Near Miss: A Case Of Ruptured Rudimentary Horn Pregnancy Managed At A Tertiary Centre In Ghana

Abstract

Objective: To increase awareness on the potentially lifethreatening consequence of rudimentary horn pregnancies, and to reiterate the need for elaborate obstetrics and gynaecologic ultrasound scans to enable early diagnosis. This is the second reported case of thiscondition in Ghana, and the first in our hospital in its 20 years of existence.Case Report and Interventions: A 26-year old with two previous uneventful pregnancies and vaginal deliveries presented at 33 weeks with a classical clinical picture of haemoperitoneum secondary to a spontaneous uterine rupture and a class IV haemorrhagic shock. Her antenatal records were nil of significance for risk factors for spontaneous preterm uterine rupture. She was resuscitated and had a successful laparotomy which revealed a unicornuate uterus with a ruptured noncommunicating rudimentary horn pregnancy. Sherecovered remarkably post-operatively. Though she delayed in reporting her symptoms, the prompt management with adherence to referral protocols was life-saving.Conclusion: The diagnosis of rudimentary horns can be quite challenging, but the consequences of a missed diagnosis can be life-threatening. Clinicians and sonographers need to consciously look for such anomalies in their routine gynaecologic and obstetricultrasound scans. There must also be a high index of suspicion for a ruptured rudimentary horn in a spontaneous pre-term rupture of an unscarred uterus.