Rudimentary horn pregnancy

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Pregnancy in a rudimentary horn of the uterus is a very rare type of ectopic pregnancy. [1] [2] [3] This type of pregnancy can be life-threatening, as the rudimentary horn is not meant to sustain a pregnancy and is at risk of rupturing. [4]

Contents

Unicornuate uterus with rudimentary horn is a type of congenital uterine anomaly that arises when one of the Müllerian ducts fails to develop fully, resulting in a small rudimentary horn on one side of the uterus. Different terms have been used in the literature to describe the rudimentary horn, such as uterus bicornis with accessory horn, uterus bicornis unicollis with rudimentary horn, uterus bicornis unicollis with atretic horn, hernia uterus inguinale, and Roberts uterus. [5]

Complications

This condition is considered a medical emergency, as rupture of the rudimentary horn can occur in the late first or second trimester of pregnancy (between 10 and 15 weeks of gestation), leading to massive bleeding and threatening the patient's life. [6] Pregnancy in a rudimentary horn is typically associated with several complications, including intrauterine growth restriction, low amniotic fluid levels, preterm birth, fetal death, and occasionally, full-term gestation. [7] While there have been cases of successful live births, the prognosis for pregnancy in the rudimentary horn is generally poor. [6] [8]

Epidemiology

It is reported that 1 out of every 200 to 600 fertile women have a congenital uterine anomaly, while the occurrence of unicornuate uterus with rudimentary horn is even less common, with a frequency of 1 in 100,000. [6] Although pregnancy in the rudimentary horn is extremely rare, it can lead to an ectopic gestation with an incidence of 1 in 100,000 to 1 in 140,000 pregnancies. [6] [8]

Diagnosis

Diagnosing rudimentary horn pregnancy requires specific tests, such as hysteroscopy, hysterosalpingography, and laparoscopy, and close monitoring is essential if a person with a suspected rudimentary horn becomes pregnant to avoid the risk of rupture and its complications. Recent progress in diagnostic imaging techniques, including magnetic resonance imaging and ultrasound, have enabled the detection of these pregnancies before they lead to rupture. [9] [10] Obstetric ultrasonography, particularly the transvaginal method, is used for attempting prenatal diagnosis. [6]

Many patients experience acute abdominal pain, and it can be challenging to differentiate rudimentary horn pregnancy from other acute abdominal or gestational problems through ultrasound, leading to a high rate of misdiagnosis. [11] Additionally, during advanced stages of gestation, rudimentary horn pregnancy can closely resemble abdominal pregnancy. [12]

Management

The standard approach for managing a rudimentary horn, regardless of the trimester, is to remove it along with the corresponding tube using either laparoscopy or laparotomy. [13] This is advised because the functional endometrial horn has a higher risk of ectopic pregnancy, infertility, and dysmenorrhoea. [13]

Related Research Articles

Obstetrics is the field of study concentrated on pregnancy, childbirth and the postpartum period. As a medical specialty, obstetrics is combined with gynecology under the discipline known as obstetrics and gynecology (OB/GYN), which is a surgical field.

<span class="mw-page-title-main">Ectopic pregnancy</span> Female reproductive system health issue

Ectopic pregnancy is a complication of pregnancy in which the embryo attaches outside the uterus. Signs and symptoms classically include abdominal pain and vaginal bleeding, but fewer than 50 percent of affected women have both of these symptoms. The pain may be described as sharp, dull, or crampy. Pain may also spread to the shoulder if bleeding into the abdomen has occurred. Severe bleeding may result in a fast heart rate, fainting, or shock. With very rare exceptions, the fetus is unable to survive.

<span class="mw-page-title-main">Amniocentesis</span> Sampling of amniotic fluid done mainly to detect fetal chromosomal abnormalities

Amniocentesis is a medical procedure used primarily in the prenatal diagnosis of genetic conditions. It has other uses such as in the assessment of infection and fetal lung maturity. Prenatal diagnostic testing, which includes amniocentesis, is necessary to conclusively diagnose the majority of genetic disorders, with amniocentesis being the gold-standard procedure after 15 weeks' gestation.

A hysterotomy is an incision made in the uterus. This surgical incision is used in several medical procedures, including during termination of pregnancy in the second trimester and delivering the fetus during caesarean section. It is also used to gain access and perform surgery on a fetus during pregnancy to correct birth defects, and it is an option to achieve resuscitation if cardiac arrest occurs during pregnancy and it is necessary to remove the fetus from the uterus.

<span class="mw-page-title-main">Placental abruption</span> Medical condition

Placental abruption is when the placenta separates early from the uterus, in other words separates before childbirth. It occurs most commonly around 25 weeks of pregnancy. Symptoms may include vaginal bleeding, lower abdominal pain, and dangerously low blood pressure. Complications for the mother can include disseminated intravascular coagulopathy and kidney failure. Complications for the baby can include fetal distress, low birthweight, preterm delivery, and stillbirth.

<span class="mw-page-title-main">Vaginal bleeding</span> Medical condition

Vaginal bleeding is any expulsion of blood from the vagina. This bleeding may originate from the uterus, vaginal wall, or cervix. Generally, it is either part of a normal menstrual cycle or is caused by hormonal or other problems of the reproductive system, such as abnormal uterine bleeding.

Dilation and evacuation (D&E) is the dilation of the cervix and surgical evacuation of the uterus after the first trimester of pregnancy. It is a method of abortion as well as a common procedure used after miscarriage to remove all pregnancy tissue.

<span class="mw-page-title-main">Prelabor rupture of membranes</span> Medical condition

Prelabor rupture of membranes (PROM), previously known as premature rupture of membranes, is breakage of the amniotic sac before the onset of labor. Women usually experience a painless gush or a steady leakage of fluid from the vagina. Complications in the baby may include premature birth, cord compression, and infection. Complications in the mother may include placental abruption and postpartum endometritis.

<span class="mw-page-title-main">Complications of pregnancy</span> Medical condition

Complications of pregnancy are health problems that are related to, or arise during pregnancy. Complications that occur primarily during childbirth are termed obstetric labor complications, and problems that occur primarily after childbirth are termed puerperal disorders. While some complications improve or are fully resolved after pregnancy, some may lead to lasting effects, morbidity, or in the most severe cases, maternal or fetal mortality.

<span class="mw-page-title-main">Abdominal pregnancy</span> Medical condition

An abdominal pregnancy is a rare type of ectopic pregnancy where the embryo or fetus is growing and developing outside the uterus, in the abdomen, and not in a fallopian tube, an ovary, or the broad ligament.

Cervical weakness, also called cervical incompetence or cervical insufficiency, is a medical condition of pregnancy in which the cervix begins to dilate (widen) and efface (thin) before the pregnancy has reached term. Definitions of cervical weakness vary, but one that is frequently used is the inability of the uterine cervix to retain a pregnancy in the absence of the signs and symptoms of clinical contractions, or labor, or both in the second trimester. Cervical weakness may cause miscarriage or preterm birth during the second and third trimesters. It has been estimated that cervical insufficiency complicates about 1% of pregnancies, and that it is a cause in about 8% of women with second trimester recurrent miscarriages.

<span class="mw-page-title-main">Placenta accreta spectrum</span> Medical condition

Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium. Three grades of abnormal placental attachment are defined according to the depth of attachment and invasion into the muscular layers of the uterus:

  1. Accreta – chorionic villi attached to the myometrium, rather than being restricted within the decidua basalis.
  2. Increta – chorionic villi invaded into the myometrium.
  3. Percreta – chorionic villi invaded through the perimetrium.
<span class="mw-page-title-main">Unicornuate uterus</span> Medical condition

A unicornuate uterus represents a uterine malformation where the uterus is formed from one only of the paired Müllerian ducts while the other Müllerian duct does not develop or only in a rudimentary fashion. The sometimes called hemi-uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.

<span class="mw-page-title-main">Bicornuate uterus</span> Medical condition

A bicornuate uterus or bicornate uterus, is a type of müllerian anomaly in the human uterus, where there is a deep indentation at the fundus (top) of the uterus.

<span class="mw-page-title-main">Velamentous cord insertion</span> Velamentous placenta

Velamentous cord insertion is a complication of pregnancy where the umbilical cord is inserted in the fetal membranes. It is a major cause of antepartum hemorrhage that leads to loss of fetal blood and associated with high perinatal mortality. In normal pregnancies, the umbilical cord inserts into the middle of the placental mass and is completely encased by the amniotic sac. The vessels are hence normally protected by Wharton's jelly, which prevents rupture during pregnancy and labor. In velamentous cord insertion, the vessels of the umbilical cord are improperly inserted in the chorioamniotic membrane, and hence the vessels traverse between the amnion and the chorion towards the placenta. Without Wharton's jelly protecting the vessels, the exposed vessels are susceptible to compression and rupture.

Amnioinfusion is a method in which isotonic fluid is instilled into the uterine cavity.

<span class="mw-page-title-main">Interstitial pregnancy</span> Medical condition

An interstitial pregnancy is a uterine but ectopic pregnancy; the pregnancy is located outside the uterine cavity in that part of the fallopian tube that penetrates the muscular layer of the uterus. The term cornual pregnancy is sometimes used as a synonym, but remains ambiguous as it is also applied to indicate the presence of a pregnancy located within the cavity in one of the two upper "horns" of a bicornuate uterus. Interstitial pregnancies have a higher mortality than ectopics in general.

Ovarian pregnancy refers to an ectopic pregnancy that is located in the ovary. Typically the egg cell is not released or picked up at ovulation, but fertilized within the ovary where the pregnancy implants. Such a pregnancy usually does not proceed past the first four weeks of pregnancy. An untreated ovarian pregnancy causes potentially fatal intra-abdominal bleeding and thus may become a medical emergency.

Early pregnancy bleeding refers to vaginal bleeding before 14 weeks of gestational age. If the bleeding is significant, hemorrhagic shock may occur. Concern for shock is increased in those who have loss of consciousness, chest pain, shortness of breath, or shoulder pain.

Müllerian duct anomalies are those structural anomalies caused by errors in Müllerian duct development during embryonic morphogenesis. Factors that precipitate include genetics, and maternal exposure to teratogens.

References

  1. ↑ Siwatch, Sujata; Mehra, Reeti; Pandher, Dilpreet Kaur; Huria, Anju (2012-11-27). "Rudimentary horn pregnancy: a 10-year experience and review of literature". Archives of Gynecology and Obstetrics. Springer Science and Business Media LLC. 287 (4): 687–695. doi:10.1007/s00404-012-2625-7. ISSN   0932-0067. PMID   23183713.
  2. ↑ Dahiya, Krishna; Duhan, Nirmala; Nanda, Smiti (2011). "Rudimentary Horn Pregnancy: Series of Four Cases and Review of the Literature". Journal of Gynecologic Surgery. Mary Ann Liebert Inc. 27 (3): 139–141. doi:10.1089/gyn.2010.0032. ISSN   1042-4067.
  3. ↑ Ambusaidi, Qamariya; Jha, Chitra (2014). "Pregnancy in the Rudimentary Uterine Horn Case Report of an Unusual Presentation = عرض لحالة نادرة لحمل في قرن رحم غير مكتمل النمو". Sultan Qaboos University Medical Journal. 14 (1): 134–138. doi:10.12816/0003349. ISSN   2075-0528. PMC   3916269 . PMID   24516746.
  4. ↑ Zhang, Salina; Lamari, Alessandra; Ferris, Edward; Maseelall, Priya (2022). "Fertility after treatment of a noncommunicating rudimentary horn pregnancy: A case report". Case Reports in Women's Health. Elsevier BV. 35: e00429. doi:10.1016/j.crwh.2022.e00429. ISSN   2214-9112. PMC   9287488 . PMID   35855949.
  5. ↑ Jayasinghe, Yasmin; Rane, Ajay; Stalewski, Harry; Grover, Sonia (2005). "The Presentation and Early Diagnosis of the Rudimentary Uterine Horn". Obstetrics & Gynecology. Ovid Technologies (Wolters Kluwer Health). 105 (6): 1456–1467. doi:10.1097/01.aog.0000161321.94364.56. ISSN   0029-7844. PMID   15932844.
  6. 1 2 3 4 5 Chopra, Seema; Keepanasseril, Anish; Rohilla, Meenakshi; Bagga, Rashmi; Kalra, Jaswinder; Jain, Vanita (2009-03-13). "Obstetric morbidity and the diagnostic dilemma in pregnancy in rudimentary horn: retrospective analysis". Archives of Gynecology and Obstetrics. Springer Science and Business Media LLC. 280 (6): 907–910. doi:10.1007/s00404-009-1013-4. ISSN   0932-0067. PMID   19283398.
  7. ↑ Zhang, Yu; Pang, Yingxin; Zhang, Xue; Zhao, Zhe; Liu, Peishu (2020-08-21). "Full-term pregnancy in a rudimentary horn with a live fetus". Medicine. Ovid Technologies (Wolters Kluwer Health). 99 (34): e21604. doi:10.1097/md.0000000000021604. ISSN   0025-7974. PMC   7447397 . PMID   32846770.
  8. 1 2 Pal, Kalpana; Majumdar, Subrata; Mukhopadhyay, Sambit (2006-05-13). "Rupture of rudimentary uterine horn pregnancy at 37 weeks gestation with fetal survival". Archives of Gynecology and Obstetrics. Springer Science and Business Media LLC. 274 (5): 325–326. doi:10.1007/s00404-006-0170-y. ISSN   0932-0067. PMID   16699796.
  9. ↑ Ueda, Makiko; Ota, Kuniaki; Takahashi, Toshifumi; Suzuki, Satoshi; Suzuki, Daisuke; Kyozuka, Hyo; Jimbo, Masatoshi; Soeda, Shu; Watanabe, Takafumi; Fujimori, Keiya (2021-10-26). "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 and Childbirth. Springer Science and Business Media LLC. 21 (1). doi: 10.1186/s12884-021-04195-5 . ISSN   1471-2393. PMC   8547051 .
  10. ↑ Dhanawat, Juhi; Pape, Julian; Stuhlmann‐Laeisz, Christiane; Maass, Nicolai; Freytag, Damaris; Gitas, Georgios; Alkatout, Ibrahim (2021). "Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management". Clinical Case Reports. Wiley. 9 (5). doi: 10.1002/ccr3.4261 . ISSN   2050-0904.
  11. ↑ Zhang, Duo-Duo; Gao, Ying; Lang, Jing-He; Zhu, Lan (2018-12-20). "Diagnosis and Treatment of Rudimentary Horn Pregnancy". Chinese Medical Journal. Ovid Technologies (Wolters Kluwer Health). 131 (24): 3012–3014. doi: 10.4103/0366-6999.247200 . ISSN   0366-6999. PMC   6302637 . PMID   30539921.
  12. ↑ Bidiga, Semtama; Henry, Kiwango; Augustino, Onesmo; Mujuni, Fridolin; Matovelo, Dismas; Ndaboine, Edgar; Kihunrwa, Albert; Kiritta, Richard (2023-05-12). "Rudimentary horn pregnancy, a differential diagnosis of an intraabdominal pregnancy: a case report". Journal of Medical Case Reports. Springer Science and Business Media LLC. 17 (1). doi: 10.1186/s13256-023-03882-5 . ISSN   1752-1947. PMC   10176794 .
  13. 1 2 Jomaa, Sami; Ahmad, Afaf; Adwan, Dema (2021). "Successful diagnosis and management of prerupture rudimentary horn pregnancy in the second trimester: a case report". Radiology Case Reports. Elsevier BV. 16 (10): 3068–3071. doi:10.1016/j.radcr.2021.07.044. ISSN   1930-0433. PMC   8365452 . PMID   34429804.
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