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Müllerian Anomalies
Published in Juan Luis Alcázar, María Ángela Pascual, Stefano Guerriero, Ultrasound of Pelvic Pain in the Non-Pregnant Female, 2019
Betlem Graupera, Jean L. Browne
In patients with a hemi-uterus, pregnancy may implant in either one of the two cavities, causing different obstetrical and maternal outcomes. Pregnancy in a noncommunicating rudimentary hemi-uterus is associated with adverse reproductive outcomes such as an increase in miscarriage, preterm labor, and malpresentation.49 If the pregnancy occurs in the noncommunicating horn, it is considered an ectopic pregnancy. In such cases, the obstetrical outcomes are very poor, with an increased risk of miscarriage, preterm labor, malpresentation, intrauterine growth restriction, intrauterine fetal death, and placenta accrete.50 Nevertheless, the most life-threatening condition is uterine rupture due to the thin myometrium that is normally found in rudimentary horns, presenting as an acute gynecologic emergency with abdominal pain and severe hemoperitoneum. The incidence of rudimentary horn pregnancy is low, but the rate of rupture is close to 80%.51
Spontaneous early first and second trimester uterine rupture following robotic-assisted myomectomy
Published in Journal of Obstetrics and Gynaecology, 2019
Nandita Mahajan, Michael L. Moretti, Nisha A. Lakhi
Uterine rupture typically occurs during active labour in the late second or third trimester; however, though rare, it may also occur during early pregnancy and even in the absence of uterine contractions. The reports of early pregnancy spontaneous rupture have included cases of uterine placenta percreta with or without a scarred uterus, a rudimentary horn pregnancy, uterine anomalies and post-myomectomy procedures (Kanao et al. 2014). Claeys et al. (2014) conducted a meta-analysis of pregnancy outcomes following myomectomy that included 3685 pregnancies and found the risk of uterine rupture to be 0.79%. Interestingly, the study found that uterine rupture following a myomectomy almost exclusively occurred prior to the onset of active labour. Of the 29 patients that experienced uterine rupture in the meta-analysis, 28 occurred prior to the onset of labour and only 1 occurred during active labour (Claeys et al. 2014). This finding may be attributed to differences in the site of the incision with the majority of myomectomies being performed in the corporeal part of the uterus as opposed to the lower uterine segment. The 28 uterine ruptures documented prior to the onset of active labour occurred between 17 and 40 weeks of gestation, with 80% of the ruptures occurring between 28 and 36 weeks (Claeys et al. 2014).