Successful diagnosis and management of prerupture rudimentary horn pregnancy in the second trimester: a case report

Rupture of non-communicating rudimentary horn at 35 weeks ending with a live birth: A case report

INTRODUCTION AND IMPORTANCE: the rudimentary horn pregnancy frequently ruptured in the second and third trimesters during the normal process of rudimentary horn pregnancy (RHP) which results in a hemoperitoneum that may be fatal, however in very rare cases and under close observation, the pregnancy may continue and end with a live birth.

CASE PRESENTATION

A 30 years-old woman gravida 3, para 4 with no symptoms presented to the hospital at 30 weeks gestation for a routine examination and misdiagnosed as an abdominal ectopic pregnancy. The pregnancy continued for approximately 35 weeks, when a ruptured rudimentary horn pregnancy was discovered accidently during an emergency surgery, the left fallopian tube and ovary and the ruptured rudimentary horn were removed.

CLINICAL DISCUSSION

Unicornuate uterus is a result of abnormal or failed development of one of the paired müllerian ducts, Spontaneous abortion in women with rudimentary horn pregnancy may occurs in the first and second trimester. Rudimentary horn pregnancies are associated with high maternal morbidity and mortality, And because of the risk of life-threatening complications, early diagnosis before rupture is essential for the successful management and prevention of these complications.

CONCLUSION

The diagnosis of most cases of rudimentary horn pregnancy is considered challenging, and could be diagnosed after rupture, during emergency surgery. Although rudimentary horn pregnancy mostly ends in the first and second trimester, in some cases it may continue until term and end with a live healthy child.

Distinguishing between cornual, angular and interstitial ectopic pregnancy: A case report and a brief literature review

For all clinical purposes, cornual, angular, and interstitial pregnancies are considered ectopic pregnancies that can have grave consequences for the patient. In this article, we describe and distinguish 3 types of ectopic pregnancies in the cornual region of the uterus. The authors advocate using the "cornual pregnancy" term only for ectopic pregnancies in malformed uteruses. We describe an ectopic pregnancy in a 25-year-old G2P1 patient in the cornual region of the uterus that was missed twice sonographically in the second trimester and had almost fatal consequences in the patient. Radiologists and sonographers should be aware of the sonographic diagnosis of angular, cornual and interstitial pregnancies. Whenever possible, first-trimester transvaginal ultrasound scanning is crucial for diagnosing these 3 types of ectopic pregnancies in the cornual region. In the second and third trimesters, ultrasound tends to become equivocal; hence alternate imaging, such as MRI, might add additional value to the management of the patient. A case report assessment and a comprehensive literature review comprising 61 case reports of ectopic pregnancy in the second and third trimesters are diligently undertaken in the Medline, Embase and Web of Science databases. The major strength of our study is that it is one of the few studies that describe a literature review of ectopic pregnancy in the cornual region exclusively in the second and third trimesters.

An abdominal ectopic pregnancy following in vitro fertilization: a rare case report

A significant rise in the incidence of abdominal pregnancy has been reported following in vitro fertilization techniques. Herein, we present a healthy 30-year-old woman, primigravida, conceived through in vitro fertilization–embryo transfer for male factor infertility. Six weeks later, she reported abdominal pain and discomfort. Ultrasonography revealed an empty uterus and a heterogenic abdominal mass in the anterior aspect of the uterus with normal adnexa. Computed tomography scan revealed a mass outside the uterus measuring 11 × 8 cm. Under general anesthesia, laparotomy exposed a gestational sac implanted outside the uterus on the anterior abdominal wall and contained an unviable fetus. Blood clots and pieces of placental tissue were also noticed. The patient had an uneventful course of recovery and was discharged after six days. Therefore, abdominal ectopic pregnancy must be considered in all patients with vaginal bleeding and/or abdominal pain who have undergone assisted reproductive technology.

A challenging diagnosis and management of Herlyn-Werner-Wunderlich Syndrome in low-resource Settings: A case report complicated with hydronephrosis

Introduction

Herlyn-Werner-Wunderlich syndrome is a rare congenital disorder that consists of a didelphic uterus, hemivaginal septum, and unilateral renal agenesis. Both diagnosis and management can be challenging in low-income countries.

Case presentation

a 13-year-old female who experienced recurrent pelvic pain, dysmenorrhea, and abdominal mass for one month. We could not obtain the MRI as it was unavailable in our hospital, and the patient cannot afford its expensive cost in a private center. Instead, US showed an absent right kidney and doubled uterus with a heterogeneous cystic formation. A pelvic CT scan revealed an absent right kidney, an enlarged left kidney, a double uterus, and a left hematocolpos. We established the diagnosis of Herlyn-Werner-Wunderlich syndrome and started planning for correcting the anomalies via laparotomy.

Discussion

ultrasound detects uterus didelphys, hematocolpos, hematometrocolpos, and renal agenesis but cannot identify the vaginal septum and the type of müllerian defect. The MRI is more convenient for a thorough assessment, but it is a high-priced diagnostic method.

Conclusion

although MRI is the gold standard for establishing the diagnosis and preoperative planning, ultrasound and CT scan can be an alternative, less expensive, and reliable approach. In addition, Laparoscopy or vaginoscopy may not be available in these countries. Therefore, correcting the anomalies can be achieved with laparotomy, which results in acceptable outcomes without any complications.

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Herlyn-Werner-Wunderlich Syndrome is a rare müllerian anomaly.

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Although MRI can implant the diagnosis, US and CT scan are a sufficient alternative approach.

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Laparotomy can be used to correct the anomaly while preserving the hymen with minimal or no post-operative complications.