Introduction
Rudimentary horn pregnancy is a rare condition that poses problems regarding the diagnosis and the treatment aspect. Rudimentary horn pregnancies develop due to disturbances in the uterine cavity formation that occurs before the birth of the female child. These uterine abnormalities develop due to malformations in embryonic structures called mullerian ducts, this happens in the fetal stage itself.
What Is a Unicornuate Uterus?
In the fertilized embryo, there are a pair of mullerian ducts, which further develop into the female reproductive system. The reproductive organs of the female include a pair of fallopian tubes, a uterus, vagina and cervix. Any malformations or absence of one of the mullerian ducts leads to the formation of an abnormal uterus, known as unicornuate uterus.
What Is a Rudimentary Horn?
Women with unicornuate uterus have an extra piece of uterus due to its anomaly, which is called rudimentary horn. More than half of the females with unicornuate uterus have rudimentary horn. Rudimentary horn in the uterus mostly affects the pregnancies, leads to miscarriages and can be fatal to mother also.
What Are the Signs And Symptoms of Rudimentary Horn Pregnancy?
Rudimentary horn pregnancy is usually noticed during routine check-ups during pregnancy. During a routine scan, a radiologist can detect the presence of rudimentary horn pregnancy. However, the signs and symptoms of rudimentary horn pregnancy mimic those of ectopic pregnancies (when eggs get implanted outside the uterus).
-
In Non-pregnant Women: Absence of menstrual cycle (amenorrhoea) is common among girls.
-
In Pregnant Women: Abnormal vaginal bleeding, back pain, pain in the pelvic are the common symptoms. When such symptoms are noticed, early visit to the gynecologist is advised.
-
Nausea and vomiting is also associated with rudimentary horn pregnancy.
-
Because of the heavy bleeding, the patient may faint and go into a coma.
How To Diagnose a Rudimentary Horn?
Rudimentary horn is an extremely rare condition and remains undiagnosed until puberty.
Some methods to diagnose a rudimentary horn are:
-
Physical examination.
-
Medical history.
-
Imaging tests, such as ultrasound, MRI (magnetic resonance imaging).
-
HSG (Hysterosalpingogram): In this procedure a dye is induced inside the uterus, and X-ray images are captured to see the internal part of the uterus.
-
Hysteroscopy: A test to examine the internal parts of the uterus.
What Are The Types of Rudimentary Horns?
-
Absence Of Rudimentary Horn: It is a common condition, where the uterus does not have any secondary rudimentary horn or fallopian tube. This type presents with no pain.
-
No Cavity Rudimentary Horn: In this condition, a secondary horn is present but the lining of the horn is absent. In simple terms, it is also called a rudimentary horn with absent endometrial lining.
-
Connecting Rudimentary Horn: In this condition, the rudimentary horn has a communication with the uterus, where the blood and fluids will flow from the horn into the uterus cavity. It is directly connected to the uterus.
-
Non-Connecting Rudimentary Horn: In this condition, no communication exists between horn and uterus cavity. But it has an endometrial lining inside the horn. Blood and fluids get struck inside the horn leading to abdominal pain, hematometra (collection of blood and fluids inside) the horn. This is one of the complicated conditions of pregnancy.
How To Treat a Unicornuate Uterus?
Treatment depends upon the type of rudimentary horn. Rudimentary horn with no cavity and communicating rudimentary horn does not require any treatment. But the non-communicating rudimentary horn with endometrial lining inside the horn requires emergency treatment in conditions where the blood gets stuck inside the horn leading to severe pain in menstruating women.
In cases of pregnancy, there is a high chance that implantation may take place inside the horn. In such conditions, surgical removal of the horn is advised to avoid fatal conditions. However, unicornuate uterus cannot be prevented since it is a congenital (by birth) anomaly.
Is It Safe to Have a Pregnancy With a Rudimentary Horn?
Rudimentary horn pregnancy is never normal and carries a lot of complications. If the treatment is delayed, the embryo (fertilized egg) tends to grow in the rudimentary horn, this causes pressure and rupture of the rudimentary horn, leading to heavy bleeding and fatal conditions. This is more evident in cases of non communicating rudimentary horn. However, other types of rudimentary horn pregnancies also carry certain risk like:
-
Stillbirths: Death of the baby before the delivery or during the delivery.
-
Miscarriage: Loss of the pregnancy (unborn baby) before twenty weeks of pregnancy, most of the rudimentary horn pregnancies end in miscarriages.
-
Preterm Baby: Birth of the baby before thirty seven weeks of gestation period.
-
Breech Position: Transverse position of the baby is known as breech position. This is common because of the lack of space in the uterus due to the missing horn of the uterus. Hence C-section (cesarean delivery) is advised in these instances.
Is Rudimentary Horn Pregnancy Recurrent?
Rudimentary horn pregnancy is not recurrent. When pregnant women are diagnosed with an embryo in the rudimentary horn, surgical excision of the rudimentary horn must be carried out to prevent further implantations in the rudimentary horn.
When a rudimentary horn is diagnosed in non-pregnant women, the condition must be clearly explained to the women, and counseling has to be carried out regarding the potential complications of the rudimentary horn pregnancy. Surgical removal of the rudimentary horn is always advised.
What Is the Follow-Up Procedure After Surgical Excision of Rudimentary Horn?
Women who has undergone surgical excision of rudimentary horn have lot of questions running in their mind, some of them are:
-
What is the time lapse between surgery and the next pregnancy?
-
Are there any chances of normal pregnancy?
-
How to safeguard the next pregnancy?
-
What special care should be taken during the pregnancy?
Hence, follow up is very much important to have a safe pregnancy in future.
Conclusion:
Rudimentary horn pregnancy should be diagnosed and treated at the earliest to prevent life-threatening conditions. Termination of the pregnancy, followed by surgical removal of the rudimentary horn, is the only possible treatment to avoid further complications. Follow-up after the surgery is mandatory for the women to have a safe and healthy pregnancy in the future.
