"Pregnancy in a non-communicating rudimentary uterine horn managed with laparoscopy in the first trimester".

Abstract

A 23-year-old woman, conceived by ovulation induction presented at 10 weeks amenorrhea with abdominal pain and a positive urinary Beta HCG. 2D ultrasound suggested a right-sided ectopic pregnancy. On 3D ultrasound imaging, an unicornuate uterus with a right rudimentary horn pregnancy of size 6 cm was diagnosed [Figure 1]. At laparoscopy, the left tube was normal. Still, on the right, there was only a fibrous streak entering a uterine horn [Figure 2], with the pregnancy in the non-communicating rudimentary horn of an unicornuate uterus (class IIB). The right rudimentary horn, pregnancy, and tube were excised, [Figure 3], and postoperative recovery was uneventful. Histopathological examination confirmed the presence of trophoblastic tissue, consistent with a rudimentary horn pregnancy. Rudimentary horn pregnancy is uncommon with an incidence of 1 in 75,000 to 150,000 pregnancies causing uterine rupture in 50% of cases with an estimated maternal mortality rate of 0.5% [1]. The pregnancy in a non-communicating horn that has no connection with the cervix is due to the transperitoneal migration of sperm to the contralateral rudimentary horn, fertilizing the ova on that side [2]. Diagnosis can be made on 2D ultrasound with accuracy being only 26% [3]. 3D ultrasound improves accuracy rates. Laparoscopic surgery is favored due to its minimally invasive nature, reduced recovery times, and lower risk of infection [4,5].