Publication:

Ruptured ectopic pregnancy in rudimentary horn

A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality which may cause many gynaecological and obstetrical complications like infertility, endometriosis, hematometra, abortions, and preterm deliveries; and is usually associated with urinary tract anomalies. Pregnancy in a non-communicating rudimentary horn is very difficult to diagnose before it ruptures, leading to life -threatening intraperitoneal hemorrhage, which usually presents in the second or third trimester. A 23 year old G2P1L1 in lactational amenorrhea was admitted to the labour room with haemorrhagic shock. Provisionally diagnosed as ruptured ectopic pregnancy, patient was taken for laparotomy after resuscitation. Intraoperative findings were: haemoperitoneum of 3 liters, unicornuate uterus with a ruptured left rudimentary non-communicating horn containing products of conception, and macroscopically normal fallopian tubes and ovaries. The left adnexa were attached to the rudimentary horn. Excision of the rudimentary horn was done. The fetus, weighing about 250 grams, was recovered en-sac from the peritoneal cavity. There is a need for an increased awareness of rudimentary horn pregnancy especially in developing countries where the possibility of detection before pregnancy or before the rupture is unlikely, and precious time is lost in shifting these women to the referral hospital.