubert T, Winer N, Gueudry P, Dochez V. Rupture of Non-communicating Rudimentary Horn of Uterus at 12 Weeks' Gestation. Cureus 2020; 12:e7191. [PMID: 32269871 PMCID: PMC7135721 DOI: 10.7759/cureus.7191] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The rudimentary horn of uterus is an extremely rare malformation and potentially serious obstetric entity, threatening maternal and fetal outcome. Diagnostic sonography of early pregnancy in a non-communicating rudimentary horn is difficult but important. We report a case of ruptured non-communicating rudimentary horn with unicornuate uterus at 12 weeks’ gestation, where diagnosis is made before surgery. Excision of the rudimentary horn and ipsilateral salpingectomy (to prevent a further ectopic tubal gestation), conserving the ovary, is the recommended surgical procedure for patients desiring to maintain their fertility potential. The subsequent obstetric prognosis is reassuring. Diagnostic imaging examinations of the reproductive system after this treatment showed no negative effect from surgery on subsequent fertility and there was no reported case of uterine rupture during subsequent pregnancy in the remaining unicornuate uterus after rudimentary horn excision. Future pregnancies will require extremely close monitoring and a caesarean section is highly recommended.
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Affiliation(s)
- Mariette Bruand
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
| | - Thibault Thubert
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
| | - Norbert Winer
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
| | - Pauline Gueudry
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
| | - Vincent Dochez
- Obstetrics and Gynecology, Centre Hospitalier Universitaire de Nantes, Nantes, FRA
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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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Sawada M, Kakigano A, Matsuzaki S, Takiuchi T, Mimura K, Kumasawa K, Endo M, Ueda Y, Yoshino K, Kimura T. Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn. J Obstet Gynaecol Res 2018. [PMID: 29516633 DOI: 10.1111/jog.13622] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Previous studies have shown adverse obstetric outcomes of the laparoscopic resection of a rudimentary horn. Our study aimed to investigate the obstetric outcome in our institution and to review previous studies. METHODS Using a retrospective analysis, data were reviewed from singleton pregnancies with maternal uterine anomalies at a medical center in Osaka, Japan, between January 2011 and March 2016. The uterine anomaly cases were divided into a 'postlaparoscopic resection of the rudimentary horn' group (study group) and an 'other uterine anomalies' (bicornuate uterus, uterine didelphys and unicornuate uterus) group (control group). Primary outcomes of interest were differences in obstetric outcomes, such as spontaneous preterm birth rate, small for gestational age (SGA) infant rate and hypertensive disorders of pregnancy (HDP) rate between the study and the control group, and the secondary outcome of interest was mode of delivery in the study group. RESULTS Data from 40 deliveries were included in the study (7 deliveries: study group, 33 deliveries: control group). No significant difference was observed between the two groups in terms of either mean gestational weeks at delivery (36.4 weeks vs 37.1 weeks; P = .38), cesarean delivery rate (57.1% vs 57.5%; P = 1.0), SGA infant rate (<10th percentile) (0% vs 24.2%; P = .31) and HDP rate (0.0% vs 3.0%; P = 1.0). Three of seven cases with postlaparoscopic resection of the rudimentary horn were able to deliver vaginally without complications. CONCLUSION Our study shows that the obstetric outcome observed in the study group was similar to that observed in the control group.
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Affiliation(s)
- Masaaki Sawada
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Shinya Matsuzaki
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tsuyoshi Takiuchi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Keiichi Kumasawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Yutaka Ueda
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kiyoshi Yoshino
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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8
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Kaveh M, Mehdizadeh Kashi A, Sadegi K, Forghani F. Pregnancy in Non-Communicating Rudimentary Horn of A Unicornuate Uterus. INTERNATIONAL JOURNAL OF FERTILITY & STERILITY 2017; 11:318-320. [PMID: 29043710 PMCID: PMC5641466 DOI: 10.22074/ijfs.2018.5022] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 05/14/2017] [Indexed: 12/04/2022]
Abstract
Diagnosis and management of pre-rupture stage of the pregnant horn are difficult and usually missed on a routine ul-
trasound scan. Also most cases are detected after rupture of pregnant horn. We presented a 28-year-oldG2 L1 woman
with diagnosis of rudimentary horn pregnancy (RHP) at 14 weeks of gestation. We diagnosed her with a normal
intrauterine pregnancy, whereas a pregnancy in a right-sided non-communicating rudimentary horn with massive he-
moperitoneum was later discovered on laparotomy. RHP has a high risk of death for mother, so there must be a strong
clinical suspicion for the diagnosis of RHP. Although there is a major advancement in field of diagnostic ultrasound
and other imaging modalities, prenatal diagnosis has remained elusive and a laparotomy surgery is considered as a
definitive diagnosis.
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Affiliation(s)
- Mania Kaveh
- Endometriosis and Gynecological Disorder Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran
| | - Abolfazl Mehdizadeh Kashi
- Endometriosis and Gynecological Disorder Research Center, Iran University of Medical Science, Tehran, Iran
| | - Kambiz Sadegi
- Pain Research Center, Iran University of Medical Science, Tehran, Iran.,Department of Anesthesiology, Zabol University of Medical Science, Zabol, Iran
| | - Forough Forghani
- Department of Obstetrics and Gynecology, Zabol University of Medical Science, Zabol, Iran.
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9
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Xia EL, Li TC, Choi SNS, Zhou QY. Reproductive Outcome of Transcervical Uterine Incision in Unicornuate Uterus. Chin Med J (Engl) 2017; 130:256-261. [PMID: 28139506 PMCID: PMC5308005 DOI: 10.4103/0366-6999.198919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: The pregnancy outcome of the unicornuate uterus is associated with an increased risk of miscarriage, cervical incompetence, and a number of obstetric complications. However, at present, there is no accepted treatment method for women with unicornuate uterus, other than expectant measures. The aim of this study was to evaluate the reproductive outcome of transcervical uterine incision (TCUI) in patients with unicornuate uterus. Methods: Thirty-three patients with unicornuate uterus presented to our tertiary center for infertility or miscarriage. All 33 patients underwent TCUI and were followed up for 10–52 months. The pregnancy outcomes (first-trimester miscarriage, second-trimester miscarriage, preterm, term, intrauterine death, ongoing pregnancy, and live birth) before and after TCUI were compared by t-test. Results: Among 31 patients who attempted to conceive after TCUI, twenty conceived including one termination of pregnancy, one second-trimester miscarriage, one ectopic pregnancy, five preterm deliveries, 11 term delivery, and one ongoing pregnancy. There were 16 live births in total. There was significant reduction in the first-trimester miscarriage rate (t = 4.890; P < 0.001), increase in term delivery (t = −3.288; P = 0.002), and live birth rates (t = −4.073; P < 0.001) after TCUI. Conclusion: TCUI appeared to improve the pregnancy outcome in women with unicornuate uterus presenting with infertility or miscarriage.
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Affiliation(s)
- En-Lan Xia
- Hysteroscopic Center, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
| | - Tin-Chiu Li
- Department of Obstetrics and Gynaecology, Prince of Wales Hospital, Hong Kong 999077, China
| | - Sze-Ngar Sylvia Choi
- Department of Obstetrics and Gynaecology, United Christian Hospital, Hong Kong 999077, China
| | - Qiao-Yun Zhou
- Hysteroscopic Center, Fu Xing Hospital, Capital Medical University, Beijing 100038, China
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10
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Abstract
Rudimentary horn could be a rare congenital uterine anomalies result from incomplete fusion of the 2 Müllerian ducts throughout embryo-genesis. Pregnancy in an exceedingly rudimentary horn is rare and typically terminates in rupture throughout the late of first or second trimester of pregnancy. We tend to present a rare case of a gravida within the trimester (31 weeks) presented with complain of abdominal pain, nausea, and vomit for 3 days. On presentation, the patient was pale and irritable. Ultrasound scan showed fetus at (30 weeks) with cardiac activity. Cardiotocography reactive. Incision showed horned uterus with pregnancy in rudimentary left horn that was ruptured. Alive fetus was delivered. The rudimentary left horn was excised. The patient was advised to not get pregnant for 3 years. Within one year, the patient came to hospital in active labor at (37 weeks). This case emphasizes the importance of fine antepartum care to avoid morbidity and mortality.
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Affiliation(s)
- Abdullah A Al Qarni
- Department of Obstetrics and Gynecology, Al Yamamah Hospital, Riyadh, Kingdom of Saudi Arabia. E-mail.
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11
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Unruptured Pregnancy in Rudimentary Horn Presenting as Hemoperitoneum. J Obstet Gynaecol India 2016; 66:626-628. [DOI: 10.1007/s13224-016-0891-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Accepted: 04/12/2016] [Indexed: 11/26/2022] Open
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12
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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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13
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Mamouni N, Ghazal N, Erraghay S, Bouchikhi C, Banani A. [Rudimentary horn pregnancy diagnostic: difficulties and therapeutic management]. Pan Afr Med J 2016; 24:14. [PMID: 27583078 PMCID: PMC4992385 DOI: 10.11604/pamj.2016.24.14.6659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 10/14/2015] [Indexed: 12/04/2022] Open
Abstract
The occurrence of rudimentary horn pregnancy is an extremely rare and potentially serious obstetric entity, threatening maternal and fetal outcome. The authors report five cases of rudimentary horn pregnancy, the difficulties in making a proper diagnosis and the therapeutic management of this pathological entity, stressing the importance of transvaginal ultrasound, of pelvic MRI and laparoscopy in the early diagnosis of this type of uterine malformation.
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Affiliation(s)
- Nisrine Mamouni
- Service de Gynécologie-Obstétrique I, CHU Hassan II, Fès, Maroc
| | - Nabil Ghazal
- Service de Gynécologie-Obstétrique I, CHU Hassan II, Fès, Maroc
| | - Sanaa Erraghay
- Service de Gynécologie-Obstétrique I, CHU Hassan II, Fès, Maroc
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14
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Ruptured rudimentary horn pregnancy at 25 weeks with previous vaginal delivery: a case report. Case Rep Obstet Gynecol 2012; 2012:985076. [PMID: 22720180 PMCID: PMC3375039 DOI: 10.1155/2012/985076] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2012] [Accepted: 04/28/2012] [Indexed: 11/26/2022] Open
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.
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15
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Sagili H, Rani PR, Najundan P. Ruptured Rudimentary Horn Pregnancy: A Diagnostic Dilemma and Management. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0108] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Haritha Sagili
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - P. Reddi Rani
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
| | - Pramya Najundan
- Department of Obstetrics and Gynaecology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, India
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Sharma D, Usha MG, Gaikwad R, Sudha S. Laparoscopic Resection of Unruptured Rudimentary Horn Pregnancy. JOURNAL OF GYNECOLOGICAL ENDOSCOPY AND SURGERY 2011; 2:101-4. [PMID: 26085754 PMCID: PMC4453207 DOI: 10.4103/0974-1216.114161] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A non-communicating rudimentary horn is an uncommon site for ectopic pregnancy. Rudimentary horn pregnancy (RHP) is a rare entity but associated with grave clinical consequences. Majority of these cases if not detected timely end up in uterine rupture and present as an obstetrical emergency. We present this case of a 32-year-old, third gravida with a 12 weeks live gestation in the right rudimentary horn, which was successfully managed with laparoscopic resection. Early diagnosis is the key stone in the management of such cases. Laparoscopic resection is a safe and viable option in the surgical management of unruptured RHP.
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Affiliation(s)
- Deepti Sharma
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - M G Usha
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - Ramesh Gaikwad
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
| | - S Sudha
- Department of Obstetrics and Gynecology, Amrita Institute of Medical Sciences, Kochi, Kerala, India
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17
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Liatsikos SA, Tsikouras P, Souftas V, Ammari A, Prassopoulos P, Maroulis G, Liberis V. Diagnosis and laparoscopic management of a rudimentary uterine horn in a teenage girl, presenting with haematometra and severe endometriosis: our experience and review of literature. MINIM INVASIV THER 2011; 19:241-7. [PMID: 20367539 DOI: 10.3109/13645701003644491] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A unicornuate uterus is a rare congenital malformation of the female genital tract, which appears in about 1/1000 women and is characterized by significant anatomic variability. In the most common type, a noncommunicating rudimentary horn coexists with the unicornuate uterus. The diagnosis of this anomaly is usually delayed, as it remains asymptomatic until adolescence and its initial symptoms are atypical. As a result, it is often diagnosed after the appearance of severe complications, such as haematometra, endometriosis, infertility and ectopic pregnancy. We report a case of a teenage girl presenting with dysmenorrhoea, endometriosis and haematometra secondary to a noncommunicating rudimentary horn. The diagnosis of the anomaly was based on magnetic resonance imaging (MRI) and laparoscopy. The excision of the symptomatic rudimentary horn and the ipsilateral fallopian tube was also performed laparoscopically. A review of the literature follows, focusing mainly on the diagnosis and laparoscopic management of a unicornuate uterus and its complications in adolescence. Laparoscopy is an accurate diagnostic tool, which also carries significant advantages in effective surgical management of congenital uterine anomalies, especially in young women.
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Affiliation(s)
- Spiros A Liatsikos
- Department of Obstetrics and Gynecology, Democritus University of Thrace, Greece
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18
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Medeiros LR, Rosa DD, Silva FR, Silva BR, Rosa MI. Laparoscopic approach of a unicornuate uterus with noncommunicating rudimentary horns. ISRN OBSTETRICS AND GYNECOLOGY 2010; 2011:906138. [PMID: 21647229 PMCID: PMC3101792 DOI: 10.5402/2011/906138] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Accepted: 09/21/2010] [Indexed: 11/23/2022]
Abstract
Background. Müllerian duct malformations delineate a miscellaneous group of congenital anomalies that result from arrested development, abnormal formation, or incomplete fusion of the mesonephric ducts.
Case. This paper describes the diagnosis and management of a noncommunicating rudimentary horn complicated by severe pelvic pain and associated endometriosis. Conclusion. This condition was diagnosed by laparoscopy and hysteroscopy examination. Operative videolaparoscopy proved to be a successful approach for the treatment of this congenital Müllerian anomaly.
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Affiliation(s)
- Lidia Rosi Medeiros
- Departament of Gynecologic Surgery, Hospital Mãe de Deus, José de Alencar 1244 apt 1009, Porto Alegre 90880-480, RS, Brazil
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19
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Shahid A, Olowu O, Kandasamy G, O'Donnell C, Odejinmi F. Laparoscopic management of a 16-week ruptured rudimentary horn pregnancy: a case and literature review. Arch Gynecol Obstet 2009; 282:121-5. [PMID: 19705138 DOI: 10.1007/s00404-009-1212-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 08/10/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pregnancy in a rudimentary horn is although rare, but is associated with the risk of rupture and life threatening hemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of the rudimentary horn along with the pregnancy and the ipsilateral tube, traditionally by laparotomy. MATERIALS AND METHODS We present a case of a 16-week ruptured rudimentary horn pregnancy diagnosed intraoperatively and managed laparoscopically in the presence of massive haemoperitoneum, which is first of its kind along with literature review. CONCLUSION This case demonstrates that laparoscopy is a feasible approach and can provide rapid diagnosis and control of bleeding in such cases provided there is availability of efficient multi-disciplinary teamwork, optimal anesthesia, advanced cardiovascular monitoring, laparoscopic expertise and ability to convert rapidly to laparotomy if required.
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Affiliation(s)
- Anupama Shahid
- Department of Obstetrics and Gynecology, Whipps Cross University Hospital, London E11 1NR, UK
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20
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Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 2009; 91:1886-94. [PMID: 18439594 DOI: 10.1016/j.fertnstert.2008.02.163] [Citation(s) in RCA: 110] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2007] [Revised: 02/20/2008] [Accepted: 02/20/2008] [Indexed: 11/24/2022]
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21
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Szabó I, Börzsönyi B, Demendi C, Langmár Z. [Successful laparoscopic management of a non-communicating rudimentary horn pregnancy]. Orv Hetil 2009; 150:513-5. [PMID: 19258247 DOI: 10.1556/oh.2009.28521] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Pregnancy in a rudimentary horn is a rare entity with the most significant risk of life-threatening intraabdominal bleeding caused by rupture. With the use of vaginal ultrasonography, an early diagnosis can be made before symptoms occur. Management consists of laparoscopic resection of the rudimentary horn with the pregnancy and the ipsilateral tube. Authors present a case of a 9-week pregnancy successfully treated with laparoscopic resection.
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Affiliation(s)
- István Szabó
- Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Szülészeti és Nogyógyászati Klinika, Budapest Ulloi út 78/A 1082
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22
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Contreras KR, Rothenberg JM, Kominiarek MA, Raff GJ. Hand-assisted Laparoscopic Management of a Midtrimester Rudimentary Horn Pregnancy with Placenta Increta: A Case Report and Literature Review. J Minim Invasive Gynecol 2008; 15:644-8. [DOI: 10.1016/j.jmig.2008.06.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2008] [Revised: 06/08/2008] [Accepted: 06/12/2008] [Indexed: 11/30/2022]
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23
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Kadan Y, Romano S. Rudimentary horn pregnancy diagnosed by ultrasound and treated by laparoscopy--a case report and review of the literature. J Minim Invasive Gynecol 2008; 15:527-30. [PMID: 18619925 DOI: 10.1016/j.jmig.2008.05.010] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Revised: 05/22/2008] [Accepted: 05/24/2008] [Indexed: 11/27/2022]
Abstract
Pregnancy in a rudimentary horn occurs once in 76,000 pregnancies. The most significant threat of pregnancy in a rudimentary horn is the risk of rupture. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of the rudimentary horn with the pregnancy and the ipsilateral tube, traditionally by laparotomy. We present a case of an 11-week pregnancy in a rudimentary horn with a nonviable fetus diagnosed by ultrasound and treated with laparoscopic resection. Review of the literature revealed 11 cases treated successfully with laparoscopic surgery. Laparoscopic treatment should be considered for pregnancy in rudimentary horn during the first trimester.
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Affiliation(s)
- Yfat Kadan
- Department of Obstetrics and Gynecology, Ha'Emek Medical Center, Afula, Israel.
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24
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Schmied R, Sentilhes L, Baron M, Grzegorczyk V, Resch B, Marpeau L. [Recurrence of a rudimentary uterine horn rupture at 25 weeks of gestation: a case report]. ACTA ACUST UNITED AC 2008; 36:296-8. [PMID: 18308608 DOI: 10.1016/j.gyobfe.2007.11.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2007] [Accepted: 11/05/2007] [Indexed: 11/30/2022]
Abstract
Pregnancy in a rudimentary uterine horn is a rare event which can be revealed by uterine rupture. Following the fetal extraction, some authors recommend the ablation of the rudimentary horn, in order to limit the risk of uterine rupture in case of subsequent pregnancy in the same horn. We report the obstetrical outcome of a patient with a history of rudimentary uterine horn rupture the treatment of which was conservative.
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Affiliation(s)
- R Schmied
- Service de gynécologie-obstétrique, clinique gynécologique et obstétricale, pavillon Mère-Enfant, hôpital Charles-Nicolle, CHU de Rouen, 1 rue de Germont, Rouen cedex, France
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25
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Errarhay S, Mahmoud S, Bouchikhi C, Châara H, Bouguern H, Melhouf M, Banani A. Recurrence of Uterine Rupture in a Pseudo-Unicornuate Uterus at 17 Weeks of Amenorrhea: Case Report and Literature Review. Libyan J Med 2008. [DOI: 10.3402/ljm.v4i1.4806] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- S. Errarhay
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - S. Mahmoud
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - C. Bouchikhi
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - H. Châara
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - H. Bouguern
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - M.A. Melhouf
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
| | - A. Banani
- Department for Gynecology and Obstetrics, Faculty of Medicine and Pharmacy, University Hospital of Fez, Morocco
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26
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Giraudet G, Mubiayi N, Nayama M, Le Goueff F, Therby D. [Uterine horn rupture at 23 weeks gestation: a case report]. ACTA ACUST UNITED AC 2007; 35:826-8. [PMID: 17151541 DOI: 10.1016/s0368-2315(06)76487-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Bicornuate uterus with rudimentary horn is a rare disability. Pregnancy can accidentally settle inside the rudimentary horn; in this case, it becomes apparent by uterine rupture generally in the second trimester. Bicornuate uterus should be diagnosed early, before pregnancy if possible. Abdominal pain of unknown origin occurring during the second trimester of pregnancy is the most frequent sign.
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Affiliation(s)
- G Giraudet
- Service de Gynécologie Obstétrique, Pavillon Paul-Gellé, Centre Hospitalier de Roubaix, 91, avenue Julien-Lagache, 59100 Roubaix
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27
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Jayasinghe Y, Rane A, Stalewski H, Grover S. The Presentation and Early Diagnosis of the Rudimentary Uterine Horn. Obstet Gynecol 2005; 105:1456-67. [PMID: 15932844 DOI: 10.1097/01.aog.0000161321.94364.56] [Citation(s) in RCA: 140] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The key to successful management of the rudimentary uterine horn is early detection. This review of the literature seeks to illustrate important aspects of diagnosis and management of this anomaly. DATA SOURCES An English language MEDLINE search from 1966 to 2003 was performed, using the search terms "rudimentary uterine horn," "accessory horn," "uterus bicornis unicollis," "hematometra," "unicornuate or bicornuate uterus," and "mullerian anomaly." References from previously published sources were also obtained. METHODS OF STUDY SELECTION One hundred thirty letters, case reports, case series, and review articles featuring rudimentary uterine horn were found. Reports before 1966 were excluded because outcomes before the advent of modern diagnostic techniques were not relevant to this study. TABULATION, INTEGRATION, AND RESULTS Three hundred sixty-six rudimentary horn presentations (210 gynecologic and 156 obstetric) were found. Noncommunicating horns accounted for 92% of cases (95% confidence interval [CI] 88-95%, P < .001), and renal anomaly was found in 36% (95% CI 29-44%). Contrary to the American Fertility Society classification of uterine anomalies, rudimentary horns may occur without a corresponding unicornuate uterus. The mean age of presentation was similar for gynecologic and obstetric presentations (23 and 26 years, 95% CIs 21.2-24.6 and 124.9-27.3 years, respectively). Presentation in the third decade of life or later occurred in 78% of patients (95% CI 70-84%, P < .001). Sensitivity of ultrasound examination for diagnosis was 26% (95% CI 18-36%). Diagnosis before clinical symptoms occurred in 14% (95% CI 7-23%). CONCLUSION Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.
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Affiliation(s)
- Yasmin Jayasinghe
- Department of Paediatric and Adolescent Gynaecology, Royal Children's Hospital, Melbourne, Australia.
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28
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Tsafrir A, Rojansky N, Sela HY, Gomori JM, Nadjari M. Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2005; 24:219-223. [PMID: 15661954 DOI: 10.7863/jum.2005.24.2.219] [Citation(s) in RCA: 91] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
OBJECTIVE Two cases of rudimentary horn pregnancy diagnosed in the first trimester by sonography and confirmed by magnetic resonance imaging (MRI) are reported. We suggest criteria for early, prerupture sonographic diagnosis of this rare condition. METHODS We report a case in which pregnancy in a rudimentary horn was suspected on routine sonographic examination. In the second case, sonographic examination at 11 weeks' gestation revealed a right unicornuate uterus and a noncommunicating left rudimentary horn containing a gestational sac. In both cases, MRI clearly confirmed the sonographic diagnosis, showing an empty cavity of the uterine body and a pregnant uterine horn without an endometrial communication to the uterine body. RESULTS Both patients underwent surgery, and the pregnant rudimentary horns were resected with no complications. CONCLUSIONS We suggest the following criteria for sonographic diagnosis of rudimentary horn pregnancy: (1) a pseudopattern of a asymmetrical bicornuate uterus, (2) absent visual continuity tissue surrounding the gestational sac and the uterine cervix, and (3) the presence of myometrial tissue surrounding the gestational sac. Typical hypervascularization of placenta accreta may support the diagnosis. Additionally, MRI can be used to confirm the diagnosis before an invasive procedure is undertaken.
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Affiliation(s)
- Avi Tsafrir
- Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein-Kerem, 91120 Jerusalem, Israel.
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29
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Dietrich JE, Young AE, Young RL. Resection of a non-communicating uterine horn with use of the harmonic scalpel. J Pediatr Adolesc Gynecol 2004; 17:407-9. [PMID: 15603985 DOI: 10.1016/j.jpag.2004.09.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Type IIA1b anomalies of the Mullerian system are rare. Traditionally, the method of treatment for such anomalies has been laparotomy. CASE We discuss a case of this specific anomaly treated by resecting the non-communicating horn with the harmonic scalpel (Ethicon EndoSurgery, Cincinnati, Ohio) by first confirming a lack of communication with hysteroscopy, followed by chromotubation to demonstrate unilateral spill from the right side without leak from the area of dissection. CONCLUSION Minimally invasive techniques are an excellent alternative to laparotomy for correction of problems related to Mullerian anomalies.
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Affiliation(s)
- Jennifer E Dietrich
- Department of Obstetrics and Gynecology, Division of Pediatric and Adolescent Gynecology, University of Louisville School of Medicine, 550 S. Jackson St., Louisville, Kentucky, USA.
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30
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Adolph AJ, Gilliland GB. Fertility following laparoscopic removal of rudimentary horn with an ectopic pregnancy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2002; 24:575-6. [PMID: 12196850 DOI: 10.1016/s1701-2163(16)31061-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rudimentary horn pregnancies are rare. Although there have been previous reports of laparoscopic management, reports of successful pregnancies following previous excision of rudimentary horn were not found. Laparotomy remains the more common approach. CASE PRESENTATION We report the story of a woman found to have a rudimentary horn pregnancy who chose to be managed laparoscopically, and subsequently became pregnant and delivered a viable term infant 15 months following laparoscopic surgery. DISCUSSION The laparoscopic approach proffers decreased hospital stay, operating time, and potential for adhesions and is thus an important option for treatment of rudimentary horn pregnancies.
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Affiliation(s)
- A J Adolph
- Center for Women's Care and Reproductive Surgery, Atlanta, GA, USA
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31
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Nezhat CR, Smith KS. Laparoscopic management of a unicornuate uterus with two cavitated, non-communicating rudimentary horns: case report. Hum Reprod 1999; 14:1965-8. [PMID: 10438410 DOI: 10.1093/humrep/14.8.1965] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
An 18 year old nulligravid woman presented with severe dysmenorrhoea secondary to stage IV (revised American Fertility Society) endometriosis, right haematosalpinx, right endometrioma, unicornuate uterus and two cavitated, non-communicating rudimentary uterine horns. To our knowledge, this is the first reported case of a unicornuate uterus accompanied by two rudimentary horns. Operative video-laparoscopy proved a successful approach for treating this previously unreported variant of congenital Müllerian anomaly. A review of the world literature confirms the uniqueness of this case while demonstrating laparoscopy to be a viable alternative to laparotomy for management of congenital Müllerian anomalies. The case presented may help to elucidate Müllerian duct embryology further.
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Affiliation(s)
- C R Nezhat
- Department of Gynecology and Obstetrics, Stanford University Medical Center, 300 Pasteur Drive, Stanford, CA 94305, USA
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