Pregnancy in unicornuate uterus without rudimentary horn: a case report

Akanksha Jain, Nitesh Singh
In: International Journal of Reproduction, Contraception, Obstetrics and Gynecology · 2020 · vol. 9(12) , pp. 5144 · doi:10.18203/2320-1770.ijrcog20205265 · W3106750655
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This case report describes a 26-year-old primigravida with a unicornuate uterus without a rudimentary horn who successfully delivered via cesarean section at 40 weeks.

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This paper is a case report describing a 26-year-old primigravida who presented at 40 weeks’ gestation with breech presentation and underwent elective caesarean delivery. Intraoperatively, the clinicians found a unicornuate uterus without a rudimentary horn. The authors emphasize that unicornuate uterus is generally linked to poor obstetric outcomes and complications but note that a successful pregnancy can occur, while also stating a limitation that management of unicornuate uterus remains uncertain and pregnancy risks include intrauterine growth restriction requiring serial ultrasound monitoring. Relevance to endometriosis: the introduction cites unicornuate uterus as being associated with endometriosis, though the paper’s main focus is this pregnancy case report in a woman with unicornuate uterus without a rudimentary horn.

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Abstract

A unicornuate uterus is associated with numerous obstetric and gynaecological complications such as infertility, endometriosis, miscarriage, malpresentations, and intrauterine growth restriction. Around 2.3-13% of Mullerian duct anomalies present as unicornuate uterus. Management of unicornuate uterus is still uncertain and it leads to poorer pregnancy outcome. We present here a case of 26-year-old primigravida who presented to us with 40-weeks pregnancy associated with breech presentation. She was taken for elective caesarean section and intra-operatively she was found to have unicornuate uterus without rudimentary horn. Unicornuate uterus is associated with poor pregnancy outcome but a successful pregnancy is possible. Usual presentation of patients with unicornuate uterus is near their menarche and they have higher than usual gynaecological complications. Pregnancies in unicornuate uterus are prone to intra uterine growth restriction hence serial ultrasound should be done for regular fetal growth monitoring.
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Pregnancy in unicornuate uterus without rudimentary horn: a case report DOI: https://doi.org/10.18203/2320-1770.ijrcog20205265Keywords: Unicornuate uterus, Mullerian duct anomaly, PregnancyAbstract A unicornuate uterus is associated with numerous obstetric and gynaecological complications such as infertility, endometriosis, miscarriage, malpresentations, and intrauterine growth restriction. Around 2.3-13% of Mullerian duct anomalies present as unicornuate uterus. Management of unicornuate uterus is still uncertain and it leads to poorer pregnancy outcome. We present here a case of 26-year-old primigravida who presented to us with 40-weeks pregnancy associated with breech presentation. She was taken for elective caesarean section and intra-operatively she was found to have unicornuate uterus without rudimentary horn. Unicornuate uterus is associated with poor pregnancy outcome but a successful pregnancy is possible. Usual presentation of patients with unicornuate uterus is near their menarche and they have higher than usual gynaecological complications. Pregnancies in unicornuate uterus are prone to intra uterine growth restriction hence serial ultrasound should be done for regular fetal growth monitoring. Metrics References Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38:371-82. Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761-71. Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886-94. Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol. 2011;205(6):558. Fedele L, Zamberletti D, Vercellini P, Dorta M, Candiani GB. Reproductive performance of women with unicornuate uterus. Fertil Steril. 1987;47(3):416-9. enetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Bio Med Online. 2014;29(6):665-83. Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, Pellicer A. Reproductive impact of congenital mullerian anomalies. Fertil Steril. 1997;12(10):2277-81. Khati NJ, Frazier AA, Brindle KA. The unicornuate uterus and its variants. Clinical presentation, imaging findings, and associated complications. J Ultrasound Med. 2012;31:319-31. Nanda S, Dahiya K, Sharma N, Aggarwal D, Sighal SR, Sangwan N. Successful twin pregnancy in a unicornuate uterus with one fetus in the non-communicating rudimentary horn. Arch Gynecol Obstet. 2009;280(6):993-5. Amritha B, Sumangali T, Priya B, Deepak S, Sharadha R. A rare case of term viable secondary abdominal pregnancy following rupture of a rudimentary horn: a case report. J Med Case Rep. 2009;3:38. Kanagal DV, Hanumanalu LC. Ruptured rudimentary horn pregnancy at 25 weeks with previous vaginal delivery: a case report. Case Rep Obstet Gynecol. 2012;985076. American Congress of Obstetrics and Gynecology Committee on Practice Bulletins- Obstetrics. ACOG practice bulletin: intrauterine growth restriction. Obstet Gynecol. 2000;95(Suppl):1-12.

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