Successful Management of a Noncommunicating Rudimentary Uterine Horn Pregnancy by Laparoscopic Surgery: A Case Report and Literature Review

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.

Successful pregnancy outcome via in-vitro fertilization and laparoscopic resection of non-communicating rudimentary horn pregnancy containing early pregnancy: a case report

“…Most of the patients were asymptomatic and were successfully treated with laparoscopy. However, this case series did not include the details of post-treatment pregnancy outcomes [ 7 ]. To our knowledge, this study presents the first case of successful pregnancy through IVF after proper management of NCRHP suggesting the applicability of ART.…”

“…Hence, the patient received timely treatment without significant complications. Delayed diagnoses, as mentioned in the literature, often lead to more severe symptoms and outcomes during the second or third trimesters, such as abdominal pain, hemoperitoneum, and hypovolemic shock, indicating potential uterine rupture or massive blood loss requiring emergency surgical intervention [ 7 ]. These scenarios usually result in low fetal viability and increased maternal complications and mortality.…”

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

“…There are few case reports of pregnancies and deliveries after treatment of rudimentary horn pregnancy [ 3 , 5 , 6 ]. A majority of these cases involved pregnancy after laparoscopic resection of uterine horn.…”

“…Diagnosis prior to rupture can be critical in facilitating timely treatment of the rudimentary horn. There are only a handful of reported cases involving repeat pregnancies and deliveries following surgical resection of a rudimentary horn [ 3 , 5 , 6 ]. Here we present a case where the patient had two pregnancies and one term delivery following resection of a non-communicating rudimentary horn pregnancy.…”

Reproductive Outcome of the Patients with Uterus Unicornis: Five Year Experience in a Tertiary Center

“…A uterus unicornis with a rudimentary horn is a rare congenital uterine anomaly that results from the developmental arrest of the two Müllerian ducts with the simultaneous incomplete fusion of the opposite side [22]. Although both uterus unicornis and rudimentary horn are related to poor reproductive outcome a remarkable majority of the published data about the reproductive outcome and obstetric complications are presented as case reports [23][24][25]. In the presented study we made laparoscopically surgery for rudimentary horns to remove them and we did not see obstetrics complications such as ectopic pregnancy and rudimentary horn rupture after the surgery.…”