SUMMARYRudimentary horn pregnancy is a rare obstetric entity and the diagnosis and management may pose some problems especially in a low-resource center. We report our experience in diagnosing and managing a case of fetal death in a rudimentary horn.Keywords: rudimentary horn, pre-rupture, pregnancy, tourniquet CASE REPORTMadam CA was a 28 years old gravida 6 para 5. She presented to Korle Bu Teaching hospital with a complaint of vaginal bleeding of two days duration. She did not remember the exact date of her last menstrual period but she believed she was six months pregnant. The vaginal bleeding was associated with lower abdominal pain. She had not booked for antenatal care in this pregnancy. All her previous deliveries were spontaneous vaginal deliveries at term.On examination, she looked well with a pulse rate of 88 beats per minute and a blood pressure of 130/70mmHg. There was a mass arising from the pelvis corresponding to the size of a 16-week pregnancy. The surface was smooth, mildly tender and not mobile. The cervix was firm, 2.5cm long, posterior and the os was closed. There were no adnexal masses felt and the mass was not displaced to either side. There was no active vaginal bleeding. A speculum examination did not reveal any cervical or vaginal pathology. A clinical impression of threatened abortion was formed.A transabdominal ultrasound scan was performed and the findings were as follows: single intrauterine pregnancy, no fetal heart activity, reduced liquor volume, femur length 2.2cm and gestation age 16weeks. Her haemoglobin was 11.2g/dl, platelet count was 320 x 10 9 /L, and the clotting profile was normal.Labour was induced with 200mcg of misoprostol in the posterior vaginal fornix, 6 hourly for a total of four doses. This was however, unsuccessful on two different occasions, 48 hours apart. There were no complications associated with the attempts at induction of labour. Based on the two failed attempts at induction of labour, extrauterine pregnancy was suspected. A repeat transabdominal ultrasound scan could not conclusively confirm or rule out an extrauterine pregnancy. Transvaginal ultrasound scan, MRI and CT scan were not readily available for further investigation of the patient. A size 18 Foley catheter was passed into the uterine cavity and the balloon inflated with 10mls of normal saline. The bladder was also filled with about 250mls of normal saline. Trans-abdominal ultrasound scan examination was then repeated. On this occasion, the fetus was seen to be outside the uterine cavity and the diagnosis of extrauterine pregnancy was confirmed. Madam CA was counselled and prepared for laparotomy which was performed under general anaesthesia.

Clinicians sometimes are confronted with the challenge of transfusing haemorrhaging Rhesus (Rh) D negative patients with Rh D positive blood to save their lives. There are concerns about alloimmunization and future haemolytic disease of the newborn in women of the reproductive age. Another fear is transfusion reaction if they receive another Rh D positive blood in future. We present a 32-year-old Rh D negative woman, who had postpartum haemorrhage in her first pregnancy and was transfused with Rh D positive blood because of unavailability of Rh D negative blood. She did not receive anti D immunoglobin but subsequently had a normal term pregnancy of an Rh positive fetus without any detectable anti D antibodies throughout the pregnancy. In life threatening situations from obstetric haemorrhage, transfusion of Rh D negative women with Rh D positive blood should be considered as the last resort.