EP27.05: The diagnostic and clinical challenge of rudimentary horn

A rudimentary horn (RH) of an unicoruate uterus is functional when there's an endometrial cavity, which may be communicating or non-communicating to the main body and cervix. This is results from the incomplete development and failure of fusion of one of the Müllerian ducts. A non-communicating RH with an endometrial cavity can present as early as menarche due to dysmenorrhea, or later as an incidental finding during pregnancy or surgical interventions. Pregnancies within the rudimentary horns (RHPs) are rare, and often under-recognised or even misdiagnosed as intrauterine pregnancy. Early and accurate diagnosis is therefore essential. Ultrasound scans (USS), MRI, laparoscopy and hysteroscopy are used to achieve the diagnosis. The standard management of RHP is to resect the entire RH and the ipsilateral fallopian tube. Excision of a functioning RH in asymptomatic patients has not yet been recommended as a standard procedure. However, incidental findings of a RH warrant further investigation and counselling of potential life-threatening pregnancy outcomes and clinical sequelaes from a functioning RH such as endometriosis. Training and education help to raise awareness to diagnose RH and RHP early, which may not only reduce the associated morbidity and mortality but also help to preserve fertility in younger patients. We present a series of three cases of RH - two with RHPs and one with pregnancy in the unicornuate uterus. Since there is no national or international consensus on how to manage incidentally detected RH in asymptomatic patients, we aim to discuss the management options for RH, especially as an incidental finding in asymptomatic patients. Asymptomatic suspicious of an extrauterine pregnancy at 12-week scan Previous scans reported as intrauterine pregnancy and live ectopic pregnancy. Diagnosis of RHP was made with postop USS- 3D scan and a review of histopathology Conservative management while pregnant with IUP. Uncomplicated CS at 36/40 breech- rudimentary left horn with normal tube and ovary seen