Ectopic pregnancy in noncommunicating horn of unicornuate uterus: 3D‐ultrasound and primary laparoscopic management

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.

Fertility after treatment of a noncommunicating rudimentary horn pregnancy: A case report

“…With recent advances in diagnostic imaging modalities, ultrasound and magnetic resource imaging (MRI) can be used to diagnose rudimentary horn pregnancies prior to rupture. The sensitivity of ultrasound alone has been noted to be low, at around 26%, with only 14% of cases diagnosed prior to clinical symptoms [ 9 , 10 ]. The addition of MRI and 3D reconstruction of the ultrasound can improve the diagnostic sensitivity by utilizing multiplanar images to visualize the exact Mullerian anomalies and confirm the diagnosis of rudimentary horn diagnosis prior to rupture [ 3 , 10 ].…”

“…Management of non-communicating rudimentary horn after diagnosis is the excision of the pregnant horn [ 8 ]. Laparoscopy is the standard treatment in hemodynamically stable patients; however, the threshold to convert to laparotomy should be low, given the typical hypervascularity of rudimentary horn pregnancies [ 3 , 5 , 10 ]. Recently, there have been case reports of combination medical and surgical management for rudimentary horn pregnancies [ 5 ].…”

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

“…Upon diagnosis of a pregnancy in a rudimentary horn, the standard treatment involves immediate excision of the pregnant rudimentary horn for avoiding recurrence of pregnancy, removing the cause of dysmenorrhea, and preventing possible endometriosis [ 4 ]. In recent years, laparoscopic surgery has been the standard treatment for rudimentary horn pregnancy in hemodynamically stable patients [ 7 , 9 ]. During resection of a pregnant-rudimentary horn, bleeding is a major surgical risk because the pregnant uterus has abundant blood flow.…”

“…Regarding the natural history of a pregnancy in the rudimentary horn, it is often diagnosed during laparotomy when the gestational horn ruptures in the first or second trimester of pregnancy, causing severe, life-threatening hemoperitoneum [ 5 , 6 ]. Recent advances in diagnostic imaging modalities, such as ultrasound and magnetic resource imaging (MRI), have made it possible to diagnose these pregnancies before occurrence of rupture [ 7 , 8 ]. Early diagnosis can help in performing laparoscopic surgical treatment before rupture [ 7 , 9 ].…”

“…Recent advances in diagnostic imaging modalities, such as ultrasound and magnetic resource imaging (MRI), have made it possible to diagnose these pregnancies before occurrence of rupture [ 7 , 8 ]. Early diagnosis can help in performing laparoscopic surgical treatment before rupture [ 7 , 9 ].…”