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Stabile G, Cracco F, Zinicola G, Carlucci S, Mangino FP, Stampalija T, Ricci G. Subserosal pregnancy: Systematic review with proposal of new diagnostic criteria and ectopic pregnancy classification. Eur J Obstet Gynecol Reprod Biol 2024; 297:254-259. [PMID: 38701545 DOI: 10.1016/j.ejogrb.2024.04.037] [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: 07/16/2023] [Revised: 04/24/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024]
Abstract
Ectopic pregnancy (EP) is a pregnancy where the growing blastocyst implants outside the endometrial cavity. EP account approximately for 0.5-1% of all pregnancies, and extrauterine implant is the leading cause of woman mortality in the first trimester of gestation. Non-tubal pregnancies (NTP) account for less than 5% of all EP. NTP are accompanied by a 7-8 times higher risk of maternal mortality when compared to tubal pregnancies, and their treatment might sometimes be very challenging. Subserosal pregnancy (SP) has been defined as rare variant of intramural pregnancy, where a portion of the gestational sac was surrounded only by the serosa of the uterus. Whereas the treatment of the ectopic pregnancies is crucial for patients' lives and for adequate fertility sparing and considering the need for surgical treatment in many cases, an early diagnosis is important; thus we believe it g might be useful to define some criteria to guide subserosal pregnancy identification, and to distinguish it from other types of non-tubal ectopic pregnancy. A systematic review on Pubmed, Scopus, Web of Science and Google Scholar was performed. Case reports, randomized controlled trials, prospective controlled studies, prospective cohort studies, retrospective studies, and case series were considered eligible. In all databases mentioned were considered manuscripts published from 1990 up to March 2023. Only four articles were eligible for inclusion in this review. All patients underwent to surgical management in laparoscopy. The main risk factors for this type of ectopic pregnancy were previous uterine surgery with opening of the endometrial cavity and assisted reproductive techniques procedures. Considering our results, we propose new classification and diagnostic criteria for subserosal pregnancy, to distinguish it from other types of non-tubal ectopic pregnancies with the aim to preserve fertility following the most correct management.
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Affiliation(s)
- Guglielmo Stabile
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy.
| | - Francesco Cracco
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy
| | - Giulia Zinicola
- Department of Woman and Child Health and Public Health, Woman Health Area, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Stefania Carlucci
- Department of Medical and Surgical Sciences, Institute of Obstetrics and Gynecology, University of Foggia, 71121 Foggia, Italy
| | | | - Tamara Stampalija
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
| | - Giuseppe Ricci
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34100 Trieste, Italy; Institute for Maternal and Child Health IRCCS "Burlo Garofolo", 34100 Trieste, Italy
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Obaid M, Abdelazim IA, Abu-Faza M. Regarding "Cornual Pregnancy Reaching Eight Weeks of Gestation without Uterine Rupture". J Minim Invasive Gynecol 2024:S1553-4650(24)00215-2. [PMID: 38750692 DOI: 10.1016/j.jmig.2024.04.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2024] [Accepted: 04/27/2024] [Indexed: 06/01/2024]
Affiliation(s)
- Mariam Obaid
- Department of Obstetrics and Gynecology (Drs Obaid, Abdelazim and Abu-Faza), Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait; Department of Obstetrics and Gynecology (Dr Abdelazim), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ibrahim A Abdelazim
- Department of Obstetrics and Gynecology (Drs Obaid, Abdelazim and Abu-Faza), Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait; Department of Obstetrics and Gynecology (Dr Abdelazim), Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Mohannad Abu-Faza
- Department of Obstetrics and Gynecology (Drs Obaid, Abdelazim and Abu-Faza), Ahmadi Hospital, Kuwait Oil Company (KOC), Ahmadi, Kuwait; Department of Obstetrics and Gynecology (Dr Abdelazim), Faculty of Medicine, Ain Shams University, Cairo, Egypt
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Dunphy L, Haresnape C, Furara S. Interstitial ectopic pregnancy successfully treated with methotrexate. BMJ Case Rep 2023; 16:e252588. [PMID: 37185311 PMCID: PMC10151976 DOI: 10.1136/bcr-2022-252588] [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] [Indexed: 05/17/2023] Open
Abstract
An ectopic pregnancy (EP) occurs when the fertilised ovum implants outside the endometrial cavity. An EP has an incidence of 1%, with the majority occurring in the fallopian tube. It has a maternal mortality of 0.2 per 1000, with about two-thirds of these deaths associated with substandard care. An interstitial pregnancy occurs when the EP implants in the interstitial part of the fallopian tube. An interstitial ectopic pregnancy (IEP) shows few early clinical symptoms, hence it is associated with serious or fatal bleeding and a mortality rate up to 2.5%. With the advent of transvaginal ultrasound scan (TV USS), correlated with serum beta human chorionic gonadotropin (BHCG) assay, earlier diagnosis of an EP can be established. An EP is often diagnosed in women who are trying to conceive; therefore, the prognosis of future fertility is one of the main concerns associated with this diagnosis. Management can be surgical, expectant or medical with methotrexate (MTX). However, the best approach is tailored to the woman's individual case. The authors present the case of a primigravida woman presenting with abdominal pain and vaginal bleeding at 6 weeks gestation following assisted reproduction. Her BHCG showed a suboptimal rise. Her TV USS showed no evidence of an intrauterine pregnancy. There was no evidence of an adnexal mass or free fluid. As her BHCG remained static, she underwent a diagnostic laparoscopy. A right sided IEP was identified. Due to the high risk of bleeding requiring transfusion or hysterectomy and her desire to preserve her fertility, she received medical management with MTX. Indeed, research has shown that women successfully managed expectantly achieve better reproductive outcomes, with the shortest time to achieve a subsequent intrauterine pregnancy. This case acts as a cautionary reminder of the challenges associated with identifying an IEP on TV USS. A high index of clinical suspicion is required to prevent maternal morbidity and mortality.
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Affiliation(s)
- Louise Dunphy
- Department of Gynaecology, Leighton Hospital, Crewe, UK
| | | | - Samira Furara
- Department of Gynaecology, Leighton Hospital, Crewe, UK
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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: 1] [Impact Index Per Article: 1.0] [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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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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Goh J, Ng Z, Shahul Hameed M. Hysteroscopy is a useful diagnostic and therapeutic tool for the treatment of angular pregnancy. Gynecol Minim Invasive Ther 2022; 11:78-79. [PMID: 35310123 PMCID: PMC8926045 DOI: 10.4103/gmit.gmit_120_20] [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: 09/09/2020] [Revised: 03/15/2021] [Accepted: 03/25/2021] [Indexed: 11/04/2022] Open
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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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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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Diagnosis and Management of Ectopic Pregnancy: A Comparative Review of Major National Guidelines. Obstet Gynecol Surv 2021; 75:611-623. [PMID: 33111962 DOI: 10.1097/ogx.0000000000000832] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Importance Ectopic pregnancies (EPs) represent a severe early pregnancy complication that is associated with increased risks of maternal morbidity and mortality. Over the years, there has been a significant reduction in the mortality from this complication by improving the diagnostic tools and the treatment options. Objective The aim of this study was to review and compare the recommendations from published guidelines on this potentially fatal condition. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the Society of Obstetricians and Gynaecologists of Canada, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence on EP was carried out. Results All the guidelines point out the crucial role of sonography in the prompt diagnosis of EP and describe similar sonographic findings. There is a consensus on the indications and contraindications to the use of methotrexate, the post-treatment surveillance, and the criteria of expectant management. The indications for a surgical approach are not well established, although the Royal College of Obstetricians and Gynaecologists, the Royal College of Physicians of Ireland, the American College of Obstetricians and Gynecologists, and the National Institute for Health and Care Excellence agree that a laparoscopy is preferred to laparotomy for hemodynamically stable patients. The latter is considered a better option only in emergency conditions. However, there is controversy in the recommended methotrexate protocols and the evaluation of β-human chorionic gonadotrophin and progesterone levels. Conclusion It is of paramount importance to build consistent international protocols, so as to help clinicians all over the world diagnose EPs in the most timely and accurate way and subsequently treat them effectively as a nonurgent medical condition, with the intention to lower the mortality and morbidity rate.
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Dhanawat J, Pape J, Stuhlmann‐Laeisz C, Maass N, Freytag D, Gitas G, Alkatout I. Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D-ultrasound and primary laparoscopic management. Clin Case Rep 2021; 9:e04261. [PMID: 34084520 PMCID: PMC8142796 DOI: 10.1002/ccr3.4261] [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: 08/18/2020] [Revised: 01/23/2021] [Indexed: 11/12/2022] Open
Abstract
Unicornuate uterus with pregnancy in the noncommunicating rudimentary horn is extremely rare. Diagnosis requires awareness, high suspicion index, 3D ultrasound, and MRI. If missed, it can be catastrophic. Treatment varies across literature. We present a case where detection was done by 3D ultrasound and primary laparoscopic surgery done for treatment.
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Affiliation(s)
- Juhi Dhanawat
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Julian Pape
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | | | - Nicolai Maass
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Damaris Freytag
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
| | - Georgios Gitas
- Department of Gynaecology and ObstetricsUniversity Hospitals Schleswing‐HolsteinLeubeckGermany
| | - Ibrahim Alkatout
- Department of Gynecology and ObstetricsUniversity Hospitals Schleswig‐HolsteinKielGermany
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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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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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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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Hirshberg B, Rheinboldt M. Multimodality imaging of acute locoregional and systemic complications in the setting of assisted reproduction. Emerg Radiol 2019; 26:205-219. [PMID: 30631995 DOI: 10.1007/s10140-018-01665-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 12/13/2018] [Indexed: 02/02/2023]
Abstract
Over the past 40 years since the first in vitro fertilization was performed, both the role of assisted reproductive technology (ART) in establishing viable pregnancy as well as the available treatment options have expanded enormously. Annually in the USA, nearly 2% of pregnancies now employ some form of ART assistance, with in vitro fertilization (IVF) being the most commonly utilized methodology. Both maternal and fetal risks are elevated in ART pregnancies, the latter including adverse outcome due to both increased gestational number as well as advanced maternal age. Maternal risks may be divided into locoregional and systemic complications. Adverse pelvic complications include those relating to gamete harvesting and transfer, ovarian hyperstimulation, the sequela of ectopic and heterotopic pregnancies, as well as ovarian torsion, all of which are elevated in the ART cohort. Ovarian hyperstimulation syndrome is the most commonly encountered complication, with both systemic and pelvic features relating to increased vascular permeability, hemoconcentration, and ascites. While life-threatening cases are relatively rare, moderate and severe manifestations may occur in up to 10% of ART cycles and, as such, are a not infrequent cause for ER visitation. Familiarity with the clinical and imaging manifestations of ART complications as well as their prognostic implications will facilitate a timely diagnosis and assist the interpreting radiologist in best expediting appropriate clinical care. In this article, we will briefly discuss the current methodology of ART then present an imaging-based multimodality review of the potentially encountered adverse maternal sequela, highlighting key diagnostic features and differential considerations as well as potential prognostic implications.
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Monacci F, Lanfredini N, Zandri S, Strigini F, Luchi C, Giannini A, Simoncini T. Diagnosis and laparoscopic management of a 5-week ectopic pregnancy in a rudimentary uterine horn: A case report. Case Rep Womens Health 2018; 21:e00088. [PMID: 30591910 PMCID: PMC6305893 DOI: 10.1016/j.crwh.2018.e00088] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Revised: 11/02/2018] [Accepted: 11/13/2018] [Indexed: 11/30/2022] Open
Abstract
Uterine anomalies result from the failure of complete fusion of the Müllerian ducts during embryogenesis. A unicornuate uterus with a rudimentary horn is the rarest anomaly and results from the failure of one of the Müllerian ducts to develop completely and an incomplete fusion with the contralateral side. Diagnosis and surgical management of a 5-week ectopic pregnancy in a non-communicating rudimentary horn in an 18-year-old nulliparous woman in whom this congenital uterine anomaly was previously unknown are described. The incidence varies from 1 per 76000 pregnancies to 1 per 140000. Ultrasound sensitivity ranges from 33% to 14% in non-symptomatic cases. The major risk is a rupture during the second or third trimester. After diagnosis, immediate laparoscopic surgery is most commonly recommended. Ultrasound during early obstetric scan is the key for a correct management.
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Affiliation(s)
- F Monacci
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - N Lanfredini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - S Zandri
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - F Strigini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - C Luchi
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - A Giannini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
| | - T Simoncini
- Department of Clinical and Experimental Medicine, Division of Gynecology and Obstetrics, University of Pisa, Italy
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Herchelroath D, Miller JL, Wang KC. Novel Management of Ectopic Pregnancy in a Noncommunicating Rudimentary Horn of a Unicornuate Uterus. J Osteopath Med 2018; 118:623-626. [DOI: 10.7556/jaoa.2018.137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
Pregnancy in a rudimentary horn is a rarely encountered form of ectopic pregnancy and is often an emergent situation because of the risk of rupture of the horn. A 31-year-old gravida 3 para 1 woman with 7 to 8 weeks’ gestational age was found to have a viable pregnancy in a rudimentary noncommunicating horn of a unicornuate uterus. She elected termination of the pregnancy via local intracardiac lidocaine and intra-amniotic methotrexate injections. Subsequent removal of the rudimentary horn was necessary to prevent recurrence. Because of the risk of rupture, the diagnosis and management of an ectopic pregnancy in a rudimentary horn can be emergent.
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Dove CK, Harvey SM, Spalluto LB. Sonographic findings of early pregnancy in the rudimentary horn of a unicornuate uterus: A two case report. Clin Imaging 2018; 47:25-29. [DOI: 10.1016/j.clinimag.2017.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 08/09/2017] [Accepted: 08/11/2017] [Indexed: 10/19/2022]
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18
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Yu L, Xu L, Xu X. Treatment of cornual pregnancy in a patient with adenomyosis by high-intensity focused ultrasound (HIFU) ablation: A case report. Medicine (Baltimore) 2017; 96:e8874. [PMID: 29310371 PMCID: PMC5728772 DOI: 10.1097/md.0000000000008874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 10/31/2017] [Accepted: 11/04/2017] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Cornual ectopic pregnancy in adenomyosis patients is a rare clinical condition, which may require careful approach for accurate diagnosis and treatment. PATIENT CONCERNS A 38-year-old woman presented with amenorrhea for 8 weeks and serum HCG levels of 1455 mmol/L. The B ultrasound showed an endometrial thickness of 1.7 cm, and the presence of a cystic structure (16 6 mm) at the right uterine horn. Color Doppler flow imaging (CDFI) accurately detected and confirmed the position of the cystic structure with its clear boundaries. DIAGNOSES Cornual ectopic pregnancy in adenomyosis. INTERVENTIONS The diagnosis was confirmed and treated by HIFU ablation. Total ablation was performed for 738 seconds without any bleeding. OUTCOMES Serum HCG levels decreased to < 0.1 mmol/L after 60 days post operation, and follow-up for 11 months showed a regular menstrual cycle without dysmenorrhea. Gestational sac was not obvious at postoperative 90 days by MRI. The adenomyosis associated lesion with blood perfusion became smaller at postoperative 90 days. LESSONS In this case, we successfully performed HIFU ablation and treated the cornual ectopic pregnancy in an adenomyosis patient for the first time, without any adverse complications.
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Yassin A, Munaza S, Mohammed A. Tale of rudimentary horn pregnancy: case reports and literature review. J Matern Fetal Neonatal Med 2017; 32:671-676. [PMID: 29034759 DOI: 10.1080/14767058.2017.1387533] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Rudimentary horn pregnancy (RHP) is a rare form of pregnancy in a rudimentary uterine horn with a reported incidence of 1 in 76,000 and 1 in 150,000. A significant number of cases is diagnosed only following rupture of the RHP with an estimated maternal mortality rate of 0.5%. Early diagnosis can help in planning management before its rupture and allows for surgical treatment using laparoscopy.
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Affiliation(s)
- Ahmed Yassin
- a Department of Obstetrics & Gynecology , Sidra Medical and Research Center & Weill Cornell Medicine , Doha , Qatar.,b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Shahzadi Munaza
- b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar
| | - Abdelbaset Mohammed
- b Department of Obstetrics & Gynecology , Women's Hospital, Hamad Medical Corporation , Doha , Qatar.,c Department of Obstetrics & Gynecology , Minia Univeristy , Minia , Egypt
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20
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Grant A, Murji A, Atri M. Can the Presence of a Surrounding Endometrium Differentiate Eccentrically Located Intrauterine Pregnancy from Interstitial Ectopic Pregnancy? JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2017; 39:627-634. [DOI: 10.1016/j.jogc.2017.03.087] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2017] [Accepted: 03/06/2017] [Indexed: 11/24/2022]
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21
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Baltarowich OH. The Term "Cornual Pregnancy" Should Be Abandoned. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:1081-1087. [PMID: 28429456 DOI: 10.1002/jum.14207] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Accepted: 03/15/2017] [Indexed: 06/07/2023]
Affiliation(s)
- Oksana H Baltarowich
- Sidney Kimmel Medical College Jefferson Ultrasound Radiology and Education Institute Department of Radiology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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22
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Blancafort C, Graupera B, Pascual MÀ, Hereter L, Browne JL, Cusidó MT. Diagnosis and laparoscopic management of a rudimentary horn pregnancy: Role of three-dimensional ultrasound. JOURNAL OF CLINICAL ULTRASOUND : JCU 2017; 45:112-115. [PMID: 27612443 DOI: 10.1002/jcu.22393] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 07/06/2016] [Accepted: 08/06/2016] [Indexed: 06/06/2023]
Abstract
Rudimentary horn pregnancy occurs in 1 in 76,000-150,000 pregnancies and causes uterine rupture in about 80% of cases. The use of three-dimensional transvaginal ultrasound seems to be useful for its early detection. We present a case of an 8-week pregnancy in a rudimentary horn, managed by laparoscopic excision. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 45:112-115, 2017.
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Affiliation(s)
- Claudia Blancafort
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Betlem Graupera
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Maria Àngela Pascual
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Lourdes Hereter
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Jean Laurent Browne
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
| | - Maria Teresa Cusidó
- Department of Obstetrics, Gynecology and Reproduction, Institut Universitari Dexeus, Barcelona, Spain
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23
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Imaging Unusual Pregnancy Implantations: Rare Ectopic Pregnancies and More. AJR Am J Roentgenol 2016; 207:1380-1392. [DOI: 10.2214/ajr.15.15290] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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25
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Ng ZY, Tan TY, Aggarwal IM. Laparoscopic Management of Rudimentary Horn Pregnancy: A Case Report and Review of the Literature. J Gynecol Surg 2016. [DOI: 10.1089/gyn.2016.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Zheng Yuan Ng
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Tse Yeun Tan
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
| | - Ieera Madan Aggarwal
- Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore, Singapore
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26
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Tanaka Y, Mimura K, Kanagawa T, Kajimoto E, Takahashi K, Kakigano A, Fujita S, Kinugasa-Taniguchi Y, Endo M, Kimura T. Three-dimensional sonography in the differential diagnosis of interstitial, angular, and intrauterine pregnancies in a septate uterus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2014; 33:2031-2035. [PMID: 25336492 DOI: 10.7863/ultra.33.11.2031] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Interstitial, angular, and cornual pregnancies and intrauterine pregnancies in an anomalous uterus are separate entities, and the impact of each condition on obstetric outcomes is completely different. However, there is considerable confusion in understanding and managing the natural course of each condition due to a lack of uniform terminology. The single most important factor for differentiating these types of pregnancies is to make an early diagnosis. The differences between interstitial, angular, and cornual pregnancies on 2-dimensional (2D) sonography are subtle. Although magnetic resonance imaging can be used to differentiate these conditions, it is not preferred as the initial assessment tool because of its limited availability and cost-effectiveness. Three-dimensional (3D) sonography has the advantage of providing views of the uterus that cannot be obtained with conventional 2D sonography. We describe 3 cases of interstitial, angular, and intrauterine pregnancies in a septate uterus that were clearly differentiated by 3D sonography. We demonstrate the differences in diagnostic imaging findings and emphasize the importance of 3D sonography in differentiating these entities.
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Affiliation(s)
- Yusuke Tanaka
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuya Mimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan.
| | - Takeshi Kanagawa
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Etsuko Kajimoto
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kei Takahashi
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Aiko Kakigano
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Satoko Fujita
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | | | - Masayuki Endo
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Tadashi Kimura
- Department of Obstetrics and Gynecology, Osaka University Graduate School of Medicine, Osaka, Japan
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Knez J, Day A, Jurkovic D. Ultrasound imaging in the management of bleeding and pain in early pregnancy. Best Pract Res Clin Obstet Gynaecol 2014; 28:621-36. [PMID: 24841987 DOI: 10.1016/j.bpobgyn.2014.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2014] [Revised: 03/16/2014] [Accepted: 04/10/2014] [Indexed: 12/27/2022]
Abstract
Bleeding and pain are experienced by 20% of women during the first trimester of pregnancy. Although most pregnancies complicated by pain and bleeding tend to progress normally, these symptoms are distressing for woman, and they are also associated with an increased risk of miscarriage and ectopic pregnancy. Ultrasound is the first and often the only diagnostic modality that is used to determine location of early pregnancy and to assess its health. Ultrasound is an accurate, safe, painless and relatively inexpensive diagnostic tool, which all contributed to its widespread use in early pregnancy. Pain and bleeding in early pregnancy are sometimes caused by concomitant gynaecological, gastrointestinal, and urological problems, which could also be detected on ultrasound scan. In women with suspected intra-abdominal bleeding, ultrasound scan can be used to detect the presence of blood and provide information about the extent of bleeding. In this chapter, we comprehensively review the use of ultrasound in the diagnosis and management of early pregnancy complications. We include information about the diagnosis of gynaecological and other pelvic abnormalities, which could cause pain or bleeding in pregnancy. We also provide a summary of the current views on the safety of ultrasound in early pregnancy.
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Affiliation(s)
- Jure Knez
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Andrea Day
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK
| | - Davor Jurkovic
- Gynaecology Diagnostic and Outpatient Treatment Unit, Elizabeth Garrett Anderson Wing, University College Hospital, 235 Euston Road, London NW1 2BU, UK.
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28
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Guerriero S, Ajossa S, Gerada M, Virgilio B, Pilloni M, Galvan R, Laparte MC, Alcázar JL, Melis GB. Transvaginal ultrasonography in the diagnosis of extrauterine pelvic diseases. ACTA ACUST UNITED AC 2014. [DOI: 10.1586/17474108.3.6.731] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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29
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Hirose I, Harada K, Kuroda R, Ishii Y, Nakajima M, Kamei Y, Takazawa Y, Yoshida KI. An autopsy report on a ruptured rudimentary horn (uterine anomaly) with ectopic pregnancy. Forensic Sci Int 2013; 224:e4-6. [PMID: 23265443 DOI: 10.1016/j.forsciint.2012.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 09/17/2012] [Accepted: 10/08/2012] [Indexed: 11/26/2022]
Abstract
The rudimentary horn is a rare developmental anomaly of the Müllerian duct. Ectopic pregnancy in the rudimentary horn is estimated to occur in one out of 76,000-150,000 pregnancies. A 30-year-old primigravida suddenly collapsed after 3 days of continuous abdominal pain. Emergency laparotomy revealed a massive intraperitoneal hemorrhage and fetal demise. The growth of the fetus after 19 weeks of gestation is believed to have caused the rudimentary horn rupture, thereby rapidly leading to hemorrhagic shock in the mother and ischemic death in the fetus. This is the first autopsy report on maternal death due to the rudimentary horn or other Müllerian duct anomalies, which emphasizes the need for forensic pathologists to consider this condition as a possible cause of unexpected death in fertile women. In addition, it is very important for clinicians to detect Müllerian duct anomalies by sonography during routine obstetric examinations, and promptly diagnose anomaly related ectopic pregnancies in women displaying symptoms of an acute abdomen, intraperitoneal hemorrhage, or shock in the emergency practice.
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Affiliation(s)
- Izumi Hirose
- Department of Forensic Medicine, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
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30
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Siwatch S, Mehra R, Pandher DK, Huria A. Rudimentary horn pregnancy: a 10-year experience and review of literature. Arch Gynecol Obstet 2012. [PMID: 23183713 DOI: 10.1007/s00404-012-2625-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
UNLABELLED Rudimentary horn pregnancy is rare, but can cause considerable morbidity and mortality. We discuss five cases presented to our hospital in the last 10 years and systematically review the 10-year literature of rudimentary horn pregnancies diagnosed antenatally pre-rupture. OBJECTIVES OF THE REVIEW The aim of the review was to find radiologic investigations/criteria to diagnose rudimentary horn pregnancy antenatally pre-rupture. SEARCH METHODS A systematic literature review was carried out in Pubmed search for rudimentary horn pregnancies. The radiologic findings of the cases diagnosed before rupture were analyzed. RESULTS Ultrasound is the most commonly used technique, though MRI seems to delineate details better. Non-continuity of the lumen of the cervix with the pregnant uterine horn is an important imaging finding. High clinical suspicion and radiologic skill for diagnosis are emphasized. CONCLUSIONS The review presents the existing imaging criteria to diagnose rudimentary horn pregnancy and suggests future research to enhance the limited evidence.
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Affiliation(s)
- Sujata Siwatch
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Sector-32, Chandigarh 160032, India.
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Abstract
The majority of ectopic pregnancies can be diagnosed on transvaginal scan before treatment. Diagnosis should be based on positive visualization of an ectopic pregnancy rather the inability to visualize an intrauterine pregnancy. The majority of ectopic pregnancies will be visible on the initial transvaginal scan performed. Those who do not have their ectopic pregnancies visualized on the first examination will be initially classified as having a pregnancy of unknown location. They will then need follow-up until a diagnosis of ectopic pregnancy is confirmed. This review discusses the use of ultrasound in the diagnosis of ectopic pregnancy and the specific criteria for diagnosis of the different types of ectopic pregnancy.
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32
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Affiliation(s)
- Cemil Yaman
- Department of Obstetrics and Gynecology, General Hospital of Linz, Linz, Austria
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33
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van Esch EMG, Lashley EELO, Berning B, de Kroon CD. The value of hysteroscopy in the diagnostic approach to a rudimentary horn pregnancy. BMJ Case Rep 2010; 2010:2010/dec17_1/bcr0820103229. [PMID: 22802375 DOI: 10.1136/bcr.08.2010.3229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 33-year-old woman presented with an ectopic pregnancy without any complaints. Laparoscopy was performed since a tubal pregnancy was expected. However, both fallopian tubes appeared normal and it was not possible to differentiate accurately between a pregnancy in a non-communicating horn and a pregnancy in a bicornuate uterus. We therefore performed MRI which showed a thin myometrium around the pregnancy. In order to differentiate between a communicating and a non-communicating uterine horn the authors performed a hysteroscopy. Since there was only one cervical os, and an entrance to the second uterine cavity was not seen along the cervical canal, it was concluded that this pregnancy was situated in a non-communicating rudimentary horn. The non-communicating uterine horn, with the pregnancy in situ, was completely removed. Since a pregnancy in a bicornuate uterus is viable in contrast to a pregnancy in a non-communicating horn, accurate diagnosis is important.
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Affiliation(s)
- E M G van Esch
- Department of Gynecology, Bronovo Hospital, The Hague, The Netherlands
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van der Veen NM, Brouns JFGM, Doornbos JP, van Wijngaarden WJ. Misoprostol and termination of pregnancy: is there a need for ultrasound screening in a general population to assess the risk for adverse outcome in cases of uterine anomaly? Arch Gynecol Obstet 2010; 283:1-5. [PMID: 20593191 PMCID: PMC3015193 DOI: 10.1007/s00404-010-1561-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2010] [Accepted: 06/08/2010] [Indexed: 11/26/2022]
Abstract
PURPOSE AND METHODS We reviewed the existing literature on medical termination of pregnancy in cases of congenital uterine malformation. Is medical termination of pregnancy safe in the presence of a uterine anomaly? Can termination of pregnancy still be performed when information concerning the presence of congenital uterine malformation is not available? RESULTS The risk of adverse outcome, i.e. uterine rupture, was high in class 2 uterine anomalies, whereas the risks in classes 3-6 were negligible. However, the very low incidence of class 2 anomalies in pregnant women results in a calculated risk of uterine rupture in medical termination of pregnancy on the basis of this anomaly of 1 in 300,000 pregnancies. Ultrasound scanning is of limited diagnostic value to diagnose congenital uterine malformations. CONCLUSIONS The implications of uterine anomalies are not an argument in the discussion whether to use misoprostol for termination of pregnancy in developing countries with scarce diagnostics tools.
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Affiliation(s)
- N. M. van der Veen
- Department of Obstetrics and Gynecology, Zaans Medical Centre, Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - J. F. G. M. Brouns
- Department of Obstetrics and Gynecology, Zaans Medical Centre, Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - J. P. Doornbos
- Department of Obstetrics and Gynecology, Zaans Medical Centre, Julianaplein 58, 1502 DV Zaandam, The Netherlands
| | - W. J. van Wijngaarden
- Department of Obstetrics and Gynecology, Bronovo Hospital, Bronovolaan 5, 2597 AX The Hague, The Netherlands
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Shahid A, Olowu O, Kandasamy G, O'Donnell C, Odejinmi F. Laparoscopic management of a 16-week ruptured rudimentary horn pregnancy: a case and literature review. Arch Gynecol Obstet 2009; 282:121-5. [PMID: 19705138 DOI: 10.1007/s00404-009-1212-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2009] [Accepted: 08/10/2009] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Pregnancy in a rudimentary horn is although rare, but is associated with the risk of rupture and life threatening hemorrhage. With the use of ultrasound the diagnosis can be made before symptoms occur. Management usually consists of excision of the rudimentary horn along with the pregnancy and the ipsilateral tube, traditionally by laparotomy. MATERIALS AND METHODS We present a case of a 16-week ruptured rudimentary horn pregnancy diagnosed intraoperatively and managed laparoscopically in the presence of massive haemoperitoneum, which is first of its kind along with literature review. CONCLUSION This case demonstrates that laparoscopy is a feasible approach and can provide rapid diagnosis and control of bleeding in such cases provided there is availability of efficient multi-disciplinary teamwork, optimal anesthesia, advanced cardiovascular monitoring, laparoscopic expertise and ability to convert rapidly to laparotomy if required.
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Affiliation(s)
- Anupama Shahid
- Department of Obstetrics and Gynecology, Whipps Cross University Hospital, London E11 1NR, UK
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36
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Treating non-tubal ectopic pregnancy. Best Pract Res Clin Obstet Gynaecol 2009; 23:529-38. [PMID: 19230785 DOI: 10.1016/j.bpobgyn.2008.12.011] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Accepted: 12/15/2008] [Indexed: 12/28/2022]
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37
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Perez-Medina T, García-Andrade C, Bajo-Arenas J. Advanced pregnancy loss in the rudimentary horn of an undiagnosed unicornuate uterus. J Obstet Gynaecol Res 2009; 35:572-3. [DOI: 10.1111/j.1447-0756.2008.00978.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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