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Mohammed AA, Abdelfattah AI, Ali MM, Elmubarak LA. Intact non-communicating rudimentary horn pregnancy in a patient with a history of two cesarean sections: A case report. Case Rep Womens Health 2024; 41:e00570. [PMID: 38152571 PMCID: PMC10750042 DOI: 10.1016/j.crwh.2023.e00570] [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: 11/04/2023] [Revised: 11/24/2023] [Accepted: 11/24/2023] [Indexed: 12/29/2023] Open
Abstract
This article reports a case of an unruptured rudimentary horn viable pregnancy at 18 weeks of gestation. The diagnosis was missed at two previous cesarean sections and on a second-trimester ultrasound scan of the index pregnancy. The condition is extremely rare, life-threatening and difficult to diagnose. This case report highlights the importance of checking the anatomy of the uterus and appendages during cesarean section.
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Shin SY, Kwon H, Kim HC, Baek MJ, Shin JE. Successful pregnancy outcome via in-vitro fertilization and laparoscopic resection of non-communicating rudimentary horn pregnancy containing early pregnancy: a case report. BMC Pregnancy Childbirth 2024; 24:115. [PMID: 38326770 PMCID: PMC10848344 DOI: 10.1186/s12884-024-06289-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 01/22/2024] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Non-communicating rudimentary horn pregnancy (NCRHP) lead to life-threatening condition for both mother and fetus. Early diagnosis of NCRHP and laparoscopic resection is important to prevent catastrophic conditions. However, delayed diagnosis until the second or third trimester makes it difficult to accurately diagnose between NCRHP and bicornuate uterine pregnancy, as both conditions present uterine rupture and massive hemoperitoneum. Furthermore, these rare cases are challenging in pregnancy trials and associated with adverse outcomes in subsequent pregnancies. CASE PRESENTATION A 31-year-old gravida 1 para 0 Korean woman visited our infertility center with a confirmed positive urine pregnancy test after timed intercourse. Before she was scheduled to have timed intercourse, a unicornuate uterus with a non-communicating right uterine horn was suspected based on an ultrasound scan and hysterosalpingography during the initial infertility workup. A gestational sac was observed in the right non-communicating rudimentary horn at 5 weeks of gestation. Serum beta-human chorionic gonadotropin (b-hCG) level was 2052.0mIU/mL. An elective laparoscopic resection of the right rudimentary horn containing a gestational sac, along with ipsilateral salpingectomy, was performed with no adverse event. After 3-month of recovery period and three cycles of conceptional trials involving timed intercourse and intrauterine insemination, in-vitro fertilization (IVF) was performed using the antagonist protocol, and successful pregnancy was confirmed. The patient had been hospitalized from 21 + 6 weeks to 35 + 6 weeks of gestation, underwent cerclage placement and tocolytics with corticosteroid treatment. She delivered an early-term male baby by cesarean section. CONCLUSION In this rare case, the successful pregnancy achieved through IVF following the appropriate management of NCRHP under laparoscopy underscores the critical importance of early diagnosis and intervention in cases of NCRHP. Timely identification and management of NCRHP are vital to prevent the occurrence of catastrophic conditions and to enhance the prognosis of a successful pregnancy through assisted reproductive technology (ART). Therefore, a high index of suspicion for NCRHP is important and employs a range of diagnostic modalities.
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Affiliation(s)
- So Yeon Shin
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 59, Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13496, Korea
| | - Hwang Kwon
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 59, Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13496, Korea
| | - Hyun Chul Kim
- Department of Obstetrics and Gynecology, CHA Women's Hospital Bundang, Seongnam-si, Gyeonggi-Do, 13496, Korea
| | - Min Jung Baek
- Department of Obstetrics and Gynecology, CHA Women's Hospital Bundang, Seongnam-si, Gyeonggi-Do, 13496, Korea
| | - Ji Eun Shin
- Department of Obstetrics and Gynecology, CHA Fertility Center Bundang, 59, Yatap-Ro, Bundang-Gu, Seongnam-Si, Gyeonggi-Do, 13496, Korea.
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Strug M, Christmas A, Schoonover A, Romero VC, Cordoba M, Leary E, Thakur M. Impact of an accessory cavitated uterine mass on fertility: case presentation and review of the literature. F S Rep 2023; 4:402-409. [PMID: 38204942 PMCID: PMC10774890 DOI: 10.1016/j.xfre.2023.09.001] [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: 06/29/2023] [Revised: 09/15/2023] [Accepted: 09/23/2023] [Indexed: 01/12/2024] Open
Abstract
Objective We report a case of an accessory cavitated uterine mass (ACUM) in a patient with infertility and chronic pelvic pain. In addition, we summarize the literature to better characterize ACUM diagnosis and management. Design A comprehensive literature search using the PubMed database was performed through April 2023. Historical ACUM diagnostic criteria were applied as inclusion criteria. Descriptive statistics and statistical evaluation were reported. Results A 31-year-old nulligravid woman presented with chronic pelvic pain, dysmenorrhea, primary infertility, and history of endometriosis. Three-dimensional ultrasonography identified an ACUM and laparoscopic excision provided complete resolution of symptoms. Subsequently, she conceived without assistance twice with uncomplicated vaginal deliveries. A total of 154 articles were identified, 34 papers met inclusion criteria and were individually reviewed, consisting of 70 reported cases. The most common presenting complaints were dysmenorrhea (81.4%), chronic pelvic/abdominal pain (54.1%), and refractory pain (34.3%). Diagnostic imaging included magnetic resonance imaging (62.9%) and transvaginal ultrasound (55.7%). Management included resection via laparoscopy (75.7%) or laparotomy (18.6%), or hysterectomy (5.7%). Of cases with reported outcomes, 90.7% had complete relief of symptoms after surgery. Conclusion ACUM often presents with dysmenorrhea, chronic pelvic pain, or abdominal pain and is identifiable on magnetic resonance imaging as a hyperenhancing mass. Three-dimensional transvaginal ultrasound can also accurately identify ACUM. A total of 90.7% of patients had complete relief of symptoms after intervention. It is important to identify ACUM early to relieve pain and reduce unnecessary interventions. Like our patient, other reports have demonstrated concomitant infertility and endometriosis. However, further investigation is needed to explore the association between infertility and ACUM.
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Affiliation(s)
- Michael Strug
- Division of Reproductive Endocrinology and Infertility, Stanford University School of Medicine, Sunnyvale, California
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Abigail Christmas
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Amanda Schoonover
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
| | - Vivian C. Romero
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Marcos Cordoba
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Maternal Fetal Medicine, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Elizabeth Leary
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Gynecology, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
| | - Mili Thakur
- Department of Obstetrics, Gynecology and Reproductive Biology, Michigan State University College of Human Medicine, Grand Rapids, Michigan
- Division of Gynecology, Department of Obstetrics, Gynecology and Women’s Health, Corewell Health Medical Group, Grand Rapids, Michigan
- The Fertility Center, Grand Rapids, Michigan
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Dadgar S, Mahmoudinia M, Davaryari N. Pregnancy in the Unicornuate Uterus and Non-Communicating Rudimentary Horn. IRANIAN JOURNAL OF MEDICAL SCIENCES 2023; 48:612-614. [PMID: 38094278 PMCID: PMC10715119 DOI: 10.30476/ijms.2023.97859.2971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 04/28/2023] [Accepted: 05/18/2023] [Indexed: 12/18/2023]
Affiliation(s)
- Salmeh Dadgar
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Maliheh Mahmoudinia
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Neda Davaryari
- Department of Obstetrics and Gynecology, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
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Liu Y, Li Z, Dou Y, Wang J, Li Y. Anatomical variations, treatment and outcomes of Herlyn-Werner-Wunderlich syndrome: a literature review of 1673 cases. Arch Gynecol Obstet 2023; 308:1409-1417. [PMID: 36823415 DOI: 10.1007/s00404-022-06856-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 11/09/2022] [Indexed: 02/25/2023]
Abstract
PURPOSE This study aimed to perform a systematic review of patients with Herlyn-Werner-Wunderlich syndrome (HWWS) and present the prevalence of symptoms, anatomical variants, endometriosis, surgical interventions, and short- and long-term outcomes. METHODS A structured search was performed in PubMed, Scopus, Embase, and China National Knowledge Infrastructure, and studies published between 1 January, 2000 and 19 April, 2022 were included. The following data on HWWS were recorded: symptoms, anatomical variations, surgical interventions and short- and long-term outcomes. RESULTS A total of 1673 patients were included in our analysis. The main symptoms were dysmenorrhea (53.8%), abnormal uterine bleeding (28.9%), and vaginal discharge (26.6%). The principal anomalies were right-obstructed hemivagina (57.3%), haematocolpos (81.7%), uterus didelphys (88.8%), and ipsilateral renal agenesis (93.1%). A majority of patients belonged to classification 1.1 (46.7%), with a blind hemivagina, and classification 2.1 (39.2%), with a small communication between two vaginas. The mainstay of treatment was vaginal septum excision (91.8%). Minimally invasive surgery (48.5%) was performed only after vaginal surgery (61.9%), and only a few patients required a second surgery (2.2%). Endometriosis was found in 9.6% of the patients. Fifty-two percent of them had ipsilateral ovarian endometriosis cysts. Pregnancy rate of these patients was 72.1%. The rate of adverse pregnancy outcomes was 22.4%. The caesarean section rate was 61.2%. CONCLUSIONS Patients with HWWS presented with nonspecific symptoms and demonstrated various combinations of anomalies. The most common anatomical variants are classifications 1.1 and 2.1. Vaginal septum excision is effective in relieving symptoms and preventing complications, with hysteroscopic surgery as an option where there is concern about protecting the hymen from minor injury. The pregnancy rate for these patients after surgery was satisfactory, and the rate of adverse pregnancy outcomes after surgery was acceptable. We advise females with urological anomalies to be screened for Müllerian anomalies because of the close association between these two types of anomalies. Thus, HWWS contributes to the occurrence of endometriosis; however, more research is required to investigate the relationship between pelvic endometriosis and HWWS.
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Affiliation(s)
- Yu Liu
- Obstetrics and Gynecology of the Hainan Hospital of PLA General Hospital, Sanya, Hainan, China
| | - Zhen Li
- PLA, Obstetrics and Gynecology of the Southwest Hospital of Army Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400000, China
| | - Yuya Dou
- PLA, Obstetrics and Gynecology of the Southwest Hospital of Army Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400000, China
| | - Jingjing Wang
- PLA, Obstetrics and Gynecology of the Southwest Hospital of Army Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400000, China
| | - Yudi Li
- PLA, Obstetrics and Gynecology of the Southwest Hospital of Army Medical University, Shapingba District, Gaotanyan Main Street 29, Chongqing, 400000, China.
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Gunjan G, Hans P. Pregnancy in Rudimentary Horn. Cureus 2023; 15:e48015. [PMID: 38034141 PMCID: PMC10687380 DOI: 10.7759/cureus.48015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2023] [Indexed: 12/02/2023] Open
Abstract
Pregnancy in rudimentary horn is an uncommon presentation of an ectopic pregnancy. It needs a very high degree of suspicion for diagnosis and the diagnosis becomes difficult in cases with previous vaginal deliveries. A 25-year-old female patient with two spontaneous vaginal deliveries and a history of spontaneous abortion at five months visited the obstetric emergency department with a history of five months of amenorrhea with pain abdomen and breathlessness for one day. On abdominal examination abdomen was distended, and rigid, and tenderness was present. Paracentesis was done where blood was present. On bimanual examination, cervical motion tenderness was present, and left-sided fornices fullness was present. The patient was admitted, and her sonography was done for suspicion of a ruptured uterus or ectopic pregnancy. The sonography report showed a bulky uterus with decidual reactions and a well-defined pregnancy of 21 weeks and 6 days in the right adnexal region with hemoperitoneum suggesting suspicion of ruptured ectopic pregnancy. After initial treatment and arrangement of two units of packed red blood cells after proper grouping and cross-matching for the patient, laparotomy was done. At the time of surgery, there was a right-sided rupture of non-communicating rudimentary horn pregnancy with a unicornuate uterus. A dead fetus of 600 grams lies in the peritoneal cavity with two liters of hemoperitoneum. Timely diagnosis and laparotomy saved the life of the patient.
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Affiliation(s)
- Gunjan Gunjan
- Obstetrics and Gynecology, Patna Medical College, Patna, IND
| | - Punit Hans
- Obstetrics and Gynecology, Patna Medical College, Patna, IND
- Obstetrics and Gynecology, Nalanda Medical College and Hospital, Patna, IND
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Hartup LA, Kostroun KE, Yauger BJ. Delayed diagnosis of a non-communicating right uterine horn: A case report and literature review. Case Rep Womens Health 2023; 39:e00535. [PMID: 37637006 PMCID: PMC10457418 DOI: 10.1016/j.crwh.2023.e00535] [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: 07/20/2023] [Revised: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 08/29/2023] Open
Abstract
Background Accurate diagnosis of a müllerian anomaly is essential for appropriate management and prevention of complications. However, diagnosis is often missed or delayed. Case This is a case of a nulliparous woman with a müllerian anomaly diagnosed at the age of 36 despite prior evaluation with ultrasound and laparoscopy. Magnetic resonance imaging (MRI) suggested a unicornuate uterus with a right non-communicating rudimentary horn. Hysteroscopy and chromopertubation confirmed the diagnosis. The rudimentary horn was resected laparoscopically using bipolar energy. Conclusion An undiagnosed müllerian anomaly should be considered in the setting of persistent dysmenorrhea. Three-dimensional ultrasound or MRI should be used judiciously in patients with refractory dysmenorrhea or when ultrasound raises concern for a müllerian anomaly.
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Affiliation(s)
- Lindsay A. Hartup
- Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
| | - Katherine E. Kostroun
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
| | - Belinda J. Yauger
- Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Texas Health Science Center San Antonio, 7703 Floyd Curl Dr, San Antonio, TX, 78229, San Antonio, TX, United States of America
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Benlghazi A, Belouad M, Messaoudi H, Benali S, El Hassani MM, Kouach J. Spontaneous successful term delivery in a unicornuate uterus: A case report and literature review. Int J Surg Case Rep 2023; 110:108689. [PMID: 37611398 PMCID: PMC10470303 DOI: 10.1016/j.ijscr.2023.108689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 08/16/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Malformations of the uterus are generally rare and are due to defective fusion of Mullerian duct. These include the unicorn uterus, with or without a rudimentary horn. Pregnancy in a unicornuate uterus is a rare event and carries with it maternal-fetal risks. CASE PRESENTATION In this report, we present an exceptional case of a pregnancy reaching full term in a unicornuate uterus without an accessory horn, which was serendipitously discovered during an emergency cesarean section. Intraoperatively, the uterus exhibited a distinct cylindrical shape with a flattened left wall, with the absence of both the left fallopian tube and left ovary. No additional abnormalities within the abdominopelvic cavity were noted. Notably, the postoperative recovery was uneventful for both the mother and newborn, without any notable complications. CLINICAL DISCUSSION The presence of a unicornuate uterus is associated with adverse obstetric outcomes, including recurrent miscarriage, premature delivery, fetal malposition, intrauterine growth retardation, and uterine rupture. In addition, around 40 % of women with this malformation may experience infertility. Although the efficacy of preconception or early interventions, such as rudimentary uterine horn resection and prophylactic cervical cerclage has not been fully established in improving obstetric outcomes, their usefulness is suggested by current medical practice. CONCLUSION Women with a unicornuate uterus are known to be at increased risk of obstetrical complications, such as spontaneous abortion, premature delivery, post-partum hemorrhage, abnormal fetal presentation and cesarean delivery. It is important to consider women with this anomaly as being at high obstetrical risk.
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Affiliation(s)
- Abdelhamid Benlghazi
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco.
| | - Moad Belouad
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Hamza Messaoudi
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | - Saad Benali
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | | | - Jaouad Kouach
- Department of Gynecology-Obstetrics, Mohammed V Military Teaching Hospital, Rabat, Morocco
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Yin SF, Chai JG, Feng RL, Yin ZY, Zhao SZ, Zhang T, Ke CX. Case report: Rudimentary uterine horn with ovarian endometriosis manifested as pelvic ectopic kidney. Front Med (Lausanne) 2023; 10:1182355. [PMID: 37476616 PMCID: PMC10354508 DOI: 10.3389/fmed.2023.1182355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/13/2023] [Indexed: 07/22/2023] Open
Abstract
Background Unicornuate uterus is a congenital uterine malformation. Unicornuate uterus with rudimentary horn, ovarian endometriosis, and congenital renal agenesis are rare combinations that can be easily misdiagnosed due to the lack of typical clinical manifestations. Case summary A 19-year-old woman with pelvic pain was admitted to the hospital after a month. Physical examination was unremarkable. B-ultrasound and CT scan both indicated pelvic ectopic kidney. In addition, renal scintigraphy revealed normal perfusion and function of the right kidney, but the perfusion and function of the left kidney were not visible. A left pelvic ectopic kidney was diagnosed by preoperative images. A laparoscopic left pelvic ectopic nephrectomy was performed after adequate surgical preparation. However, the postoperative pathological diagnosis revealed a rudimentary uterine horn with ovarian endometriosis and congenital renal agenesis. Fortunately, she got recovered and was discharged from the hospital after 5 days following the operation. Moreover, she received regular follow-ups at the gynecology clinic. To date, no right adnexal or uterine abnormalities have been detected on ultrasound during the follow-up visits. Conclusion Rudimentary uterine horn with ovarian endometriosis and congenital renal agenesis are rare and are easily Misdiagnosed due to the lack of typical clinical manifestations. A gynecological examination is recommended for patients who may have this disease.
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Affiliation(s)
- Si-fan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Jia-gui Chai
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Run-lin Feng
- Department of Pathology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Zhi-yuan Yin
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Shen-zhao Zhao
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Tao Zhang
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Chang-xing Ke
- Department of Urology, The Second Affiliated Hospital of Kunming Medical University, Kunming, China
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10
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Suryawanshi SV, Dwidmuthe KS. A Case Report on a Left Unicornuate Uterus With Communicating Right Rudimentary Horn Associated With Hematometra and Hematosalpinx. Cureus 2023; 15:e37959. [PMID: 37252551 PMCID: PMC10212723 DOI: 10.7759/cureus.37959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/31/2023] Open
Abstract
Congenital uterine anomalies (CUAs) or Müllerian duct anomalies are rare and can be either complete failure or partial failure in the development of the Mullerian duct, and they have a probability to result in a condition known as the unicornuate uterus. Partial development of one of the horns results in a rudimentary horn, which may be communicating consisting of category II A or noncommunicating consisting of category II B. This report illustrates a rare case of a 23-year-old female, unmarried, nulligravida, who presented to the outpatient department with chief complaints of acute abdominal pain and dysmenorrhea associated with an average menstrual flow. Pelvic ultrasound and magnetic resonance imaging (MRI) confirmed the diagnosis of a left unicornuate uterus with communicating right rudimentary horn associated with hematometra and hematosalpinx. As a treatment option, the surgical intervention mainly involved laparoscopic excision of the rudimentary horn and right salpingectomy that was performed by aspiration of blood from the rudimentary horn of around 25cc. Then, the right hydrosalpinx was removed, followed by right salpingectomy and excision of the rudimentary horn to reduce the risk of ectopic pregnancy having an incidence of 10% for which laparoscopic or robotic-assisted removal is preferable and practicable for young girls, compared with the open procedure. The patient adhered well to the surgical intervention.
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Affiliation(s)
- Shweta V Suryawanshi
- Department of Obstetrics and Gynaecology, Narendra Kumar Prasadrao (NKP) Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - Kanchan S Dwidmuthe
- Department of Obstetrics and Gynaecology, Narendra Kumar Prasadrao (NKP) Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
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11
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Zhang H, Zhang Y, Bao L, Ning G. MRI presentations of Müllerian duct anomalies in association with unilateral renal agenesis. Clin Radiol 2023; 78:168-174. [PMID: 36273955 DOI: 10.1016/j.crad.2022.09.119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 07/21/2022] [Accepted: 09/13/2022] [Indexed: 11/28/2022]
Abstract
AIM To evaluate the presentations of Müllerian duct anomalies (MDAs) associated with unilateral renal agenesis (URA) on magnetic resonance imaging (MRI). MATERIALS AND METHODS From 2014 to 2021, 92 patients with MDAs coexisting with URA who had undergone MRI were reviewed, and imaging patterns were analysed. RESULTS Based on the different imaging patterns, there were 74 cases of Herlyn-Werner-Wunderlich (HWW) syndrome (80.4%), nine cases of unicornuate uterus (10.9%), and nine cases of Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome (8.7%). In HWW syndrome, URA was ipsilateral to the vaginal or cervical obstruction. All the nine cases of unicornuate uterus were obstructive, and the most common subtype was unicornuate uterus with a non-communicating functioning rudimentary horn. The other two cases of unicornuate uterus with no rudimentary horn were obstructed due to cervical os obliteration, one of which was complicated with contralateral absent ovary. URA was contralateral to the unicornuate uterus in all cases. In MRKH syndrome, seven patients had bilateral rudiments and ovaries, all of which were unilaterally or bilaterally located above the pelvic brim, and URA was ipsilateral to the ectopic ovary in all cases. The other two patients had unilateral absent rudiment, ovary, and ipsilateral URA. CONCLUSIONS MRI presentations of URA-associated MDAs are diverse, with HWW syndrome being the most common form, followed by different patterns of unicornuate uterus and MRKH syndrome. An ectopic or absent ovary might be associated with URA in MRKH syndrome and unicornuate uterus.
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Affiliation(s)
- H Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, China
| | - Y Zhang
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, China
| | - L Bao
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, China
| | - G Ning
- Department of Radiology, Key Laboratory of Obstetric & Gynecologic and Pediatric Diseases and Birth Defects of Ministry of Education, National Key Laboratory of Biotherapy, West China Second University Hospital, Sichuan University, China.
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12
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Tellum T, Bracco B, De Braud LV, Knez J, Ashton‐Barnett R, Amin T, Chaggar P, Jurkovic D. Reproductive outcome in 326 women with unicornuate uterus. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:99-108. [PMID: 36099518 PMCID: PMC10107309 DOI: 10.1002/uog.26073] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 08/27/2022] [Accepted: 09/05/2022] [Indexed: 05/27/2023]
Abstract
OBJECTIVES To study the reproductive outcomes of women with a unicornuate uterus and compare them to those of women with no congenital uterine anomaly. METHODS This was a single-center, retrospective cohort study. Cases were women aged at least 16 years who were diagnosed with a unicornuate uterus on transvaginal/transrectal ultrasound between January 2008 and September 2021. Controls were women with no congenital uterine anomaly matched 1:1 by age and body mass index. The primary outcome was live-birth rate. Secondary outcomes were pregnancy loss (miscarriage, ectopic pregnancy, termination of pregnancy), preterm delivery, mode of delivery and concomitant gynecological abnormalities (endometriosis, adenomyosis, fibroids). RESULTS Included in the study were 326 cases and 326 controls. Women with a unicornuate uterus had a significantly lower live-birth rate (184/388 (47.4%) vs 229/396 (57.8%); P = 0.004) and higher rates of overall miscarriage (178/424 (42.0%) vs 155/465 (33.3%); adjusted odds ratio (aOR), 2.21 (95% CI, 1.42-3.42), P < 0.001), ectopic pregnancy (26/424 (6.1%) vs 11/465 (2.4%); aOR, 2.52 (95% CI, 1.22-5.22), P = 0.01), preterm delivery (45/184 (24.5%) vs 17/229 (7.4%); aOR, 3.04 (95% CI, 1.52-5.97), P = 0.001) and Cesarean delivery (116/184 (63.0%) vs 70/229 (30.6%); aOR, 2.54 (95% CI, 1.67-3.88), P < 0.001). Rudimentary-horn pregnancies accounted for 7/26 (26.9%) ectopic pregnancies in the study group. Women with a unicornuate uterus were more likely to have endometriosis (17.5% vs 10.7%; P = 0.018) and adenomyosis (26.7% vs 15.6%; P = 0.001), but were not more likely to have fibroids compared with controls. Women with a functional rudimentary horn were more likely to have pelvic endometriosis compared to those without (odds ratio, 2.4 (95% CI, 1.4-4.1), P = 0.002). CONCLUSIONS Pregnant women with a unicornuate uterus should be classified as high risk. Removal of a functional rudimentary horn should be discussed with the patient to prevent a rudimentary-horn ectopic pregnancy. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- T. Tellum
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
- Department of GynecologyOslo University HospitalOsloNorway
| | - B. Bracco
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - L. V. De Braud
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - J. Knez
- Clinic for GynecologyUniversity Medical Centre MariborMariborSlovenia
| | - R. Ashton‐Barnett
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - T. Amin
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - P. Chaggar
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
| | - D. Jurkovic
- Institute for Women's Health, Faculty of Population Health SciencesUniversity College LondonLondonUK
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13
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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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14
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Uncommon Surgical Emergencies in the Adult Gynecologic Patient: Two Cases of Missed Diagnosis of Outflow Tract Obstruction from Congenital Uterine Anomalies. Case Rep Obstet Gynecol 2022; 2022:3179656. [DOI: 10.1155/2022/3179656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 10/25/2022] [Accepted: 10/29/2022] [Indexed: 11/17/2022] Open
Abstract
Gynecologic emergencies may result from congenital uterine anomalies (CUAs) with outflow tract obstruction. Not limited to the “classic” presentation of an adolescent amenorrheic pain patient, such anomalies should be part of the differential diagnosis for adult female patients presenting with severe pelvic pain. Obstructed rudimentary noncommunicating cavitary horns may result in severe chronic or acute pain and necessitate urgent surgical management. While two-dimensional (2D) ultrasound is often the initial diagnostic tool, three-dimensional (3D) ultrasound and MRI can accurately delineate CUAs for definitive diagnosis. When excision of a rudimentary horn is required, a laparoscopic approach is preferable. This case series focuses on two adult patients with severe pelvic pain due to unicornuate uteruses with obstructed noncommunicating cavitated rudimentary horns. Both cases involve a delayed diagnosis, the inability to make the diagnosis at standard surgical observation, and the resultant need for urgent surgical management.
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15
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Fontana E, Parma M, Fedele F, Girardelli S, Parazzini F, Candiani M. Forty-two normomenstruating adolescents with Müllerian obstructive anomalies: Presentation, pitfalls in the dagnosis and surgical management. Acta Obstet Gynecol Scand 2022; 102:92-98. [PMID: 36285343 PMCID: PMC9780719 DOI: 10.1111/aogs.14454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 07/03/2022] [Accepted: 08/18/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION We analyzed the frequency, presentation and pitfalls in the diagnosis and surgical management of a large group of normomenstruating adolescents with obstructive reproductive tract anomalies. MATERIAL AND METHODS Retrospective analysis of prospectively collected data. Of the 143 outpatients referred for severe dysmenorrhea and persistent pelvic pain, 42 (29.3%) young women with obstructive Müllerian anomalies and regular menstrual flow were identified. These patients were divided into four groups: (1) patients with duplicate uterine cavities, obstructed hemivagina and ipsilateral renal agenesis (n = 34); (2) patients with unicornuate uterus and noncommunicating cavitated rudimentary horn (n = 5); (3) patients with accessory cavitated uterine mass (n = 2); (4) patients with partially obstructed transverse vaginal septum (n = 1). All 42 patients were conservatively treated via laparoscopy and 35/42 patients had also vaginal surgery. RESULTS Of the four groups, patients in groups 2 and 3 (n = 7) were conservatively managed by laparoscopy alone; for patients in groups 1 and 4 (n = 35), laparoscopy and the vaginal approach were used. Patients of group 1 were treated by resecting the obstructed vaginal septum with drainage of retained collections. In patients in group 2, surgery consisted of the removal of the rudimentary horn. Patients of group 3 were treated by the removal of myometrial neoformations. In the patient in group 4, treatment consisted of removal of the septum. All surgical procedures were successful and no major complications were recorded. Follow-up reports highlighted the disappearance of obstruction and clear improvement in pain symptoms. CONCLUSIONS Unilateral obstructive anomalies of the female genital tract are difficult to identify. Early diagnosis allows the preservation of reproductive activity and avoids potential complications.
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Affiliation(s)
- Eleonora Fontana
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly,Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Marta Parma
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Francesco Fedele
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly,Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Serena Girardelli
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
| | - Fabio Parazzini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore PoliclinicoUniversity of MilanMilanItaly
| | - Massimo Candiani
- Obstetrics and Gynecology DepartmentIRCCS San Raffaele Scientific InstituteMilanItaly
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16
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Alrawashdeh MM, Alkazaleh F. Successful Laparoscopic Management of Non-communicating Rudimentary Horn Pregnancy. Cureus 2022; 14:e27268. [PMID: 36039256 PMCID: PMC9403603 DOI: 10.7759/cureus.27268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Unicornuate uteri are a type of Mullerian duct anomaly and the majority present with rudimentary horns. Rudimentary horn pregnancies are extremely rare and have a high risk of rupture. A high index of suspicion is needed to diagnose them early and unfortunately, the majority of cases are undetected until the patient presents with a ruptured uterus. Early diagnosis and management will reduce morbidities and mortality for patients. We present a case of a 29 year old who had a routine ultrasound scan in the first trimester that raised an index of suspicion for a rudimentary horn pregnancy. An MRI scan was performed and supplemented the ultrasound findings. The patient underwent laparoscopic management, and the non-communicating rudimentary horn, the foetus, and the attached tube were excised. The patient had a smooth recovery and had no complications. Due to the rarity of rudimentary horn pregnancies, a high index of suspicion is needed for a diagnosis. Timely detection and intervention are crucial to prevent complications. Ultrasound scans and MRIs can aid in the diagnosis. Traditional management involved laparotomy, but with surgical advancements, laparoscopic surgery can be utilized as a less invasive alternative.
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17
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Zhang S, Lamari A, Ferris E, Maseelall P. Fertility after treatment of a noncommunicating rudimentary horn pregnancy: A case report. Case Rep Womens Health 2022; 35:e00429. [PMID: 35855949 PMCID: PMC9287488 DOI: 10.1016/j.crwh.2022.e00429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/26/2022] Open
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18
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Wang L, Ren S, Zhang Y, Liu W, Shi W. Non-communicated rudimentary uterine horn pregnancy and uterine rupture: A case report. SAGE Open Med Case Rep 2022; 10:2050313X221104034. [PMID: 35720249 PMCID: PMC9201294 DOI: 10.1177/2050313x221104034] [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: 02/28/2022] [Accepted: 05/12/2022] [Indexed: 11/24/2022] Open
Abstract
Rudimentary uterine horn pregnancy is a rare and serious type of ectopic pregnancy and is
hard to diagnose due to a lack of typical clinical symptoms at the early stage. A
35-year-old woman who was17 weeks pregnant and had a complicated history of infertility
came to our hospital complaining of abdominal pain without vaginal bleeding. Computed
tomography scan after 12 hours showed that her pregnancy was in the small cavity of a
rudimentary uterine horn, which had ruptured. Noncommunicating rudimentary uterine horn
pregnancy is an extremely rare form of ectopic gestation, and its diagnosis and management
remain challenging. Nevertheless, physician awareness of various forms of unicornuate
uteri and rudimentary uterine horn can save lives.
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Affiliation(s)
- Li Wang
- Medical College of Liaocheng University, Liaocheng, P.R. China
| | - Songtao Ren
- Medical College of Liaocheng University, Liaocheng, P.R. China.,Department of Neurosurgery, Liaocheng People's Hospital, Liaocheng, P.R. China
| | - Yan Zhang
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, P.R. China
| | - Wei Liu
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, P.R. China
| | - Wentian Shi
- Department of Obstetrics and Gynecology, Liaocheng People's Hospital, Liaocheng, P.R. China
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19
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Candiani M, Vercellini P, Ferrero-Caroggio C, Fedele F, Salvatore S, Fedele L. Conservative treatment of Herlyn-Werner-Wunderlich syndrome: Analysis and long-term follow-up of 51 cases. Eur J Obstet Gynecol Reprod Biol 2022; 275:84-90. [PMID: 35763966 DOI: 10.1016/j.ejogrb.2022.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 05/04/2022] [Accepted: 06/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The purpose of this study is to analyze the precise anatomical characteristics of a large group of patients with Herlyn-Werner-Wunderlich syndrome together with the long-term follow-up and the reproductive performance. STUDY DESIGN Retrospective analysis of prospectively collected data. In two tertiary medical centers, from 2008 to 2021, 51 patients with HWWS underwent surgery via the same technique. Presenting symptoms, preoperative investigations, operative management, and long-term follow-up with obstetric outcome were assessed. RESULTS The surgical procedure was successful in all cases with no major complications recorded. Postoperative course was uneventful. The median follow-up was 6,5 years, with a range from 6 months to 13 years. After surgery, among 14 patients who sought pregnancies, 12 (85,71%) were successful. Of these 11 patients had a total of 22 pregnancies, resulting in spontaneous miscarriage in 27% (6/22), premature birth (<37 weeks) in 36% (8/22) and full-term birth in 36% (8/22). Overall the pregnancies demonstrated had a good course. CONCLUSIONS Early diagnosis is essential in establishing prompt and correct surgical treatment.
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Affiliation(s)
- M Candiani
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - P Vercellini
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico
| | | | - F Fedele
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - S Salvatore
- Obstetrics and Gynaecology Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - L Fedele
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico.
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20
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136 Unicornuate uterus with a non-communicating functioning rudimentary horn: A case report. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2022.02.165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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21
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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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22
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Ma YC, Law KS. Pregnancy in a Non-Communicating Rudimentary Horn of Unicornuate Uterus. Diagnostics (Basel) 2022; 12:diagnostics12030759. [PMID: 35328312 PMCID: PMC8946958 DOI: 10.3390/diagnostics12030759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of non-communicating rudimentary horn pregnancy (RHP). The patient presented with lower abdominal pain and underwent laparoscopic surgery in which the gestational tissue was removed without excision of the rudimentary horn and ipsilateral fallopian tube. Unicornuate uteri often coexist with rudimentary horns, most of which are non-communicating. RHP is rare, and symptomatic women tend to complain of abdominal pain. Once RHP is suspected, the clinician should monitor the patient for signs of hypovolemic shock, such as hypotension, because the RHP can rupture owing to the poorly developed musculature. Early surgical intervention with removal of the rudimentary horn along with the ipsilateral fallopian tube is generally suggested to prevent future ectopic pregnancy. The theory of sperm transmigration from the contralateral oviduct has been hypothesized in non-communicating RHP.
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Affiliation(s)
- Yi-Cih Ma
- Department of Obstetrics and Gynecology, Tung’s Taichung MetroHarbor Hospital, Taichung 435, Taiwan;
| | - Kim-Seng Law
- Department of Obstetrics and Gynecology, Tung’s Taichung MetroHarbor Hospital, Taichung 435, Taiwan;
- Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: ; Tel.: +886-916120758
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23
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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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24
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Romanski PA, Bortoletto P, Pfeifer SM. Unilateral Obstructed Müllerian Anomalies: A Series of Unusual Variants of Known Anomalies. J Pediatr Adolesc Gynecol 2021; 34:749-757. [PMID: 33910086 DOI: 10.1016/j.jpag.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Obstructed Müllerian anomalies in adolescents can be grouped into complete outflow obstruction or unilateral outflow obstruction. The challenge with unilateral obstructions is that diagnosis can be delayed for weeks to years, as menstruation occurs normally through the patent side and thus obstruction is often not initially considered in the differential diagnosis. CASES In this case series, we present 3 unusual and challenging cases of unilateral Müllerian obstructions in adolescent female patients, along with strategies for diagnosis and management. Each case involves a unique variation of a recognized Müllerian anomaly that was initially misdiagnosed, leading to a significant delay in definitive diagnosis and treatment. SUMMARY AND CONCLUSION These cases highlight that even among the well-described Müllerian anomalies, there can be unusual variations. Patients who do not respond to initial management or who develop new symptoms should be further evaluated to confirm the correct diagnosis Tools that may be helpful in making the correct diagnosis include imaging studies that use contrast dye to better delineate cavities and their connections, magnetic resonance imaging with a radiologist experienced in Müllerian anomalies, and an examination under anesthesia. A definitive diagnosis is critical to the successful management of these conditions, and individualized management plans are required for each patient depending on their specific anomaly and their preferences for treatment.
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Affiliation(s)
- Phillip A Romanski
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York.
| | - Pietro Bortoletto
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
| | - Samantha M Pfeifer
- The Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical College, New York, New York
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25
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Coakley KE, Yang TB, Chung JH. Periviable delivery of a pregnancy in a rudimentary uterine horn: A case report. Case Rep Womens Health 2021; 32:e00346. [PMID: 34381697 PMCID: PMC8339228 DOI: 10.1016/j.crwh.2021.e00346] [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: 07/21/2021] [Revised: 07/21/2021] [Accepted: 07/22/2021] [Indexed: 12/03/2022] Open
Abstract
Pregnancy in a rudimentary uterine horn is an extremely rare form of ectopic pregnancy, with an incidence of 1 in 76,000-140,000 pregnancies. Given its high-risk nature, the standard of care is to terminate such pregnancies at the time of diagnosis. This is a case of a nulliparous patient at 23 5/7 weeks of gestation with a new diagnosis of a rudimentary horn pregnancy. She elected to proceed with full intervention for her fetus and was delivered at 24 0/7 weeks after administration of antenatal corticosteroid therapy. While the infant did have some adverse effects related to prematurity, she met developmental milestones and was alive and well at the age of two. Although the standard of care is to manage these cases as ectopic pregnancies, when diagnosed at a periviable gestational age, optimization of fetal status prior to delivery may be an alternative approach to immediate delivery.
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Affiliation(s)
- Katherine E. Coakley
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
| | - Tyler B. Yang
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
| | - Judith H. Chung
- University of California, Irvine Medical Center, Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, 333 City Boulevard West, Suite 1400, Orange, CA 92868, United States of America
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26
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A Jalil RA, Alsada AI. Unicornuate uterus with a functional non-communicating horn in adolescent. BMJ Case Rep 2021; 14:e242874. [PMID: 34446512 PMCID: PMC8395356 DOI: 10.1136/bcr-2021-242874] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
Abstract
Common causes of pelvic pain are primary dysmenorrhoea, Müllerian duct anomalies, outflow obstruction, leiomyoma, endometriosis and adenomyosis. Unicornuate uterus with a rudimentary horn is a rare congenital malformation of the female genital tract, asymptomatic because of lack of functional endometrium. This study presents a rare case of a non-communicating functional rudimentary horn. A 16-year-old unmarried Yemeni female adolescent with a history of irregular painful menstrual period visited Obstetrics and Gynaecology outpatient clinic. Pelvic ultrasound was conducted showing an asymmetrical uterine configuration with the non-communicating rudimentary horn on the right side. Laparoscopic excision of the horn was planned for the patient. Non-communicating rudimentary horn with functional endometrium should be considered as a differential diagnosis in the female adolescent with obstructive uterine symptoms. Early diagnosis is crucial. Using the laparoscopic approach, an expert surgeon prefers definitive management to excise the rudimentary horn.
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Affiliation(s)
| | - Abeer Isa Alsada
- Department of Obstetrics and Gynaecology, Bahrain Defence Force Hospital, Manama, Bahrain
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Jomaa S, Ahmad A, Adwan D. Successful diagnosis and management of prerupture rudimentary horn pregnancy in the second trimester: a case report. Radiol Case Rep 2021; 16:3068-3071. [PMID: 34429804 PMCID: PMC8365452 DOI: 10.1016/j.radcr.2021.07.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Revised: 07/18/2021] [Accepted: 07/18/2021] [Indexed: 11/21/2022] Open
Abstract
Rudimentary horn pregnancy has concerns due to the high incidence of an extreme risk of a life-threatening rupture. Thus, early diagnosis and management are essential to preserving the patient's life. We present a successful diagnosis and management of a prerupture rudimentary horn pregnancy in a 24-year-old woman presented with chronic pelvic pain and amenorrhea for the last 3 months. On physical examination, she had a mobile, nontender mass equals 16 weeks of gestation. Transvaginal ultrasound revealed an empty uterus with signs of a decidual reaction and a gestational sac adjacent to the uterus and surrounded by less than a 2 mm-in-thickness muscular wall with a positive fetal heart rate. The gestational age was 16 weeks based on biparietal diameter and femur length. Based on these findings rudimentary horn pregnancy was suspected. Laparotomy was performed, unicornuate uterus with unruptured, left rudimentary horn pregnancy was observed, and the pregnant horn with the ipsilateral tube was excised. To conclude, an empty uterus and extrauterine gestational sac surrounded by a thin muscular wall (<2 mm) on ultrasound should raise the suspicion of rudimentary horn pregnancy.
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Affiliation(s)
- Sami Jomaa
- Faculty of Medicine, Damascus University, Damascus, 97009 Syria
| | - Afaf Ahmad
- Faculty of Medicine, Damascus University, Damascus, 97009 Syria
| | - Dema Adwan
- Department of Emergency, University Hospital of Obstetrics and Gynecology, Damascus University, Damascus, 97009 Syria
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28
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Takahashi T, Shiojima S, Hamano T, Konno H, Yamada S. Laparoscopic resection of a non-communicating uterine rudimentary horn using intra-operative indigocarmine injection: A case report. Int J Surg Case Rep 2021; 81:105743. [PMID: 33743251 PMCID: PMC8010390 DOI: 10.1016/j.ijscr.2021.105743] [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: 02/10/2021] [Revised: 03/06/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE An unicornuate uterus with a non-communicating rudimentary horn (UUNCRH) is a very rare uterine malformation which is difficult to diagnose and to decide the surgical plan. We aim to describe the case of pediatric UUNCRH patient and our operative technique of laparoscopic intra-uterus indigo carmine injection (LIUICI) to confirm that the rudimentary horn (RH) is non-communicating before the resection and review the relevant literature to ascertain the most appropriate treatment option in these patients. CASE PRESENTATION A 11-year-old girl who developed progressive severe abdominal pain and dysmenorrhea was referred to our hospital. Uterine malformation and right hematosalpinx was confirmed with magnetic resonance imaging (MRI). Pre-operative treatment with a gonadotropin-releasing hormone agonist enabled improvement in the symptoms. Laparoscopic exploration was scheduled. The right fallopian tube was resected laparoscopically and a 3Fr tube was inserted into its cut end. Indigo carmine injected in the RH through the tube. No leakage of indigo carmine was found from the vagina, indicating the diagnosis of the uterine malformation is an UUNCRH and we performed the resection of the RH safely. CLINICAL DISCUSSION In pediatric patients transvaginal detailed examination is not easy to perform. Therefore, diagnostic and operative laparoscopy is critically important for the safe treatment. In addition, laparoscopic removal of a RH can be used to decrease the incidence of adhesions. CONCLUSION We found LIUICI technique before the resection of the RH is safe, technically feasible and minimally invasive approach for pediatric UUNCRH patients.
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Affiliation(s)
- Toshiaki Takahashi
- Department of Pediatric Surgery, Seirei General Hospital, Hamamatsu, Japan.
| | - Satoshi Shiojima
- Department of Gynecology, Seirei General Hospital, Hamamatsu, Japan.
| | - Takashi Hamano
- Department of Colorectal Surgery, Seirei General Hospital, Hamamatsu, Japan.
| | - Hiroko Konno
- Department of Gynecology, Seirei General Hospital, Hamamatsu, Japan.
| | - Shunsuke Yamada
- Department of Pediatric Surgery, Seirei General Hospital, Hamamatsu, Japan.
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29
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Liu Y, Wang S, Hong Y, Wang J, Niu J, Li X, Li H, Wang Y. Pregnancy in the blind hemi-cavity of Robert's uterus: a case report. Radiol Case Rep 2021; 16:1085-1088. [PMID: 33717388 PMCID: PMC7921196 DOI: 10.1016/j.radcr.2021.02.013] [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: 12/10/2020] [Revised: 02/05/2021] [Accepted: 02/06/2021] [Indexed: 12/01/2022] Open
Abstract
Robert's uterus is a rare Müllerian malformation first characterized by a French gynecologist Héléne Robert in 1969. It represents an asymmetric division of the uterine cavity. A 45-year-old female patient presented with vaginal bleeding and vague abdominal pain for the course of 20 days, with a blood human chorionic gonadotropin level of 10331.00 mIU/mL, and a gestational sac in the right uterine horn without a fetal heart beat revealed by the ultrasound. Ectopic pregnancy in the right uterine horn seemed to be the most likely diagnosis. Laparoscopic and hysteroscopic attempts to terminate the pregnancy failed. A pelvic magnetic resonance imaging (MRI) performed after the surgery demonstrated Robert's uterus with pregnancy in the blind hemicavity. When a pregnancy sac has been revealed by an ultrasound but nothing has been found by a hysteroscopy, a possibility of uterine malformation should be considered. Radiologists and gynecologists should consider the application of MRI for diagnosis of congenital Müllerian uterine anomalies.
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Affiliation(s)
- Yan Liu
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Shanshan Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Yue Hong
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Jia Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Junqiao Niu
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Xiaojuan Li
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Hui Li
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
| | - Yan Wang
- Department of Radiology, People's Hospital of Xinjiang Uygur Autonomous region, China
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30
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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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31
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Rupture of Rudimentary Horn Pregnancy at 16 Weeks of Gestation. Case Rep Obstet Gynecol 2021; 2021:8829053. [PMID: 33505745 PMCID: PMC7815397 DOI: 10.1155/2021/8829053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022] Open
Abstract
Pregnancy in the rudimentary horn is rare and a life-threatening. Rupture of pregnant rudimentary horn in the second trimester is a usual presentation. Early diagnosis and fast management are necessary to decrease the mortality and the morbidity of this pathological entity. This report confirms the diagnostic and therapeutic difficulties of the pregnant rudimentary horn. An emergency laparotomy was taken, and ruptured right rudimentary horn was diagnosed. A hemi-hysterectomy was carried out. The patient's postoperative follow-up was uneventful, and she left the hospital 5 days after.
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32
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Kirk E, Ankum P, Jakab A, Le Clef N, Ludwin A, Small R, Tellum T, Töyli M, Van den Bosch T, Jurkovic D. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020; 2020:hoaa055. [PMID: 33354626 PMCID: PMC7738750 DOI: 10.1093/hropen/hoaa055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN SIZE DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS SETTING METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESHRE. T.T. declares speakers' fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE's GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE's GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.
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Affiliation(s)
| | - Emma Kirk
- Early Pregnancy and Emergency Gynaecology Unit, Royal Free Hospital London, London, UK
| | - Pim Ankum
- Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | | | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Rachel Small
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tina Tellum
- Department of Gynecology, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, Leuven, KU, Belgium
| | - Davor Jurkovic
- Department of OB/GYN, University College Hospital, London, UK
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33
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Kozar N, Serdinšek T, Tašner T, Reljič M, Gavrić Lovrec V, Kovač V. Diagnosis and management of rudimentary horn pregnancy rupture, misinterpreted as bicornuate uterus in the 14th week of pregnancy. J Obstet Gynaecol Res 2020; 47:843-846. [PMID: 33271628 DOI: 10.1111/jog.14586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/08/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
We present a 26-year-old primigravida with rudimentary horn pregnancy rupture at 14 weeks of pregnancy. Uterine anomaly was first diagnosed at the time of nuchal translucency scan and was presumed to be a bicornuate uterus with normal intrauterine pregnancy in the right horn. One day later, she was admitted to our department with abdominal pain, shortly leading to massive hemoperitoneum and hypovolemic shock. Uterine rupture was confirmed ultrasonically, followed by immediate laparotomy. Ruptured rudimentary horn with already expulsed pregnancy was encountered during surgery. Despite significant advances in ultrasonography, diagnosis of prerupture stage remains controversial. However, high mortality of the condition should ensure low threshold for surgical exploration.
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Affiliation(s)
- Nejc Kozar
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Tamara Serdinšek
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Department of General Gynaecology and Gyanecological Urology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Tanja Tašner
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Vida Gavrić Lovrec
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Vilma Kovač
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
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34
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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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35
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Begum J, Maharana N, Behera SS, Ali M, Mohakud S. Laparoscopic Approach Towards Non-Communicating Functional Rudimentary Uterine Horn: A Report of Two Cases. Cureus 2020; 12:e11419. [PMID: 33312815 PMCID: PMC7727771 DOI: 10.7759/cureus.11419] [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
A unicornuate uterus is a relatively rare Müllerian anomaly with an incidence of 2.5-13%. It may lead to various gynecological or obstetric complications, and diagnosis can often be confusing and delayed. It is associated with varying clinical presentations depending on the presence of functional endometrium, which requires immediate surgical resection on the diagnosis. We report two cases of the unicornuate uterus in young women who presented with severe progressive dysmenorrhoea. These cases highlight the challenges in diagnosing the condition by ultrasound, which was confirmed later by MRI. Both cases were managed by laparoscopic resection of the functional non-communicating uterine horn. On follow-up, both patients were found asymptomatic with normal menstrual cycles. In patients of young age who present with abdominal pain, adnexal masses of unknown origin, and severely painful periods, we should consider Müllerian duct anomalies as one of the differential diagnoses. Early and proper preoperative diagnosis of these cases is essential to prevent complications and to offer adequate treatment. Operative laparoscopy is an excellent alternative to laparotomy for their management, particularly in young unmarried girls.
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Affiliation(s)
- Jasmina Begum
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Nibedita Maharana
- Obstetrics and Gynecology, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Shashi Shankar Behera
- Obstetrics and Gynecology, The Advanced Medical Research Institute, Bhubaneswar, IND
| | - Manwar Ali
- Surgery, All India Institute of Medical Sciences, Bhubaneswar, IND
| | - Sudipta Mohakud
- Radiology, All India Institute of Medical Sciences, Bhubaneswar, IND
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36
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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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37
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Walker C, Collins L, Pham A, George J, Johnson S. Avoiding the fatal misdiagnosis of pregnancy in a noncommunicating rudimentary horn using 3D transvaginal ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:553-556. [PMID: 32255499 DOI: 10.1002/jcu.22836] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 03/12/2020] [Accepted: 03/23/2020] [Indexed: 06/11/2023]
Abstract
Rudimentary horn pregnancies are an increasingly recognized complication of Mullerian duct anomalies. They can lead to uterine rupture with severe maternal morbidity and mortality. We present the case of a 28-year-old woman with a prior surgical diagnosis of bicornuate uterus who was diagnosed with a 7-week pregnancy in the left horn of a bicornuate uterus by 2D ultrasound. Further investigation with 3D ultrasound revealed that the pregnancy was within a noncommunicating rudimentary horn of a unicornuate uterus. These findings were confirmed at laparotomy. This case illustrates the importance and benefits of utilizing 3D ultrasound in diagnosing suspected Mullerian anomalies.
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Affiliation(s)
- Christopher Walker
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Laura Collins
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Amanda Pham
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Joshua George
- Department of Obstetrics and Gynecology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Samuel Johnson
- Department of Radiology, Wayne State University School of Medicine, Detroit, Michigan, USA
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38
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Rajbhandary S, Das A, Rai M, Sah AK. Rupture of Non-communicating Rudimentary Horn Pregnancy at 15 Weeks with Previous Normal Pregnancies: A Case Report. ACTA ACUST UNITED AC 2020; 58:614-617. [PMID: 32968300 PMCID: PMC7580373 DOI: 10.31729/jnma.5104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Rudimentary horn is a mullerian anomaly that is a variant of unicornuate uterus. Rudimentary horn pregnancies are rare and associated with increased maternal morbidity and mortality. Diagnosis of rudimentary horn pregnancy and its rupture in a woman with previous vaginal delivery is challenging. Although ultrasonography is an important diagnostic tool, it has low sensitivity in making diagnosis of ruptured rudimentary horn pregnancy. Therefore, clinicians should have high index of suspicion in such cases. We report a case of G3P2L2 at 15 weeks period of gestation referred to our centre as a case of intrauterine pregnancy with acute abdomen. She underwent emergency laparotomy and was found to have ruptured rudimentary horn intraoperatively. Excision of the ruptured rudimentary horn and ipsilateral salpingectomy was done and the patient had an uneventful postoperative recovery.
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Affiliation(s)
- Sanyukta Rajbhandary
- Department of Obstetrics and Gynecology, B.P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Anamika Das
- Department of Obstetrics and Gynecology, B.P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Mausam Rai
- Department of Obstetrics and Gynecology, B.P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
| | - Archana Kumari Sah
- Department of Obstetrics and Gynecology, B.P Koirala Institute of Health Sciences, Ghopa, Dharan, Nepal
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39
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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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Supermaniam S, Thye WL. Diagnosis and laparoscopic excision of accessory cavitated uterine mass in young women: Two case reports. Case Rep Womens Health 2020; 26:e00187. [PMID: 32211298 PMCID: PMC7082520 DOI: 10.1016/j.crwh.2020.e00187] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 02/24/2020] [Accepted: 03/02/2020] [Indexed: 12/03/2022] Open
Abstract
Introduction An accessory cavitated uterine mass (ACUM) is a rare congenital Mullerian anomaly where an accessory cavity with normal endometrial lining lies within a normally functioning uterus. It is common among young and nulliparous women presenting with severe dysmenorrhea and infertility. Presentation of the Cases We present two cases of ACUM. The first case was a 22-year-old woman who presented with severe dysmenorrhea and was initially misdiagnosed with non-communicating rudimentary horn The second case was a 36-year-old woman who presented with primary infertility and dysmenorrhea. Gynecological examination and ultrasound scanning were done for both patients. Subsequently, laparoscopic excision of the ACUM was performed on both patients. Histopathological examination confirmed the diagnosis. Postoperatively, both patients did well, with no further dysmenorrhea. The second patient conceived spontaneously at the first attempt and at the time of writing was 33 weeks pregnant without any maternal or fetal problems. Conclusion The diagnosis of ACUM is often confused with non-communicating rudimentary uterine horn, true cavitated adenomyosis and degenerating fibroids. It is important to understand and distinguish ACUM. A thorough history, detailed gynecological examination and correct radiological modalities are critical to a proper diagnosis so that the correct surgery can be performed, especially when fertility is desired. Accessory cavitated uterine mass is rare congenital Mullerian anomaly. It happens among young, nulliparous women presenting with dysmenorrhea and infertility. It is a diagnostic challenge and often confused with other differential diagnosis. A thorough history, detailed and proper examination and imaging are mandatory. Laparoscopic excision is crucial to relieve symptoms and improve reproduction.
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Affiliation(s)
- Sevellaraja Supermaniam
- Mahkota Medical Centre, Suite 105, Mahkota Medical Centre, No 3, Mahkota Melaka, Jalan Merdeka, 75000 Melaka, Malaysia
| | - Wei Lin Thye
- Mahkota Medical Centre, Suite 105, Mahkota Medical Centre, No 3, Mahkota Melaka, Jalan Merdeka, 75000 Melaka, Malaysia
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Management of Acute Obstructive Uterovaginal Anomalies: ACOG Committee Opinion, Number 779. Obstet Gynecol 2020; 133:e363-e371. [PMID: 31135762 DOI: 10.1097/aog.0000000000003281] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Obstructive uterovaginal anomalies may present after puberty with amenorrhea, dysmenorrhea, pelvic pain, recurrent vaginal discharge, or infertility. The evaluation of a patient with a suspected obstructive reproductive anomaly should include a detailed medical history, physical examination, and imaging. The genital examination is critical to differentiate a patient with an imperforate hymen from a patient with labial adhesions, urogenital sinus, transverse vaginal septum, or distal vaginal atresia. Pelvic ultrasonography is the initial imaging method recommended for a patient with cyclic pain and amenorrhea or a patient with persistent dysmenorrhea. It is important to note that diagnosis of a uterine or vaginal anomaly by imaging before puberty can be challenging and misleading because of the small size of the prepubertal uterus and the lack of endometrial stimulation and menstrual distention of the vagina. Consultation with a radiologist experienced with imaging of uterovaginal anomalies may be helpful to determine the most accurate diagnosis. In general, obstructive vaginal and uterine anomalies are not surgical emergencies, and the complexities of these conditions are best managed by gynecologic care providers familiar with the surgical management of these conditions. Given the high risk of stenosis and complications associated with transverse vaginal septum, distal vaginal atresia, and cervical atresia, referral to a center with expertise in the management of these anomalies is paramount. The best long-term outcome is achieved with a complete evaluation, clear understanding of the anomaly, mobilization of appropriate surgical resources, sufficient preoperative counseling, and planned surgical intervention.
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Ross ME, Scott S, Behbakht K, Harper T. Spontaneous dichorionic-diamniotic twins in a noncommunicating uterine horn: A case report. Case Rep Womens Health 2020; 26:e00177. [PMID: 32055454 PMCID: PMC7005551 DOI: 10.1016/j.crwh.2020.e00177] [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: 01/19/2020] [Revised: 01/22/2020] [Accepted: 01/23/2020] [Indexed: 12/02/2022] Open
Abstract
Background We present a rare case of a dichorionic-diamniotic twin pregnancy in a noncommunicating rudimentary uterine horn diagnosed prior to rupture at 12 weeks of gestation. Case A 33-year-old woman with history of two prior spontaneous abortions presented with a spontaneously conceived dichorionic-diamniotic twin pregnancy. Routine first-trimester screening ultrasound detected an extrauterine twin pregnancy. The patient was admitted for observation and treatment planning. Magnetic resonance imaging (MRI) of the pelvis led to the radiologic diagnosis of suspected abdominal ectopic pregnancy. Exploratory laparotomy led to an intraoperative diagnosis of twin pregnancy within a rudimentary uterine horn, which was removed without incident. Conclusion This is a rare case of a twin pregnancy contained in a noncommunicating rudimentary uterine horn. The presence of this horn was not detected on ultrasonography or MRI. Ectopic twin pregnancy found within noncommunicating rudimentary horn not seen on ultrasound or magnetic resonance imaging Noncommunicating rudimentary uterine horns can be missed on imaging. Ectopic pregnancy in a noncommunicating uterine horn can appear as an abdominal ectopic pregnancy. Early detection of Mullerian anomaly in pregnancy is potentially lifesaving. Selective preoperative imaging can guide patient counseling and ensure necessary consulting services are available.
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Affiliation(s)
- Megan E Ross
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Stephen Scott
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Kian Behbakht
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
| | - Teresa Harper
- University of Colorado School of Medicine, Department of Obstetrics and Gynecology, USA
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The infected hematometra in a rudimentary noncommunicating horn misdiagnosed as pelvic mass: A case report. Int J Surg Case Rep 2020; 68:4-7. [PMID: 32109769 PMCID: PMC7044467 DOI: 10.1016/j.ijscr.2020.01.052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Revised: 01/17/2020] [Accepted: 01/27/2020] [Indexed: 11/30/2022] Open
Abstract
The rudimentary noncommunicating horn with a functional endometrial cavity is should be treated promptly to prevent obstetric and gynecologic complications. The MRI is essential in assessing Müllerian anomaly. The presence of concomitant congenital malformation, renal and skeletal anomalies, should raise the high suspicion of Müllerian anomaly.
Introduction The rudimentary noncommunicating horn with a functional endometrial cavity is rare and often challenging to diagnose because of the variety in clinical features. We present a case of a patient for whom the diagnosis of a uterine horn was missed during the prior cesarean section, which later successfully treated with robotic-assisted laparoscopic removal of a rudimentary noncommunicating horn of uterus and ipsilateral tube. Presentation of case A 20-year old woman, gravida 3 para 2, presented with a complaint of acute and severe pelvic pain with fever. Multiple imaging modalities of pelvis and abdomen showed an 8 cm right-sided pelvic mass with a tubular structure adjacent to the uterus. The pelvic inflammatory disease was diagnosed and treated with intravenous antibiotics. After reviewing multiple radiology images, Müllerian anomaly was suspected, and the rudimentary horn with the fallopian tube was confirmed via diagnostic hysteroscopy and laparoscopy. Subsequently, robotic-assisted laparoscopic removal of the right horn with the fallopian tube was performed. Discussion Assessment of a rudimentary noncommunicating horn with unicornuate uterus can be achieved by several radiology methods, including computed tomography, magnetic resonance imaging, two and 3-dimensional ultrasonography, hysterosalpingogram, and sonohysterography. In addition, evaluation of concomitant skeletal and renal anomalies is essential in enhancing diagnostic accuracy. In our case, the Müllerian anomaly with delayed onset complications was diagnosed by multiple imaging studies and treated successfully. Conclusion The early and correct diagnosis of the Müllerian anomaly remains difficult but essential as misdiagnosis can be associated with serious complications in patients.
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Thurber BW, Fleischer AC. Ultrasound Features of Rudimentary Horn Ectopic Pregnancies. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2019; 38:1643-1647. [PMID: 30341954 DOI: 10.1002/jum.14847] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Accepted: 09/07/2018] [Indexed: 06/08/2023]
Abstract
Rudimentary horn ectopic pregnancies are uncommonly encountered in women with müllerian duct anomalies. The clinical presentation of this entity is nonspecific, giving ultrasound a critical role in making the diagnosis. Timely diagnosis and management of rudimentary horn ectopic pregnancies are pivotal in reducing the high rates of uterine rupture and maternal mortality historically associated with this condition.
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Affiliation(s)
- Brian W Thurber
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Arthur C Fleischer
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Li XQ, Qian HJ, Zhang XY, He Y, Zhang SF, Hua KQ, Ding JX. Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship. Arch Gynecol Obstet 2019; 299:1321-1330. [PMID: 30850851 DOI: 10.1007/s00404-019-05106-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Accepted: 02/22/2019] [Indexed: 11/26/2022]
Abstract
PURPOSE To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus. METHODS This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24 weeks' gestation, n = 34), Group 3 (preterm delivery, 24-35 weeks' gestation, n = 13), Group 4 ( ≥ 35 weeks' gestation, n = 72), followed them up and then analyzed the data. RESULTS Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90 ± 0.56 cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P = 0.001) was statistically significant. Women with uterine lengths ≥ 4.5 cm were more likely to experience full-term delivery compared with the other group (P = 0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR = 9.03 (95% CI: 2.90-28.13)] and uterine cavity length [OR = 0.32 (95% CI: 0.06-2.04)] were independent protective factors for better obstetric outcomes CONCLUSION: The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.
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Affiliation(s)
- Xiao-Qing Li
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Hui-Jun Qian
- Department of Radiology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
| | - Xu-Yin Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Yuan He
- Public Health School of Fudan University, Shanghai, 200032, China
| | - Shao-Fen Zhang
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China
| | - Ke-Qin Hua
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
| | - Jing-Xin Ding
- Department of Gynecology, Obstetrics and Gynecology Hospital, Fudan University, Shanghai, 200011, China.
- Shanghai Key Laboratory of Female Reproductive Endocrine Related Diseases, Shanghai, 200011, China.
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Theodoridis TD, Pappas PD, Grimbizis GF. Surgical management of congenital uterine anomalies (including indications and surgical techniques). Best Pract Res Clin Obstet Gynaecol 2019; 59:66-76. [PMID: 30910446 DOI: 10.1016/j.bpobgyn.2019.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 02/02/2019] [Accepted: 02/11/2019] [Indexed: 11/17/2022]
Abstract
The prevalence of congenital uterine anomalies (CUA) is reported to be 4.3-6.7% in the general population, 3.4%-8% in the infertile population, and 12.6-18.2% of those with recurrent miscarriages. They are the result of abnormal formation, differentiation, and fusion of the Müllerian or paramesonephric ducts during fetal life. To date, various classification systems have been proposed for the categorization of CUA, but the recently introduced ESHRE/ESGE classification seems to be a new, clear, and systematic categorization, which could be the basis for clinicians to rely on when they refer to CUA and their clinical impact either generally or concerning pregnancy outcomes. CUA are apparently related to an impaired reproductive outcome, while their exact clinical impact as well as the effectiveness of their treatment remain considered controversial. Surgery is indicated in women presenting with symptoms related to specific uterine anomalies, especially in those with fertility problems. In this review, indications, surgical techniques for the repair of CUA according to their classification, and fertility and pregnancy outcomes before and after surgery will be thoroughly reviewed.
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Affiliation(s)
- Theodoros D Theodoridis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece.
| | - Panagiotis D Pappas
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
| | - Grigoris F Grimbizis
- 1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Papageorgiou Hospital, Thessaloniki, Greece
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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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A Novel Approach to Management of Angular Pregnancies: A Case Series. J Minim Invasive Gynecol 2019; 26:178-181. [DOI: 10.1016/j.jmig.2018.08.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 07/29/2018] [Accepted: 08/01/2018] [Indexed: 11/17/2022]
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Magnetic resonance imaging of common, uncommon, and rare implantation sites in ectopic pregnancy. Abdom Radiol (NY) 2018; 43:3425-3435. [PMID: 29713741 DOI: 10.1007/s00261-018-1604-2] [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: 02/06/2023]
Abstract
OBJECTIVE To review the MRI appearances of tubal and non-tubal implantation sites in ectopic pregnancy. CONCLUSION Transvaginal ultrasound is the primary imaging modality in ectopic pregnancy and MRI is used as a problem-solving tool in selected indications as detailed in the article. MRI features of tubal, interstitial, cervical, cesarean scar, cornual, ovarian, abdominal, and heterotopic pregnancies are provided to familiarize the radiologists with their appearances thereby assisting them in making early and accurate diagnosis.
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