Publication:

Spectrum of rudimentary horn pregnancy: a case series

Uterine malformations are the results of abnormal mullerian duct development -fusion, canalization, and septal defects. A unicornuate uterus with a rudimentary horn is one such anomaly of the uterus occurring due to fusion defects. It is associated with a high rate of spontaneous abortion, preterm labor, intrauterine growth retardation, intra-peritoneal haemorrhage, and uterine rupture. We have three cases of rudimentary horn pregnancy of which: the first one was in the first trimester and diagnosed before rupture and managed by excision of the rudimentary horn; the second one was diagnosed after a rupture in the first trimester and managed by surgical excision; and the third one was diagnosed as an obstetric emergency as a second-trimester rupture of rudimentary horn pregnancy. It was managed by initial resuscitation followed by complete excision of the rudimentary horn. Despite advances in ultrasound technology, the antenatal diagnosis of a rudimentary horn pregnancy remains difficult for inexperienced physicians. A high index of clinical suspicion for uterine malformations early in gestation can reduce the mortality rate, along with early intervention. When a rudimentary horn pregnancy is diagnosed, the excision of the horn with ipsilateral salpingectomy is the recommended surgical treatment for the best prognosis. This case series highlights the need for high clinical suspicion of this rare condition.