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Year : 2015 Month : August Volume : 4 Issue : 66 Page : 11580-11585

PREGNANCY IN A NON-COMMUNICATING RUDIMENTARY HORN OF A UNICORNUATE UTERUS: A CASE REPORT .

B. Anuradha1, B. Sudharani2, K. Sambasiva3, V. Sarath Chand4

1. Associate Professor, Department of Radiology, Rangaraya Medical College, Kakinada.
2. Assistant Professor, Department of Radiology, Rangaraya Medical College, Kakinada.
3. Assistant Professor, Department of Radiology, Rangaraya Medical College, Kakinada.
4. Assistant Professor, Department of Radiology, Rangaraya Medical College, Kakinada.

CORRESPONDING AUTHOR

Dr. B. Anuradha,
Email : anuradhabonthu@yahoo.co.in

ABSTRACT

CORRESPONDING AUTHOR:
Dr. B. Anuradha,
Associate Professor and Incharge HOD,
Department of Radiology, Government
General Hospital, Kakinada,
East Godavari District, Andhra Pradesh.
E-mail: anuradhabonthu@yahoo.co.in

INTRODUCTION: Pregnancy in a rudimentary horn of a unicornuate uterus is rare.1 An incidence of 1 in 76,000-150,000 pregnancies is reported in the literature.2,3 We present a case report of rupture of a 25 weeks pregnancy in the non-communicating rudimentary horn of a unicornuate uterus. Congenital malformations of the uterus, also known as Mullerian duct anomalies, are rare in general population (Approx. 1%). These abnormalities result from arrested development, abnormal formation or incomplete fusion of mesonephric ducts. Unicornuate uterus results from unilateral arrested mullerian duct development. Rarely unicornuate uterus may also have a rudimentary horn, more on the right than on the left side. The incidence of unicornuate uterus is estimated to be 1:250 and its occurrence with rudimentary horn is 1:100,000. Such anomalies are reported to result in increased rate of miscarriages, recurrent pregnancy losses, preterm labor, infertility and other obstetric complications. Conception in rudimentary horn arises either from a small communication with the uterine cavity (Communicating) or by Trans peritoneal migration of the fertilized ovum from the contra-lateral side (Non-communicating). The proportion of non-communicating rudimentary horns is 70-90%. The frequency of pregnancy in rudimentary horn is reported to be 1:76000. The clinical presentations vary from being asymptomatic to vague complaints of mild lower abdominal pain with gastrointestinal upset to its severest form of acute abdomen with hemorrhagic shock. The most significant threat of a rudimentary horn pregnancy is the risk of rupture because of poorly developed musculature. In view of the paucity of literature on rare observation of pregnancy in rudimentary horn of uterus, the case reported here is of crucial importance.

KEYWORDS: Unicornuate uterus, Rudimentary horn, Secondary abdominal pregnancy.

CASE HISTORY:

  • 20 yrs Gravida 2 para 1 female with 25weeks of gestation according to her LMP referred to radiology department for obstetric scan, as she had complained of decreased fetal movements and abdominal pain since two days. She did not underwent ultrasound examination previously in the present pregnancy.
  • She had previous history of full term normal vaginal delivery of live child 2 years back. Her post-partum period was uneventful.
  • Her past medical and gynecologic histories were unremarkable with regular menses and without dysmenorrhea.
  • Her vital parameters were normal. Her abdominal examination revealed suprapubic mass corresponds to 24 to 26 weeks of gestation.

Per vaginal examination shows fullness in the left fornix.

IMAGING FEATURES:

  • Patient was sent for ultrasound examination which showed a dead intra-abdominal fetus of      25–26 weeks of gestation with scanty amniotic fluid, with empty uterus lying in the pelvis towards left side and minimal free fluid in the peritoneal cavity (Fig. 1). MRI was also done, MRI had showed a fetus outside the uterus in the abdominal cavity within a clearly defined gestational sac. (Fig. 2).
  • The placenta was seen with definitive borders located in the antero inferior part of the sac.
  • No signs of placental invasion of the neighboring structures were observed.
  • Ruptured rudimentary horn seen with fetus lying in abdominal cavity. No cavity connection between the gestational horn and the uterus (Fig. 4, 5).

 

Uterus noted towards left side of pelvis. Ruptured rudimentary horn with placenta noted on right side (Fig. 4).

 

Fig. (1): Showing Ultrasonographic evaluation revealed bulky uterus (red arrow) displaced to left side by the neighboring gestational sac (block arrow) with endometrial collection and minimal free fluid.

 

Figure-1

 

Fig. (2): Showing Coronal T2WI images showing fetus (Red arrow) lying in the abdominal cavity with surrounding gestation sac. Placenta (Blue arrow) seen anteroinferiorly in the pelvis.

Figure-2

 

Fig. (3): CorT2WI images posteriorly showing rudimentary horn (Red arrow) towards right side of pelvis and uterus (block arrow) pushed towards left.

Figure-3

 

Fig. (4): Axial T2WI images showing fetus in transverse lie (Red arrow), in next sections cord, placental attachment (Orange arrow) and ruptured horn (blue arrow).

Figure-4

 

Fig. (5): Showing Sag T2WI images from right to left shows ruptured horn (red arrow) and normal uterus (blue arrow).

Figure-5

 

Fig. (6): Showing Operative findings.