Combined Medical and Surgical Management of Rudimentary Uterine Horn Pregnancy

BACKGROUND: Pregnancy within a noncommunicating rudimentary horn is a known complication of unicornuate uterus. The risk of rupture approximates 50%, most of which occur in the second trimester. CASE: A rudimentary horn pregnancy was discovered at 8 weeks gestation. Medical termination was then performed with fetal intracardiac potassium chloride and intraplacental methotrexate. Magnetic resonance imaging (MRI) of the pelvis was obtained. Laparoscopic uterine horn resection 6 weeks after medical termination was performed. DISCUSSION: While surgical resection of a rudimentary horn pregnancy is necessary, early diagnosis affords the opportunity to take steps that minimize surgical risks. MRI assists surgical planning by demonstrating the form of attachment of the uterine horn to the unicornuate uterus. Preoperative medical termination may decrease vascularity of the gestation, thereby decreasing operative blood loss.