[Show abstract][Hide abstract] ABSTRACT: Surviving twins were born to a woman with a unicornuate uterus having a noncommunicating rudimentary uterine horn; this was the first such case reported. Further, it is the first report on a multiple gestation with one twin delivered successfully by cesarean section and the second vaginally at a later date.
The first twin in a unicornuate uterus was delivered via cesarean section at 28 2/7 weeks due to intractable preterm labor with breech presentation. The ipsilateral hypogastric and ovarian arteries were ligated intraoperatively to arrest myometrial hemorrhage. Continuing preterm contractions resulted in contralateral rudimentary uterine horn rupture eight days later, allowing successful vaginal delivery of the second twin.
Neonatal survival in rudimentary uterine horn pregnancies is poor, occurring in only 11% of cases during the past half century. The probability of attaining a favorable outcome is increased if aggressive antenatal management is instituted after establishing an early prenatal diagnosis. In the case of dual-chamber uterine anomalies, it is possible to effect surgical delivery of one fetus while maintaining a second preterm fetus in utero. This maneuver can decrease preterm morbidity for later-born siblings and enhance neonatal survival.
The Journal of reproductive medicine 09/1997; 42(8):525-32. · 0.70 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The key to successful management of the rudimentary uterine horn is early detection. This review of the literature seeks to illustrate important aspects of diagnosis and management of this anomaly.
An English language MEDLINE search from 1966 to 2003 was performed, using the search terms "rudimentary uterine horn," "accessory horn," "uterus bicornis unicollis," "hematometra," "unicornuate or bicornuate uterus," and "mullerian anomaly." References from previously published sources were also obtained.
One hundred thirty letters, case reports, case series, and review articles featuring rudimentary uterine horn were found. Reports before 1966 were excluded because outcomes before the advent of modern diagnostic techniques were not relevant to this study.
Three hundred sixty-six rudimentary horn presentations (210 gynecologic and 156 obstetric) were found. Noncommunicating horns accounted for 92% of cases (95% confidence interval [CI] 88-95%, P < .001), and renal anomaly was found in 36% (95% CI 29-44%). Contrary to the American Fertility Society classification of uterine anomalies, rudimentary horns may occur without a corresponding unicornuate uterus. The mean age of presentation was similar for gynecologic and obstetric presentations (23 and 26 years, 95% CIs 21.2-24.6 and 124.9-27.3 years, respectively). Presentation in the third decade of life or later occurred in 78% of patients (95% CI 70-84%, P < .001). Sensitivity of ultrasound examination for diagnosis was 26% (95% CI 18-36%). Diagnosis before clinical symptoms occurred in 14% (95% CI 7-23%).
Many functional noncommunicating horns present during or after the third decade of life with acute obstetric uterine rupture. Surgical removal before pregnancy is recommended. Rates of prerupture diagnosis remain disappointingly low.
Obstetrics and Gynecology 06/2005; 105(6):1456-67. DOI:10.1097/01.AOG.0000161321.94364.56 · 5.18 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Pregnancy in rudimentary horn of uterus, a form of ectopic gestation, is associated with significant rates of morbidity and mortality. Despite the recent advances in the ultrasonography, diagnosis of cornual pregnancy still remains elusive; with confirmatory diagnosis usually made during laparotomy. The aim of the present study is to analyze the obstetric implications and the diagnostic dilemma of rudimentary horn pregnancy.
Records of women diagnosed with ectopic pregnancy in the rudimentary horn, during the years 2004 to 2008, managed in a referral hospital in northern India; were reviewed for their diagnostic difficulties and the associated morbidity.
During the four year study period, rudimentary horn pregnancies accounted for 12 pregnancies. Non communicating horn accounted for 75% of the cases. The mean age of women at presentation was 26 +/- 5.11 years and the period of gestation at diagnosis varied between 10 and 34 weeks. Preruputure diagnosis was possible only in two cases and sensitivity of ultrasonographic diagnosis was 33.3%. Laprotomy with excision of rudimentary horn and salpingectomy was done in all cases. Multiple blood transfusions were required in 83.3% of women.
Management of pregnancy in a rudimentary uterine horn continues to be a challenge to this day. Maintaining a higher degree of alertness, especially in high risk groups by emergency staff is required to prevent the morbidity, as they may present with acute uterine rupture in pregnancy.
Archives of Gynecology 04/2009; 280(6):907-10. DOI:10.1007/s00404-009-1013-4 · 1.36 Impact Factor
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