Subsequent pregnancy after a ruptured rudimentary uterine ho
Rudimentary uterine horn pregnancy is rare and associated with risk of rupture, life-threatening haemorrhage and high foetal and maternal mortality. Published in the European Journal of Obstetrics and Gynecology and Reproductive Biology, the authors, therefore, highlight the following case and the void in the literature regarding outcomes in subsequent pregnancies.

A 38-year-old multiparous (G8 P5+2) woman presented to the emergency department collapsed at 19 weeks’ gestation with a history of sudden-onset abdominal pain. Routine anomaly screening by ultrasonography the previous day had diagnosed placenta praevia and a cervical fibroid but was otherwise normal. Her pregnancy had been uneventful.

On examination she was haemodynamically unstable, with a distended tense painful abdomen and no blood in the vagina. Abdominal ultrasonography in the emergency department revealed a viable foetus, no sign of abruption or blood in the liquor, but fluid in the left iliac fossa and around the liver suggesting intra-abdominal haemorrhage.

Findings at emergency laparotomy were a left sided ruptured rudimentary uterine horn containing placenta, an intra-abdominal intact amniotic sac containing the foetus, and significant haemoperitoneum. The rudimentary uterine horn and pregnancy and ipsilateral fallopian tube were removed. She was transferred to ICU where, following a blood transfusion, she made a full recovery.

Five months later she attended the clinic to discuss the possibility of future pregnancy. She was informed of the lack of literature on this subject. The risk of uterine rupture in a subsequent pregnancy was discussed. She underwent hysteroscopy to determine the resulting uterine anatomy.

This revealed a regular cavity with smooth endometrium, a single right tubal ostium and no evidence of an original communication between the left horn and the uterine cavity. In view of these findings and that a communication was not identified at the time of laparotomy it is believed that the rudimentary horn was non-communicating.

She conceived spontaneously a year later. This pregnancy was complicated by placenta praevia and antepartum haemorrhage. A live female infant was delivered by emergency caesarean section at 32 weeks’ gestation.

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