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Shamase NB, Ntsele SJ, Hammond AS. Non-communicating rudimentary horn pregnancy presenting as sudden unexpected maternal death: an autopsy diagnosis. Forensic Sci Med Pathol 2023; 19:382-387. [PMID: 35877006 DOI: 10.1007/s12024-022-00504-2] [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] [Accepted: 07/10/2022] [Indexed: 10/16/2022]
Abstract
Pregnancy on a rudimentary uterine horn is a rare condition that can lead to a catastrophic outcome when it ruptures. The majority of cases are diagnosed late, after the rupture has occurred. We present the case of a 29-year-old female G2 P1 who complained of abdominal pain. She consulted a medical practitioner who prescribed her analgesics. In the next day, she was found dead in her bedroom. The pregnancy was undiagnosed as she was not aware that she was in a gravid state. At autopsy, there was massive haemoperitoneum and a 24-week gestation foetus lying outside the uterus. The uterus revealed an anomaly in keeping with a non- communicating rudimentary horn. Forensic pathologists do encounter undiagnosed ectopic pregnancies in practice. However, abdominal ectopic pregnancy with a uterine anomaly remains uncommon. These cases are often associated with a high maternal and foetal mortality.
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Affiliation(s)
- Nonhlanhla B Shamase
- eThekwini Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa.
- Department of Forensic Medicine, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa.
- Department of Forensic Medicine, Level 1, Laboratory Building, Inkosi Albert Luthuli Central Hospital, 800 Bellair Road, Mayville, Durban, 4058, South Africa.
| | - Sibusiso J Ntsele
- eThekwini Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa
- Department of Forensic Medicine, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Ashley S Hammond
- eThekwini Forensic Pathology Services, KwaZulu-Natal Department of Health, Durban, South Africa
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2
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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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3
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Alsahabi JA, Alsary SA, Safwat D, Al-kadri HM. Acute late presentation of a functioning non-communicating rudimentary uterine horn containing an adenomyosis: A case report. Radiol Case Rep 2022; 17:4323-4327. [PMID: 36132060 PMCID: PMC9483621 DOI: 10.1016/j.radcr.2022.08.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 08/06/2022] [Accepted: 08/10/2022] [Indexed: 11/17/2022] Open
Abstract
A functioning noncommunicating rudimentary horn is a rare uterine malformation. The presence of rudimentary uterine horn with adenomyosis is even rarer situation. Clinical presentation varies from mild pain that might present late in the clinical course with complications that can be gynecological such as pelvic pain and endometriosis or obstetrical such as preterm delivery, cesarean section, and ectopic pregnancy. We are reporting a case of a young woman who presented with acute abdominal pain that was superimposed by chronic pelvic pain due to endometriosis and deep pelvic vein thrombosis secondary to an enlarging noncommunicating rudimentary uterine horn containing extensive adenomyosis. With the help of MRI, initial diagnosis was given as rudimentary functioning horn containing fibroid and unilateral renal agenesis. The treatment comprised complete laparoscopic excision of the entire horn, and the patient reported significant improvement afterward. Final histopathology was rudimentary horn containing adenomyosis. Our paper is one of few papers reported adenomyosis in function noncommunication rudimentary horn.
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Ma YC, Law KS. Pregnancy in a Non-Communicating Rudimentary Horn of Unicornuate Uterus. Diagnostics (Basel) 2022; 12:diagnostics12030759. [PMID: 35328312 PMCID: PMC8946958 DOI: 10.3390/diagnostics12030759] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 03/01/2022] [Accepted: 03/17/2022] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of non-communicating rudimentary horn pregnancy (RHP). The patient presented with lower abdominal pain and underwent laparoscopic surgery in which the gestational tissue was removed without excision of the rudimentary horn and ipsilateral fallopian tube. Unicornuate uteri often coexist with rudimentary horns, most of which are non-communicating. RHP is rare, and symptomatic women tend to complain of abdominal pain. Once RHP is suspected, the clinician should monitor the patient for signs of hypovolemic shock, such as hypotension, because the RHP can rupture owing to the poorly developed musculature. Early surgical intervention with removal of the rudimentary horn along with the ipsilateral fallopian tube is generally suggested to prevent future ectopic pregnancy. The theory of sperm transmigration from the contralateral oviduct has been hypothesized in non-communicating RHP.
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Affiliation(s)
- Yi-Cih Ma
- Department of Obstetrics and Gynecology, Tung’s Taichung MetroHarbor Hospital, Taichung 435, Taiwan;
| | - Kim-Seng Law
- Department of Obstetrics and Gynecology, Tung’s Taichung MetroHarbor Hospital, Taichung 435, Taiwan;
- Department of Nursing, Jenteh Junior College of Medicine, Nursing and Management, Miaoli 356, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung 402, Taiwan
- Correspondence: ; Tel.: +886-916120758
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5
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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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6
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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: 6] [Impact Index Per Article: 2.0] [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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7
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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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8
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Surgical Management of an Obstructive Müllerian Anomaly in a Patient with Anorectal Malformation. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2021; 71. [PMID: 34414074 DOI: 10.1016/j.epsc.2021.101908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Müllerian duct anomalies are rare in the general population, occurring in less than 3% of women, but much more prevalent in female patients with anorectal malformation, occurring in up to 30% of these patients. Unicornuate uterus with a rudimentary non-communicating horn is a congenital anomaly of Mullerian development which can be seen in isolation or in conjunction with other anomalies, with several case reports described in patients with VACTERL association. These anomalies may be asymptomatic until the patient develops dysmenorrhea or devastating obstetrical complications. We describe the successful surgical management of an obstructive Müllerian anomaly in a post-pubertal female patient with anorectal malformation.
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9
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Ebanga L, Dabi Y, Thomassin-Naggara I, Castaigne V, Lefebvre M, Lecarpentier E, Miailhe G, Haddad B. [Original two steps management of an ectopic pregnancy on rudimentary horn in a patient with an unicornuate uterus: A unique case report with a literature review]. ACTA ACUST UNITED AC 2021; 49:943-946. [PMID: 34051426 DOI: 10.1016/j.gofs.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Indexed: 11/20/2022]
Affiliation(s)
- L Ebanga
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France.
| | - Y Dabi
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Université de Médecine Paris Est Créteil (UPEC), Paris XII, France.
| | - I Thomassin-Naggara
- Service de Radiologie, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Service de radiologie, Hôpital Tenon, AP-HP, UPMC Université Paris 06, France
| | - V Castaigne
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - M Lefebvre
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - E Lecarpentier
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Université de Médecine Paris Est Créteil (UPEC), Paris XII, France
| | - G Miailhe
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France
| | - B Haddad
- Service de Gynécologie Obstétrique et Médecine de la Reproduction, Centre Hospitalier Intercommunal de Créteil, 40, avenue de Verdun, 94000 Créteil, France; Université de Médecine Paris Est Créteil (UPEC), Paris XII, France
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10
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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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11
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Rupture of Rudimentary Horn Pregnancy at 16 Weeks of Gestation. Case Rep Obstet Gynecol 2021; 2021:8829053. [PMID: 33505745 PMCID: PMC7815397 DOI: 10.1155/2021/8829053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/22/2022] Open
Abstract
Pregnancy in the rudimentary horn is rare and a life-threatening. Rupture of pregnant rudimentary horn in the second trimester is a usual presentation. Early diagnosis and fast management are necessary to decrease the mortality and the morbidity of this pathological entity. This report confirms the diagnostic and therapeutic difficulties of the pregnant rudimentary horn. An emergency laparotomy was taken, and ruptured right rudimentary horn was diagnosed. A hemi-hysterectomy was carried out. The patient's postoperative follow-up was uneventful, and she left the hospital 5 days after.
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12
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Kirk E, Ankum P, Jakab A, Le Clef N, Ludwin A, Small R, Tellum T, Töyli M, Van den Bosch T, Jurkovic D. Terminology for describing normally sited and ectopic pregnancies on ultrasound: ESHRE recommendations for good practice. Hum Reprod Open 2020; 2020:hoaa055. [PMID: 33354626 PMCID: PMC7738750 DOI: 10.1093/hropen/hoaa055] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 10/09/2020] [Indexed: 11/24/2022] Open
Abstract
STUDY QUESTION What recommendations can be provided to improve terminology for normal and ectopic pregnancy description on ultrasound? SUMMARY ANSWER The present ESHRE document provides 17 consensus recommendations on how to describe normally sited and different types of ectopic pregnancies on ultrasound. WHAT IS KNOWN ALREADY Current diagnostic criteria stipulate that each type of ectopic pregnancy can be defined by clear anatomical landmarks which facilitates reaching a correct diagnosis. However, a clear definition of normally sited pregnancies and a comprehensive classification of ectopic pregnancies are still lacking. STUDY DESIGN SIZE DURATION A working group of members of the ESHRE Special Interest Group in Implantation and Early Pregnancy (SIG-IEP) and selected experts in ultrasound was formed in order to write recommendations on the classification of ectopic pregnancies. PARTICIPANTS/MATERIALS SETTING METHODS The working group included nine members of different nationalities with internationally recognised experience in ultrasound and diagnosis of ectopic pregnancies on ultrasound. This document is developed according to the manual for development of ESHRE recommendations for good practice. The recommendations were discussed until consensus by the working group, supported by a survey among the members of the ESHRE SIG-IEP. MAIN RESULTS AND THE ROLE OF CHANCE A clear definition of normally sited pregnancy on ultrasound scan is important to avoid misdiagnosis of uterine ectopic pregnancies. A comprehensive classification of ectopic pregnancy must include definitions and descriptions of each type of ectopic pregnancy. Only a classification which provides descriptions and diagnostic criteria for all possible locations of ectopic pregnancy would be fit for use in routine clinical practice. The working group formulated 17 recommendations on the diagnosis of the different types of ectopic pregnancies on ultrasound. In addition, for each of the types of ectopic pregnancy, a schematic representation and examples on 2D and 3D ultrasound are provided. LIMITATIONS REASONS FOR CAUTION Owing to the limited evidence available, recommendations are mostly based on clinical and technical expertise. WIDER IMPLICATIONS OF THE FINDINGS This document is expected to have a significant impact on clinical practice in ultrasound for early pregnancy. The development of this terminology will help to reduce the risk of misdiagnosis and inappropriate treatment. STUDY FUNDING/COMPETING INTERESTS The meetings of the working group were funded by ESHRE. T.T. declares speakers' fees from GE Healthcare. The other authors declare that they have no conflict of interest. TRIAL REGISTRATION NUMBER N/A. DISCLAIMER This Good Practice Recommendations (GPR) document represents the views of ESHRE, which are the result of consensus between the relevant ESHRE stakeholders and where relevant based on the scientific evidence available at the time of preparation. ESHRE's GPRs should be used for informational and educational purposes. They should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. They do not replace the need for application of clinical judgement to each individual presentation, nor variations based on locality and facility type. Furthermore, ESHRE's GPRs do not constitute or imply the endorsement, recommendation or favouring of any of the included technologies by ESHRE.
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Affiliation(s)
| | - Emma Kirk
- Early Pregnancy and Emergency Gynaecology Unit, Royal Free Hospital London, London, UK
| | - Pim Ankum
- Amsterdam Medical Centre, Amsterdam, the Netherlands
| | - Attila Jakab
- Department of Obstetrics and Gynecology, University of Debrecen, Debrecen, Hungary
| | | | - Artur Ludwin
- Department of Gynecology and Oncology, Jagiellonian University Medical College, Krakow, Poland
| | - Rachel Small
- Heart of England NHS Foundation Trust, Birmingham, UK
| | - Tina Tellum
- Department of Gynecology, Oslo University Hospital, Ullevål, Oslo, Norway
| | | | - Thierry Van den Bosch
- Department of Obstetrics and Gynaecology, University Hospital Leuven, Belgium
- Laboratory for Tumor Immunology and Immunotherapy, Leuven, KU, Belgium
| | - Davor Jurkovic
- Department of OB/GYN, University College Hospital, London, UK
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13
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Kozar N, Serdinšek T, Tašner T, Reljič M, Gavrić Lovrec V, Kovač V. Diagnosis and management of rudimentary horn pregnancy rupture, misinterpreted as bicornuate uterus in the 14th week of pregnancy. J Obstet Gynaecol Res 2020; 47:843-846. [PMID: 33271628 DOI: 10.1111/jog.14586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 10/08/2020] [Accepted: 11/19/2020] [Indexed: 11/29/2022]
Abstract
We present a 26-year-old primigravida with rudimentary horn pregnancy rupture at 14 weeks of pregnancy. Uterine anomaly was first diagnosed at the time of nuchal translucency scan and was presumed to be a bicornuate uterus with normal intrauterine pregnancy in the right horn. One day later, she was admitted to our department with abdominal pain, shortly leading to massive hemoperitoneum and hypovolemic shock. Uterine rupture was confirmed ultrasonically, followed by immediate laparotomy. Ruptured rudimentary horn with already expulsed pregnancy was encountered during surgery. Despite significant advances in ultrasonography, diagnosis of prerupture stage remains controversial. However, high mortality of the condition should ensure low threshold for surgical exploration.
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Affiliation(s)
- Nejc Kozar
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Tamara Serdinšek
- Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Department of General Gynaecology and Gyanecological Urology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Tanja Tašner
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia
| | - Milan Reljič
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Vida Gavrić Lovrec
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
| | - Vilma Kovač
- Department of Reproductive Medicine and Gynaecologic Endocrinology, Clinic for Gynaecology and Perinatology, University Medical Centre Maribor, Maribor, Slovenia.,Faculty of Medicine, University of Maribor, Maribor, Slovenia
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Rudimentary Horn Pregnancy Diagnosed after Laparotomy. Case Rep Obstet Gynecol 2020; 2020:5816487. [PMID: 32774959 PMCID: PMC7396123 DOI: 10.1155/2020/5816487] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/17/2022] Open
Abstract
Müllerian abnormalities are present in 0.17% of fertile women and 3.5% of infertile women, and a unicornuate uterus is observed in 0.4% of women. The uterus is normally formed during embryogenesis by the fusion of the two Müllerian ducts. If one of the ducts does not develop, only one Müllerian duct contributes to the uterine development. We report a case of Gravida II, abortion I referred from a primary hospital with a referral paper and sonography stating she had IUFD. She had regular antenatal care follow-up at the primary hospital and had 8 months of amenorrhea. Our ultrasound assessment confirmed the intrauterine fetal demise, but the rudimentary horn pregnancy was missed. Repeated attempts at the induction of labor were tried but unsuccessful. The diagnosis was confirmed at laparotomy. She underwent cesarean section with right intact rudimentary horn removal. A nonviable male fetus with birth weight of 1.2 kg was delivered. Women with this abnormality are asymptomatic and unaware of having a unicornuate uterus. Abdominal pain is the most common presenting symptom with the rudimentary horn, but communicating horn pregnancy is generally asymptomatic in early pregnancy. Early awareness of this rare clinical condition is so crucial especially in developing countries where the availability of new technologies is scarce to explore uterine abnormalities. The patient had uneventful postoperative recovery and was discharged after 3 postoperative days.
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Rodrigues Â, Neves AR, Castro MG, Branco M, Geraldes F, Águas F. Successful management of a rudimentary uterine horn ectopic pregnancy by combining methotrexate and surgery: A case report. Case Rep Womens Health 2019; 24:e00158. [PMID: 31799126 PMCID: PMC6881690 DOI: 10.1016/j.crwh.2019.e00158] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 10/21/2019] [Accepted: 10/28/2019] [Indexed: 11/30/2022] Open
Abstract
The prevalence of rudimentary uterine horn ectopic pregnancy is very low (1 in 76 000–150 000 pregnancies). Early diagnosis of a rudimentary horn pregnancy is the key to successful management. The medical treatment may be a successful adjuvant therapy to surgical removal in asymptomatic women.
Pregnancy in a non-communicating rudimentary uterine horn is rare but presents a significantly increased risk of maternal and foetal morbidity due to uterine rupture. We describe a case of rudimentary horn pregnancy diagnosed in the first trimester in an asymptomatic and haemodynamically stable woman. Medical termination of the pregnancy was performed with systemic and intrasacular methotrexate. Laparoscopic uterine horn excision was performed three months after termination. This case shows that early diagnosis of a rudimentary horn pregnancy is key to the successful management of this condition. Preoperative medical termination in an asymptomatic woman proved to be an effective and safe option that minimized surgical risks.
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Affiliation(s)
- Ângela Rodrigues
- University Clinic of Ginaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal.,Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Ana Raquel Neves
- University Clinic of Ginaecology, Faculty of Medicine, University of Coimbra, Clinical Academic Centre of Coimbra, CACC, Coimbra, Portugal.,Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | | | - Miguel Branco
- Department of Obstetrics, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Fernanda Geraldes
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
| | - Fernanda Águas
- Department of Gynaecology, Coimbra Hospital and University Centre, Coimbra, Portugal
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