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Second-Trimester Rudimentary Uterine Horn Pregnancy

Rupture After Labor Induction With Misoprostol

From the ¹Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, New York.

BACKGROUND: Uterine anomalies are often first suspected after bimanual or ultrasonographic examination. Currently there are no specific recommendations for further evaluation of asymptomatic women with suspected uterine anomalies in pregnancy.

CASE: A young primigravida with a history of an ultrasound diagnosis of bicornuate uterus presented with mild abdominal pain. An ultrasound examination showed a viable 18-week fetus with anhydramnios in the left uterine horn. Labor induction with misoprostol culminated in uterine rupture. At laparotomy, a ruptured left noncommunicating rudimentary uterine horn of a unicornuate uterus was noted.

CONCLUSION: Pregnancies within noncommunicating uterine horns significantly increase the risk of potentially catastrophic outcome, therefore, consideration should be given to performing 3-dimensonal ultrasonography and/or magnetic resonance imaging examinations to determine the nature of uterine anomalies. Caution should be exercised if prostaglandins are considered for use in this setting.