Unruptured pregnancy in a noncommunicating rudimentary horn at 37 weeks with a live fetus: a case report

We report an extremely rare case of an unruptured non-communicating rudimentary horn full-term pregnancy. A woman who had a uterine malformation was misdiagnosed as uterus didelphys and gave birth to a live, healthy fetus. The correct diagnosis was not made until cesarean section at 37 4/7 weeks. The case suggests that women who are pregnant in a rudimentary horn could obtain a full-term delivery and give birth to a live and healthy baby.     

Laparoscopic management of rudimentary horn pregnancy

A unicornuate uterus with rudimentary horn is a rare Mullerian abnormality. This uterine anomaly may cause many gynaecological and obstetric complications, including infertility, recurrent abortions, preterm deliveries and rupture of the uterus, especially when the pregnancy implants in the rudimentary horn. To date, laparotomy has been the treatment of choice when resection of a rudimentary horn was indicated. We report on the case of a woman who benefited from laparoscopic surgery of a rudimentary horn pregnancy. Laparoscopy, in these exceptional cases, is the most accurate diagnostic tool that carries significant advantages in effective surgical management, thereby avoiding laparotomy.      

Successful triplet pregnancy in a patient with a unicornuate uterus with a cavitary communicating rudimentary horn

In a patient with primary infertility, ovulation was inducedby monitored stimulation with human menopausal gonadotrophins(HMG) because of polycystic ovarian disease. Infertility work-uphad shown a unicornuate uterus with a cavitary communicatingrudimentary horn. The husband showed a varicocele-related moderateoligoasthenoterato-zoospermia. A triplet pregnancy occurredin a third HMG ovulation induction cycle combined with intra-uterineinsemination of the husband's washed semen. The pregnancy wascarefully monitored, and measures to prevent premature deliverywere taken. Because of the patient's obvious discomfort in thepresence of premature labour, Caesarean section was performedat 33 weeks gestation and three healthy infants were delivered.This is the first report of a successful triplet pregnancy ina women with a unicornuate uterus. The reproductive and obstetricoutcome of this condition in general, and in the case of multiplepregnancy, is discussed.     

A case of pregnancy in a woman with cloacal dysgenesis and a rudimentary uterine horn

Cloacal dysgenesis is frequently associated with uterine anomalies. We report a case of pregnancy which resulted in an abortion in a woman with a persistent cloaca. Presumptive diagnosis before operation was ectopic pregnancy of the left tube. Postoperatively, the site of implantation of the conceptus was found to be the cavity of a unicornuate uterus in association with a rudimentary horn, the presence of which misled us to diagnose an ectopic pregnancy.      

Rupture of left horn of bicornuate uterus at twenty weeks of gestation

Rupture uterus in nulliparous patients is generally associated with mullerian anomalies. A case of 23 years primigravida with 19 weeks gestation presenting with features of rupture is reported here. Ultrasound helped in the diagnosis of left horn of bicornuate uterus. After exploration, right ruptured horn was excised. The incidence, diagnosis and management of such cases is discussed.     

Laparoscopic surgery of unicornuate uterus with rudimentary uterine horn

This report describes a new procedure for laparoscopic treatment of non-communicating rudimentary uterine horn when attached to the contralateral unicornuate uterus by a band of tissue. A retrograde dissection with primary bipolar coagulation and section of the band of tissue enables primary occlusion of the main blood supply. In our opinion, this new approach may prevent bleeding during laparoscopic dissection of the rudimentary horn and may avoid myometrial injury of the resting unicornuate uterus.     

Unruptured postdated pregnancy with a live fetus in a noncommunicating rudimentary horn

Pregnancy in a noncommunicating rudimentary horn is an extremely rare and a life-threatening condition as it mostly terminates by rupture by the second trimester of pregnancy. Postdated pregnancy and delivery of a live fetus in a rudimentary horn have been rarely reported. A case of noncommunicating unruptured rudimentary horn pregnancy progressing to 41 weeks and 3 days period of gestation where the diagnosis was initially missed at obstetric sonogram at 18 and 34 weeks and then misdiagnosed later as abdominal pregnancy is being reported. Preoperative diagnosis, successful delivery of a live fetus and excision of the rudimentary horn was performed.     

Ectopic pregnancy unusually occuring in rudimentary uterine horn--report of two cases

Two rare cases of second term ectopic pregnancy in non-communicating rudimentary horn of unicornuate uterus, one intact and another ruptured, are discussed here considering the rarity of its occurrence. An attempt has been made to address the associated multitude of complications with stress on the importance of early diagnosis of such unusual pregnancies and timely surgical intervention which contribute towards improved management and patient care.     

Case report of ruptured non-communicating right rudimentary horn pregnancy: an acute emergency

Ruptured pregnancy in the rudimentary horn of women who have had a vaginal delivery is rare and unpredictable. However, when undiagnosed, this condition could lead to maternal morbidity and mortality. We report a pregnancy at 19 weeks gestation presented with acute abdomen and hypovolemic shock. She was initially thought to have an intrauterine pregnancy with the provisional diagnosis of a ruptured uterus. Intraoperatively, a ruptured non-communicating right rudimentary horn with ex utero pregnancy was discovered.     

Pregnancy: Ultrasonographic features of uterine blood flow during the first 16 weeks of pregnancy

Uterine blood flow volume has been thought to increase in alinear fashion throughout pregnancy, but previous studies inearly pregnancy may have not been performed often enough orin sufficient numbers of patients. We measured uterine arteryblood flow volume, average velocity, vessel cross-sectionalarea, resistance index, and spiral artery resistance index withDoppler ultrasound at 1–3 week intervals from gestational(post-menstrual) weeks 5–6 to week 16 in 44 normal, spontaneous,single pregnancies. Uterine artery blood flow volume and velocityincreased gradually until the end of week 9, and then rapidlyfrom weeks 10–16. Uterine artery vessel size increasedlinearly. The uterine artery resistance index was the inverseof volume and velocity, in contrast to the spiral artery resistanceindex, which decreased linearly. These findings indicate thatearly pregnancy changes in uterine and spiral artery blood flowoccur by different mechanisms, and that when investigating uterineblood flow in early pregnancy, studies need to begin by week6 and need to be performed at least biweekly.     

Ultrasound diagnosis of cephalopagus conjoined twin pregnancy at 29 weeks

The authors report a case of a cephalopagus conjoined twin that was diagnosed at 29 weeks of gestation despite the mother having had two ultrasounds done previously. The fetus had one head and face, fused thoraces, common umbilicus but had two pelvises and two sets of genitalia. The fetus had four normally formed legs and arms.Antenatal ultrasound images are supplemented by post natal photographs. A review of literature, clues to ultrasound diagnosis and possible causes of missing this significant abnormality until the 3rd trimester are discussed.     

妊娠4～9周孕妇血清雌二醇变化与妊娠结局的关系

目的探讨妊娠4～9周孕妇血清雌二醇（E2）变化与妊娠结局的关系。方法选择在本院就诊的妊娠4～9周的孕妇,根据孕妇妊娠结局分为正常妊娠组和胚胎停育组,正常妊娠组又根据有无复发性流产病史者分为两组,各组按孕周又分为6个亚组。采用化学发光分析法检测各组孕妇血清E2水平,并进行比较分析。结果正常妊娠组妊娠4～9周孕妇每周血清E2水平随妊娠周数增加而增加,有复发性流产病史的患者和无复发性流产的患者各孕周E2水平的变化差异无统计学意义（P〉0.05）;而胚胎停育组随孕周增加呈下降趋势。与正常妊娠组的相应孕周两两比较胚胎停育组各个孕周孕妇血清E2水平相应均数显著偏低（P〈0.05）。结论胚胎停育孕妇各孕周血清E2水平均显著下降,提示E2可能是维持早期妊娠的重要因素之一。     

Leukocyte subpopulations in the human uterine cervical stroma at early and term pregnancy

Leukocyte subsets were detected by immunohistochemical methods in cervical tissue in either the first trimester or at term pregnancy. In tissue obtained during first trimester lower total numbers of leukocytes were observed in comparison with late pregnancy (2.7 cells/0.04 mm2 versus 5.5 cells/0.04 mm2). The major subgroup of leukocytes present in early pregnancy was T-lymphocytes. The majority of these cells were of the suppressor/cytotoxic subtype. Neutrophils were present at about 1/5th of the density of T-lymphocytes. Very few macrophages were observed at this stage. At term pregnancy, neutrophils were present in significantly higher numbers than during first trimester with no difference between tissue obtained before or during active labour. Macrophages were present at about 10-fold higher density than during early pregnancy. In conclusion, tissue-bound leukocytes are present in the human cervix at a higher density in late pregnancy compared to first trimester. The increased densities of neutrophils and macrophages at this stage indicate a role for these cells during cervical ripening.      

The mitotic activity of the uterine epithelium in mice at different periods of pregnancy

Summary In comparison with the usual mitotic activity during estrus, the mitotic activity of the epithelium uterine mucous membrane rises on the 2nd and 3rd days, decreases considerably on the 5th and ceases entirely on the 8th day of pregnancy. These changes of mitotic activity correspond to the morphological endometrial readjusment associated with the formation of decidual tissue and epithelial resorption. In mice with inoculated Ehrlich's adenocarcinoma the mitotic coefficient decreased in the epithelium of the uterine mucous membrane on the third day of pregnancy. No disturbances of the cleavage process nor changes in the blastomere structure were noted.Presented by Active Member AMN SSSR N. N. Zhukov-Verezhnikov