Pregnancy in a non-communicating rudimentary horn: a cause of failed medical and surgical management of second trimester pregnancy loss

Abstract

Objectives: We present the management of a case of failed medical and surgical management of second trimester pregnancy loss due to pregnancy in a non-communicating rudimentary horn.

Case: A 16-week intrauterine fetal death singleton pregnancy was referred to us after failed medical and surgical termination of pregnancy. Ultrasound confirmed the diagnosis and showed minimal blood clots and fluid in the pouch of Douglas. Laparoscopy showed a soft, enlarged right uterine horn not communicating with the cervix and containing the pregnancy, and a left uterine horn communicating with the cervix and showing a posterior wall perforation. The procedure was converted to laparotomy, and the right uterine horn and adjacent tube were excised. The patient made an uneventful recovery and was discharged after 3 days.

Conclusion: Pregnancy in a non-communicating horn is rare and usually presents with serious complications. Any case of failed medical termination of pregnancy after repeated doses of misoprostol should be carefully assessed to exclude the possibility of uterine anomalies (especially in a primigravida), before proceeding with dilatation and evacuation to minimise the risk of complications.

Chinese abstract

目的：我们讲述了一个孕中期妊娠失败的病例由于是非交通性残角子宫妊娠, 药物及手术处理均失败后的处理。病例：一个孕16周单胎胎死宫内的孕妇药物及手术终止妊娠均失败后转至我院。超声明确诊断, 并显示道格拉斯陷凹有少量血块和积液。腹腔镜检查显示右侧宫角柔软、增大, 不与宫颈相通, 并伴有妊娠, 左侧宫角与宫颈相通, 后壁穿孔。手术中转开腹, 切除右侧宫角及相邻的输卵管。病人恢复正常, 3天后出院。结论：非交通性残角子宫妊娠非常罕见, 常伴有严重的并发症。任何情况下, 重复剂量米索前列醇药物终止妊娠失败后, 在扩宫和清宫前应仔细评估以排除子宫畸形的可能性（尤其是初产妇）, 尽量减少并发症的风险。

Keywords:

• Second trimester
• failed medical and surgical termination
• pregnancy in non-communicating rudimentary horn

Disclosure statement

The authors declare that there is no conflict of interest associated with this manuscript and no financial support has been received for this work.