Journal des rapports de cas cliniques

Near Term Rudimentary Horn Pregnancy with Term Intrauterine Pregnancy: A Case Presentation

Abstract

Melkamu Abte Afele and Mulat Adefris Woldetsadik

Introduction: Unicornuate uterus accounts for 5 percent of all Mullerian anomalies.Rarely it could be a site for ectopic pregnancy, where natural course is rupture during second trimester, with a potentially life-threatening heavy bleeding. However, in about 10 percent of cases horn pregnancy will go to term or form a lithopedion. We describe an unexpected horn pregnancy reaching near term with live term intrauterine pregnancy, an unusual presentation. Case presentation: 25 years old Gravida III, Para II woman presented to our hospital with complaint of right upper quadrant swelling of 5 months duration. Thirteen months back, she was diagnosed to have IUFD with femoral length of 34 weeks and misoprostol used for induction of labor but failed. Patient went home and she came again with the above complaint. On examination, uterus was 26 weeks sized, positive fetal heartbeat. She has 20 cm × 20 cm firm, non-tender right upper quadrant mass. Ultrasound showed singleton intrauterine alive pregnancy of 26 weeks + 5 days and dead fetus of 34 weeks by femur length in the right abdominal cavity. Transverse lower uterine segment cesarean was done to effect 3800 gm male alive neonate. Resection of rudimentary horn and right salpingectomy was done. The horn was connected to the isthmic right wall of the uterus by a thin fibromuscular tissue and contained 2200 gm macerated fetus and placenta. No right ovary seen. The patient and neonate progressed well and were discharged. Conclusion: An ectopic pregnancy in a rudimentary horn is rare and carries severe maternal and fetal consequences; antenatal diagnosis is challenging. Therefore, high index of suspicion is recommended to prevent morbidity and mortality after failed induction. The life-threatening complication is rupture of the horn.