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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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Xu S, Zhang J, Yue S, Qian J, Yang L, Xu YZ, Zhang J. A case of rudimentary uterine horn pregnancy complicated with placental implantation in later stages of pregnancy. Quant Imaging Med Surg 2024; 14:1167-1172. [PMID: 38223025 PMCID: PMC10784043 DOI: 10.21037/qims-23-889] [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: 06/19/2023] [Accepted: 10/16/2023] [Indexed: 01/16/2024]
Affiliation(s)
- Shengfang Xu
- Second Clinical School, Lanzhou University, Lanzhou, China
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
- Medical Imaging Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Jinlong Zhang
- Department of Respiratory Medicine, The 940th Hospital of Joint Logistic Support Force of People’s Liberation Army, Lanzhou, China
| | - Songhong Yue
- Second Clinical School, Lanzhou University, Lanzhou, China
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
| | - Jifang Qian
- Medical Imaging Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Lei Yang
- Medical Imaging Center, Gansu Provincial Maternity and Child-Care Hospital, Lanzhou, China
| | - Yuan-Zhe Xu
- School of Stomatology, Jinan University, Guangzhou, China
| | - Jing Zhang
- Second Clinical School, Lanzhou University, Lanzhou, China
- Department of Magnetic Resonance, Lanzhou University Second Hospital, Lanzhou, China
- Gansu Province Clinical Research Center for Functional and Molecular Imaging, Lanzhou, China
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Moufawad G, Giannini A, D’Oria O, Laganà AS, Chiantera V, Khazzaka A, Maziad G, Nasr E, Geagea V, Jardali MA, Sleiman Z. Obstructed Hemivagina and Ipsilateral Renal Anomaly Syndrome: A Systematic Review about Diagnosis and Surgical Management. Gynecol Minim Invasive Ther 2023; 12:123-129. [PMID: 37807996 PMCID: PMC10553600 DOI: 10.4103/gmit.gmit_103_22] [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: 09/12/2022] [Revised: 10/03/2022] [Accepted: 11/15/2022] [Indexed: 10/10/2023] Open
Abstract
Obstructed hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome is a rare congenital defect of the Müllerian ducts characterized by uterus didelphys, unilateral obstructed hemivagina, and ipsilateral renal agenesis. The aim of this systematic review is to summarize the main symptoms and presentation of the OHVIRA syndrome, as well as the different types of management, fertility, and obstetrical outcomes. A comprehensive search was performed in PubMed, EMBASE, SCOPUS, and Web of Science databases since inception to May 1, 2022, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. After duplicate records removed, the search strategy retrieved 103 articles. The full texts of 73 articles further were assessed for eligibility, and 44 studies were finally included in the systematic review. The mainstay surgical treatment of OHVIRA syndrome is usually a minimally invasive vaginal approach to remove the septum. Ultrasound-guided hysteroscopic resection and laparoscopic resection of the septum have been described as alternatives. Considering the feasibility of minimally invasive approach for the management of the syndrome, laparotomy should be avoided as much as possible and considered only in selected cases.
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Affiliation(s)
- Graziella Moufawad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Andrea Giannini
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Ottavia D’Oria
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University, Rome, Italy
| | - Antonio Simone Laganà
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Vito Chiantera
- Unit of Gynecologic Oncology, ARNAS “Civico – Di Cristina – Benfratelli”, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Aline Khazzaka
- Department of Obstetrics and Gynaecology, Laboratory of Science and Research, Saint Joseph University, Beirut, Lebanon
| | - Ghida Maziad
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Elena Nasr
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Vanessa Geagea
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Marwa Al Jardali
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
| | - Zaki Sleiman
- Department of Obstetrics and Gynaecology, School of Medicine, Lebanese American University, Beirut, Lebanon
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Garapati J, Jajoo S, Sharma S, Cherukuri S. Unicornuate Uterus with a Non-Communicating Rudimentary Horn: Challenges and Management of a Rare Pregnancy. Cureus 2023; 15:e40666. [PMID: 37485214 PMCID: PMC10359052 DOI: 10.7759/cureus.40666] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
We present a unique case of pregnancy developed in a unicornuate uterus with a non-communicating rudimentary horn, emphasizing the importance of early identification, careful management, and counseling. Our patient, a 28-year-old woman, presented with abdominal pain and premature rupture of membranes at 37 weeks of gestation. She had a history of one previous normal vaginal delivery and no significant medical or genetic factors. An emergency cesarean section was performed, and a baby boy weighing 2900 grams was delivered without complications. The uterine anomaly was identified as a unicornuate uterus with a non-communicating rudimentary horn. This case report highlights the challenges and risks associated with unicornuate pregnancies, such as fetal growth restriction and preterm labor. Timely identification, meticulous monitoring, and comprehensive counseling are crucial for optimal outcomes in such cases. Further research and larger-scale studies are needed to enhance our understanding of these rare and complex pregnancies.
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Affiliation(s)
- Jyotsna Garapati
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Shubhada Jajoo
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Sakshi Sharma
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
| | - Srinidhi Cherukuri
- Obstetrics and Gynaecology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education & Research, Wardha, IND
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Lay ZM, Gonzalez GPC, Paredes JS, Huang KG, Lee CL. Three-dimensional Laparoscopic Hemihysterectomy in a Case of Herlyn-Werner-Wunderlich Syndrome. Gynecol Minim Invasive Ther 2023; 12:99-100. [PMID: 37416104 PMCID: PMC10321342 DOI: 10.4103/gmit.gmit_40_23] [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: 03/17/2023] [Revised: 03/20/2023] [Accepted: 03/27/2023] [Indexed: 07/08/2023] Open
Affiliation(s)
- Zin Mar Lay
- Department of Obstetrics and Gynecology, Nyein Hospital, Mandalay, Myanmar
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Gillian Patrick C. Gonzalez
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Batangas Medical Center, Philippines
| | - Jhanice S. Paredes
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
- Department of Obstetrics and Gynecology, Luis Hora Memorial Regional Hospital, Philippines
| | - Kuan-Gen Huang
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
| | - Chyi-Long Lee
- Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kwei-Shan, Taoyuan, Taiwan
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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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Mert SA, Dilbaz B, Cukurova ES, Kose C, Engin Ustun Y. Reproductive Outcome of the Patients with Uterus Unicornis: Five Year Experience in a Tertiary Center. Acta Med Litu 2022; 29:295-303. [PMID: 37733391 PMCID: PMC9799010 DOI: 10.15388/amed.2022.29.2.14] [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: 06/20/2022] [Revised: 11/07/2022] [Accepted: 11/10/2022] [Indexed: 11/23/2022] Open
Abstract
Aim The aim is to evaluate the pregnancy outcomes of patients with uterus unicornis for 5-year experience in a tertiary center. Material and Method Twenty patients with uterus unicornis who were diagnosed with hysterosalpingography and/or 3D TVUSG between 2017 and 2021 and then confirmed with laparoscopy and simultaneous hysteroscopy were recruited into this retrospective study. The reproductive outcome and obstetric complications of the patients were followed up for two years postoperative period. Results Overall 20 patients who fulfilled the inclusion criterion were recruited for the study. The mean age was 28.65±5.03 years. Thirteen patients (65%) had primary infertility while the remaining seven had secondary infertility with two of them having a previous ectopic pregnancy. Rudimentary communicating uterine horn was observed in 7 (35%) of the patients. The horns were excised during laparoscopy. Overall, 14 (70%) pregnancies were achieved during the 2 years follow-up period. Twelve (85.7%) patients had a live birth (71.4% term delivery, 21.4% preterm delivery), and two (15.3%) had a first-trimester spontaneous abortion. Six (50%) of 12 patients who had a live birth received tocolytics for preterm labor. Conclusion Unicorn uterus is a rare anomaly diagnosed mostly during infertility work-up and might be related to the poor obstetric outcome, but early diagnosis is important for successful pregnancy results for preterm delivery especially in the secondary infertile group. In addition, rudimentary horn excision is recommended due to the high risk of obstetric complications.
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Affiliation(s)
- Sule Atalay Mert
- University of Health Sciences, Etlik Zubeyde Hanim Women’s Health, Training and Research Hospital, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
| | - Berna Dilbaz
- University of Health Sciences, Etlik Zubeyde Hanim Women’s Health, Training and Research Hospital, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
| | - Ece Sevin Cukurova
- University of Health Sciences, Etlik Zubeyde Hanim Women’s Health, Training and Research Hospital, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
| | - Caner Kose
- University of Health Sciences, Etlik Zubeyde Hanim Women’s Health, Training and Research Hospital, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
| | - Yaprak Engin Ustun
- University of Health Sciences, Etlik Zubeyde Hanim Women’s Health, Training and Research Hospital, Department of Reproductive Endocrinology and IVF, Ankara, Turkey
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