Rudimentary horn pregnancy — ten years of experience
Abstract
Objectives: This study aimed to evaluate data on early diagnosis and therapeutic management of rudimentary horn
pregnancy (RHP).
Material and methods: Patients diagnosed with RHP at a tertiary center between for two periods of 2008–2012 and
2013–2018 were analysed retrospectively. We obtained information of patients from hospital electronic archive registration
system. Data on demographic characteristics, clinical presentation, gestational age at presentation, presenting symptoms,
diagnostic methods, and therapeutic management were noted and analysed by descriptive statistical method. Demographic
datas, the complaint of patient’s admission to hospital, history of cesarean section, preliminary diagnosis and intraoperative
diagnosis were compared between periods of 2008–2012 and 2013–2018.
Results: A total of 14 RHP patients were included. Eight (57.1%) of these patients were diagnosed between 2008–2012 (Group
1), whereas six patients (42.9%) were diagnosed between 2013–2018 (Group 2). Rudimentary horn was non-communicating
in 13 patients (92.8%). Communicated form was observed in 1 patient in group 1. RHP was diagnosed on the left side in nine
patients (64.2%). Six of these patients were observed in group 1 and 3 were in group 2. The pre-rupture diagnosis was made
in 10 (71.4%) patients. Six (100%) of 10 patients were in group 2. In addition, in group 1, four patients (50%) experienced
intraoperative RHP rupture. RHP was diagnosed before rupture in 2 (33.3%) patients in group 2.
Conclusions: It is an indication of advanced ultrasonographic technology as well as increased carefulness on the physician
side and raised alertness on the patient side that today both RHP and preoperative rupture of RHP are less frequent.
Still, further awareness is required among physicians of the necessity of excision of a rudimentary horn that is detected
at the time of C-section.
Keywords: Mullerian anomaliesobstetrics complicationsprenatal care
References
- Nahum GG. Rudimentary uterine horn pregnancy. A case report on surviving twins delivered eight days apart. J Reprod Med. 1997; 42(8): 525–532.
- Brady PC, Molina RL, Muto MG, et al. Diagnosis and management of a heterotopic pregnancy and ruptured rudimentary uterine horn. Fertil Res Pract. 2018; 4: 6.
- The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril. 1988; 49(6): 944–955.
- Speroff L, Glass RH, Kase NG. Clinical Gynecologic Endocrinology and Infertility. Sixth Edition. Williams & Wilkins, Philadelphia 1999: 123–158.
- Cheng C, Tang W, Zhang L, et al. Unruptured pregnancy in a noncommunicating rudimentary horn at 37 weeks with a live fetus: a case report. J Biomed Res. 2015; 29(1): 83–86.
- Tsafrir A, Rojansky N, Sela HY, et al. Rudimentary horn pregnancy: first-trimester prerupture sonographic diagnosis and confirmation by magnetic resonance imaging. J Ultrasound Med. 2005; 24(2): 219–223.
- Junqueira BLP, Allen LM, Spitzer RF, et al. Müllerian duct anomalies and mimics in children and adolescents: correlative intraoperative assessment with clinical imaging. Radiographics. 2009; 29(4): 1085–1103.
- Nahum GG. Rudimentary uterine horn pregnancy. The 20th-century worldwide experience of 588 cases. J Reprod Med. 2002; 47(2): 151–163.
- Thurber BW, Fleischer AC. Ultrasound Features of Rudimentary Horn Ectopic Pregnancies. J Ultrasound Med. 2019; 38(6): 1643–1647.
- Arslan T, Bilgiç E, Sentürk MB, et al. Rudimentary uterine horn pregnancy: a mystery diagnosis. Fertil Steril. 2009; 92(6): 2037.e1–2037.e3.
- Jayasinghe Y, Rane A, Stalewski H, et al. The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol. 2005; 105(6): 1456–1467.
- Peker N, Tunc SY, Sak S. et. al. Retrospective Evaluation of the Treatment Approaches of Ectopic Pregnancies According to Gestational Week. Zeynep Kamil Tıp Bülteni. 2017; 48(1): 8–11.
- Matalliotakis I, Goumenou A, Koumantakis G, et al. Pulmonary endometriosis in a patient with unicornuate uterus and noncommunicating rudimentary horn. Fertility and Sterility. 2002; 78(1): 183–185.
- Hussain A, Jawaid H, Faisal N, et al. Ruptured Rudimentary Horn Pregnancy Revealed on Emergency Laparotomy: A Case of Primigravida Presenting in a Developing Country. Cureus. 2018; 10(5): e2591.
- Li X, Peng P, Liu X, et al. The pregnancy outcomes of patients with rudimentary uterine horn: A 30-year experience. PLoS One. 2019; 14(1): e0210788.
- Sefrioui O, Azyez M, Babahabib A, et al. [Pregnancy in rudimentary uterine horn: diagnostic and therapeutic difficulties]. Gynecol Obstet Fertil. 2004; 32(4): 308–310.
- Lai YJ, Lin CH, Hou WC, et al. Pregnancy in a noncommunicating rudimentary horn of a unicornuate uterus: Prerupture diagnosis and management. Taiwan J Obstet Gynecol. 2016; 55(4): 604–606.
- Parveen R. Detection and Management of Pregnancy in Rudimentary Horn of Uterus. J Coll Physicians Surg Pak. 2019; 29(6): S70–S72.
- Lennox G, Pantazi S, Keunen J, et al. Minimally invasive surgical management of a second trimester pregnancy in a rudimentary uterine horn. J Obstet Gynaecol Can. 2013; 35(5): 468–472.
