A rare case of unruptured ectopic pregnancy in a rudimentary horn with a dead foetus of Fifteen weeks: A Case Report
Abstract
Pregnancy in non-communicating rudimentary horn is very rare and life threatening. It is often not diagnosed unless it terminates by rupture in the second trimester. Prerupture diagnosis of rudimentary horn pregnancy with USG is technically difficult, with sensitivity of 30%. Here a case of unruptured ectopic pregnancy in non-communicating rudimentary horn of unicornuate uterus at 15 weeks of gestation is presented. This patient presented in emergency department as a case of intrauterine fetal death. Laparotomy was carried out and excision of rudimentary horn was done.
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Introduction
Ectopic pregnancy refers to the implantation of a fertilized egg in a location outside the uterine cavity, including the fallopian tubes, cervix, ovary, cornual region of the uterus, rudimentary horn of uterus, and abdominal cavity and broad ligament. The abnormally implanted fetus grows and draws its blood supply from the abnormal implantation site. As the fetus enlarges, it creates the potential for organ rupture because only the uterine cavity is designed by nature to expand and accommodate fetal development. The prevalence of unicornuate uterus in the general population is 0.1%. 1 A unicornuate uterus with a rudimentary horn is a rare mullerian abnormality in female resulting from defective fusion or resorption during embryonic life, which may cause many gynaecological and obstetrical complications like infertility, endometriosis, hematometra, abortions, and preterm deliveries; and is usually associated with urinary tract anomalies. Rudimentary horn is the rarest uterine anomaly and pregnancy in non communicating rudimentary horn is even rarer form of ectopic gestation Pregnancy in a non-communicating rudimentary horn is very diffiult to diagnose before it ruptures, leading to life - threatening intraperitoneal hemorrhage, which usually presents in the second or third trimester. The only possible explanation for pregnancy to occur in this case is by trans-peritoneal migration of spermatozoa or embryo through contralateral tube. Incidence of rudimentary horn pregnancy is between 1 per 76000 to 1 per 140000 pregnancies. 2 While in sporadic cases a live infant may be delivered, most rudimentary horn pregnancies experience uterine rupture at 10- 15 weeks of gestation. 3 Therefore early pre-rupture diagnosis is of major importance. We report a case of ectopic pregnancy in non-communicating rudimentary horn.
Conclusion
This case report highlighted the need for high level of suspicion of this rare entity. In this report we suggest criteria for early sonographic diagnosis of rudimentary horn pregnancy. High clinical suspicion, early diagnosis and timely laparotomy can reduce maternal morbidity and mortality. In our opinion, routine excision of rudimentary horn should be undertaken during non pregnant state. However, those women who refuse should be adequately counseled regarding potential complications and if pregnancy occurs in rudimentary horn, first trimester laparoscopic excision should be done.