Surgical approach for the non-communicating rudimentary horn of a pregnant unicornuate uterus during c-section

Introduction and aims of the study: Unicornuate uterus with a rudimentary horn is a congenital uterine malformation as a result of fusion defects of the Mullerian ducts and is commonly associated with renal tract anomalies. This pathology relates to poor obstetric outcomes, moreover, since pre- and post-conceptional management of rudimentary horns with functioning endometrium remains indefinite. The aim of this report is to illustrate a different approach to the rudimentary horn at the moment of delivery. Methods: A 36-year-old Caucasian woman G4 P3 was admitted to the delivery suite at 35 weeks of pregnancy with preterm premature rupture of membranes and 4 cm dilated cervix. The patient’s medical history revealed unilateral renal agenesis, whilst reproductive history includes chronic pelvic pain, dysmenorrhea and menorrhagia, two miscarriages (at 9 and 23 weeks), and one previous C-section at 28 weeks (ruptured membranes with the fetus in breech presentation). Prior follow-ups of current pregnancy disclose a type U4a unicornuate right uterus with rudimentary non-communicating cavitary left horn and inpatient care at 30 and 33 weeks for contractions and shortening of the cervix. Admission sonography report shows a viable fetus in breech presentation with an estimated weight of 2600g. Results: A male fetus weighing 2660g (Apgar score = 7) was delivered by C section. In addition, a left dilated non-communicating rudimentary horn connecting the normal tube and ovary was identified as attached to the unicornuate uterus on its superior right side. Transverse hysterotomy with decidua removal and cavity curettage followed by a simple interrupted suture was performed on the rudimentary horn to prevent further complications. The early postoperative follow-up period was uneventful under additional antibiotherapy (Cervical swab test positive for Group B Streptococcus), and the parturient was discharged with further recommendations of removing the rudimentary uterine horn. Conclusions: Removing the decidua of the cavitary non-communicating rudimentary horn at delivery should be considered in order to decrease postpartum complications.