Rudimentary horn pregnancy explained

Pregnancy in a rudimentary horn of the uterus is a very rare type of ectopic pregnancy.[1] [2] [3] This type of pregnancy can be life-threatening, as the rudimentary horn is not meant to sustain a pregnancy and is at risk of rupturing.[4]

Unicornuate uterus with rudimentary horn is a type of congenital uterine anomaly that arises when one of the Müllerian ducts fails to develop fully, resulting in a small rudimentary horn on one side of the uterus. Different terms have been used in the literature to describe the rudimentary horn, such as uterus bicornis with accessory horn, uterus bicornis unicollis with rudimentary horn, uterus bicornis unicollis with atretic horn, hernia uterus inguinale, and Roberts uterus.[5]

Complications

This condition is considered a medical emergency, as rupture of the rudimentary horn can occur in the late first or second trimester of pregnancy (between 10 and 15 weeks of gestation), leading to massive bleeding and threatening the patient's life. Pregnancy in a rudimentary horn is typically associated with several complications, including intrauterine growth restriction, low amniotic fluid levels, preterm birth, fetal death, and occasionally, full-term gestation.[6] While there have been cases of successful live births, the prognosis for pregnancy in the rudimentary horn is generally poor.

Epidemiology

It is reported that 1 out of every 200 to 600 fertile women have a congenital uterine anomaly, while the occurrence of unicornuate uterus with rudimentary horn is even less common, with a frequency of 1 in 100,000. Although pregnancy in the rudimentary horn is extremely rare, it can lead to an ectopic gestation with an incidence of 1 in 100,000 to 1 in 140,000 pregnancies.[7]

Diagnosis

Diagnosing rudimentary horn pregnancy requires specific tests, such as hysteroscopy, hysterosalpingography, and laparoscopy, and close monitoring is essential if a person with a suspected rudimentary horn becomes pregnant to avoid the risk of rupture and its complications. Recent progress in diagnostic imaging techniques, including magnetic resonance imaging and ultrasound, have enabled the detection of these pregnancies before they lead to rupture.[8] [9] Obstetric ultrasonography, particularly the transvaginal method, is used for attempting prenatal diagnosis.[10]

Many patients experience acute abdominal pain, and it can be challenging to differentiate rudimentary horn pregnancy from other acute abdominal or gestational problems through ultrasound, leading to a high rate of misdiagnosis.[11] Additionally, during advanced stages of gestation, rudimentary horn pregnancy can closely resemble abdominal pregnancy.[12]

Management

The standard approach for managing a rudimentary horn, regardless of the trimester, is to remove it along with the corresponding tube using either laparoscopy or laparotomy.[13] This is advised because the functional endometrial horn has a higher risk of ectopic pregnancy, infertility, and dysmenorrhoea.[13]

Notes and References

  1. Siwatch . Sujata . Mehra . Reeti . Pandher . Dilpreet Kaur . Huria . Anju . Rudimentary horn pregnancy: a 10-year experience and review of literature . Archives of Gynecology and Obstetrics . Springer Science and Business Media LLC . 287 . 4 . 2012-11-27 . 0932-0067 . 10.1007/s00404-012-2625-7 . 687–695 . 23183713.
  2. Dahiya . Krishna . Duhan . Nirmala . Nanda . Smiti . Rudimentary Horn Pregnancy: Series of Four Cases and Review of the Literature . Journal of Gynecologic Surgery . Mary Ann Liebert Inc . 27 . 3 . 2011 . 1042-4067 . 10.1089/gyn.2010.0032 . 139–141.
  3. Ambusaidi . Qamariya . Jha . Chitra . Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو . Sultan Qaboos University Medical Journal . 14 . 1 . 2014 . 2075-0528 . 10.12816/0003349 . 134–138. 24516746 . 3916269 .
  4. Zhang . Salina . Lamari . Alessandra . Ferris . Edward . Maseelall . Priya . Fertility after treatment of a noncommunicating rudimentary horn pregnancy: A case report . Case Reports in Women's Health . Elsevier BV . 35 . 2022 . e00429 . 2214-9112 . 10.1016/j.crwh.2022.e00429. 35855949 . 9287488 .
  5. Jayasinghe . Yasmin . Rane . Ajay . Stalewski . Harry . Grover . Sonia . The Presentation and Early Diagnosis of the Rudimentary Uterine Horn . Obstetrics & Gynecology . Ovid Technologies (Wolters Kluwer Health) . 105 . 6 . 2005 . 0029-7844 . 10.1097/01.aog.0000161321.94364.56 . 1456–1467 . 15932844 .
  6. Zhang . Yu . Pang . Yingxin . Zhang . Xue . Zhao . Zhe . Liu . Peishu . Full-term pregnancy in a rudimentary horn with a live fetus . Medicine . Ovid Technologies (Wolters Kluwer Health) . 99 . 34 . 2020-08-21 . e21604 . 0025-7974 . 10.1097/md.0000000000021604. 32846770 . 7447397 .
  7. Pal . Kalpana . Majumdar . Subrata . Mukhopadhyay . Sambit . Rupture of rudimentary uterine horn pregnancy at 37 weeks gestation with fetal survival . Archives of Gynecology and Obstetrics . Springer Science and Business Media LLC . 274 . 5 . 2006-05-13 . 0932-0067 . 10.1007/s00404-006-0170-y . 325–326 . 16699796.
  8. Ueda . Makiko . Ota . Kuniaki . Takahashi . Toshifumi . Suzuki . Satoshi . Suzuki . Daisuke . Kyozuka . Hyo . Jimbo . Masatoshi . Soeda . Shu . Watanabe . Takafumi . Fujimori . Keiya . Successful pregnancy and term delivery after treatment of unicornuate uterus with non-communicating rudimentary horn pregnancy with local methotrexate injection followed by laparoscopic resection: a case report and literature review . BMC Pregnancy and Childbirth . Springer Science and Business Media LLC . 21 . 1 . 2021-10-26 . 715 . 1471-2393 . 10.1186/s12884-021-04195-5. free . 34702216 . 8547051 .
  9. Dhanawat . Juhi . Pape . Julian . Stuhlmann-Laeisz . Christiane . Maass . Nicolai . Freytag . Damaris . Gitas . Georgios . Alkatout . Ibrahim . Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management . Clinical Case Reports . Wiley . 9 . 5 . 2021 . e04261 . 2050-0904 . 10.1002/ccr3.4261. free . 34084520 . 8142796 .
  10. Chopra . Seema . Keepanasseril . Anish . Rohilla . Meenakshi . Bagga . Rashmi . Kalra . Jaswinder . Jain . Vanita . Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: retrospective analysis . Archives of Gynecology and Obstetrics . Springer Science and Business Media LLC . 280 . 6 . 2009-03-13 . 0932-0067 . 10.1007/s00404-009-1013-4 . 907–910 . 19283398.
  11. Zhang . Duo-Duo . Gao . Ying . Lang . Jing-He . Zhu . Lan . Diagnosis and Treatment of Rudimentary Horn Pregnancy . Chinese Medical Journal . Ovid Technologies (Wolters Kluwer Health) . 131 . 24 . 2018-12-20 . 0366-6999 . 10.4103/0366-6999.247200 . 3012–3014 . 6302637 . 30539921 . free .
  12. Bidiga . Semtama . Henry . Kiwango . Augustino . Onesmo . Mujuni . Fridolin . Matovelo . Dismas . Ndaboine . Edgar . Kihunrwa . Albert . Kiritta . Richard . Rudimentary horn pregnancy, a differential diagnosis of an intraabdominal pregnancy: a case report . Journal of Medical Case Reports . Springer Science and Business Media LLC . 17 . 1 . 2023-05-12 . 210 . 1752-1947 . 10.1186/s13256-023-03882-5. free . 37170291 . 10176794 .
  13. Jomaa . Sami . Ahmad . Afaf . Adwan . Dema . Successful diagnosis and management of prerupture rudimentary horn pregnancy in the second trimester: a case report . Radiology Case Reports . Elsevier BV . 16 . 10 . 2021 . 1930-0433 . 10.1016/j.radcr.2021.07.044 . 3068–3071. 34429804 . 8365452 .

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