DOI: http://dx.doi.org/10.18203/2320-1770.ijrcog20212207

Unicornuate uterus: case reports of heterogenous presentations challenging clinical diagnosis and management

Swati Trivedi, Santosh Khokher, Prasoon Rastogi, Vinod Kumar Dhaka

Abstract


Unicornuate uterus is an anomaly arising from defective lateral fusion of incompletely developed mullerian duct or paramesonephric duct with the contralateral duct. Pregnancy in non-communicating rudimentary horn can result in I and II trimester pregnancy losses along with maternal morbidity and mortality. Here we describe three such cases of unicornuate uterus with non-communicating rudimentary horn pregnancy, who presented to our hospital with pain in lower abdomen. Two of them with II trimester pregnancy landed in haemorrhagic shock owing to rupture of pregnant horn, though were revived by immediate intervention. Third patient who came with a definitive diagnosis of I trimester rudimentary horn pregnancy was managed electively by hemi-hysterectomy. Rupture of pregnant uterus can occur in II trimester when associated with uterine anomaly. Early sonographic diagnosis has a major offering in workup, management and prevention of mother from grave life threatening consequences.


Keywords


Defective lateral fusion, Hemi-hysterectomy, Mullerian duct, Rudimentary horn, Unicornuate uterus

Full Text:

PDF

References


Grimbizis GF, Gordts S, Sardo ADS, Brucker S, Angelis CD, Gergolet M, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032-44.

Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886-94.

Troiano RN, McCarthy SM. Müllerian duct anomalies: imaging and clinical issues. Radiology. 2004;233(1):19-34.

Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-74.

Arslan T, Bilgiç E, Sentürk MB, Yücel N. Rudimentary uterine horn pregnancy: a mystery diagnosis. Fertil Steril. 2009;92(6):2037.

Buntugu K, Ntumy M, Ameh E, Obed S. Rudimentary horn pregnancy: pre-rupture diagnosis and management. Ghana Med J. 2008;42(2):92-4.

Holden R, Hart P. First-trimester rudimentary horn pregnancy: prerupture ultrasound diagnosis. Obstet Gynecol. 1983;61(3):56-8.

Dogra Y, Minhas S, Marwaha PD. Müllerian duct anomaly with congenital rectovaginal fistula: a rare case presentation. South Afr J Obstet Gynaecol. 2015;21(1):22.

Rackow BW, Arici A. Reproductive performance of women with müllerian anomalies. Curr Opin Obstet Gynecol. 2007;19(3):229-37.

George Pados G, Tsolakidis D, Athanatos D, Almaloglou K, Nikolaidis N, Tarlatzis B. Reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn: a case series. European J Obstet Gynecol Reproductive Bio.2014;182:33-7.

Nwosu BO, Ugboaja JO, Obi-Nwosu A. Spontaneous rupture of gravid horn of bicornuate uterus at term: a case report. Niger Med J. 2010;51(4):184-5.

Panayotidis C, Prabhu S. Management of un-ruptured pregnancy in a rudimentary horn of unicornuate uterus at 14 weeks gestation. Gynecol Surg. 2007;4(4):281-4.