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Ponniah R, Battina S, Battina S. Pregnancy in a Non-communicating Rudimentary Uterine Horn Managed with Laparoscopy in the First Trimester. J Minim Invasive Gynecol 2024:S1553-4650(24)01570-X. [PMID: 39742958 DOI: 10.1016/j.jmig.2024.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 12/24/2024] [Accepted: 12/27/2024] [Indexed: 01/04/2025]
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Ekpe E, Garg N, Lui P, Sheran J, Chaudhari A. Laparoscopic Management of an Advanced Nonruptured Ectopic Pregnancy in a Rudimentary Uterine Horn. J Minim Invasive Gynecol 2023; 30:169-170. [PMID: 36509395 DOI: 10.1016/j.jmig.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 12/04/2022] [Accepted: 12/05/2022] [Indexed: 12/14/2022]
Affiliation(s)
- Etoroabasi Ekpe
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Drs. Ekpe, Lui, Sheran, and Chaudhari)
| | - Nisha Garg
- Arizona Gynecology Consultants, Phoenix, Arizona (Dr. Garg).
| | - Pamela Lui
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Drs. Ekpe, Lui, Sheran, and Chaudhari)
| | - Jordan Sheran
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Drs. Ekpe, Lui, Sheran, and Chaudhari)
| | - Angela Chaudhari
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, Illinois (Drs. Ekpe, Lui, Sheran, and Chaudhari)
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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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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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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: 2.3] [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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Ueda M, Ota K, Takahashi T, Suzuki S, Suzuki D, Kyozuka H, Jimbo M, Soeda S, Watanabe T, Fujimori K. 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 Childbirth 2021; 21:715. [PMID: 34702216 PMCID: PMC8547051 DOI: 10.1186/s12884-021-04195-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 10/12/2021] [Indexed: 11/10/2022] Open
Abstract
Background Pregnancy in a rudimentary horn is an extremely rare type of ectopic pregnancy. A rudimentary uterine horn pregnancy is associated with a risk of spontaneous rupture and bleeding during surgery due to the increased uterine blood flow. Recent advances in imaging modalities have enabled laparoscopic surgery to be performed in cases without rupture in the early stages of pregnancy. However, there are few reports of successful pregnancies and deliveries after treatment of rudimentary horn pregnancies. We report the successful management of a case of non-communicating rudimentary horn pregnancy by local injection of methotrexate followed by complete laparoscopic excision along with a review of the literature. Case presentation The patient was a 29-year-old Japanese woman, gravida 2, nullipara. She was diagnosed with a left unicornuate uterus with a right non-communicating rudimentary horn on hysterosalpingography and magnetic resonance imaging. A gestational sac with a heartbeat was observed in the right rudimentary uterine horn at 6 weeks of gestation. A diagnosis of ectopic pregnancy in a non-communicating rudimentary horn was made. Color Doppler detected multiple blood flow signals around the gestational sac, which were clearly increased compared to the left unicornuate uterus. Her serum human chorionic gonadotropin level was 104,619 mIU/ml. A 100 mg methotrexate injection into the gestational sac was administered, and laparoscopic surgery was performed on day 48 after the methotrexate treatment. The right rudimentary horn and fallopian tube were successfully excised with minimal bleeding. A spontaneous normal pregnancy was established 6 months after the surgery. The pregnancy was uneventful, and a baby girl was born by elective cesarean section at 38w0d. Conclusion Combined local methotrexate injection and laparoscopic surgery are safe treatment options for patients with a unicornuate uterus with a non-communicating rudimentary horn pregnancy.
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Affiliation(s)
- Makiko Ueda
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
| | - Kuniaki Ota
- Fukushima Medical Center for Children and Women, Fukushima medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.,Department of Obstetrics and Gynecology, Toho University, Tokyo, 143-8541, Japan
| | - Toshifumi Takahashi
- Fukushima Medical Center for Children and Women, Fukushima medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan.
| | - Satoshi Suzuki
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
| | - Daisuke Suzuki
- Fukushima Medical Center for Children and Women, Fukushima medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Hyo Kyozuka
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
| | - Masatoshi Jimbo
- Fukushima Medical Center for Children and Women, Fukushima medical University, 1 Hikarigaoka, Fukushima City, Fukushima, 960-1295, Japan
| | - Shu Soeda
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
| | - Takafumi Watanabe
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
| | - Keiya Fujimori
- Department of Obstetrics and Gynecology, Fukushima medical University, Fukushima, 960-1295, Japan
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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: 6] [Impact Index Per Article: 1.5] [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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