Timely Identification of Pregnancy in Noncommunicating Horn of Unicornuate Uterus by Three-Dimensional Transvaginal Ultrasonography

Abstract

Pregnancy in the rudimentary horn of a unicornuate uterus is uncommon and needs to be diagnosed at early stages to avoid uterine rupture to avert the high morbidity and mortality. In this case report, we discussed the advantage of three-dimensional transvaginal ultrasonography (3D TV-USG) in assessing the early pregnancy in the noncommunicating rudimentary horn of uterus. A 23-year-old woman approached us for routine pregnancy scan. The location of 5-week pregnancy was confirmed in the right noncommunicating horn of a unicornuate uterus by 3D TV-USG. She has undergone laparohysteroscopy, and excision of a gravid rudimentary horn was done. After an interval of 6 months, the patient received fertility treatment and conceived consequently. Although magnetic resonance imaging (MRI) is an excellent way of diagnosing uterine anomalies, the procedure is expensive, time-consuming, and not widely available. 3D USG is less expensive and more readily accessible for early diagnosis of uterine anomalies, particularly in health-care centers where MRI is not readily available or affordable.

Keywords: Gestational sac; laparohysteroscopy; three-dimensional ultrasound; transvaginal; unicornuate uterus.

Figure 1

A 23-year-old woman approached us with 1½ months of amenorrhea and a positive urine pregnancy test. A transvaginal two-dimensional image showed the presence of intrauterine gestational sac in the right horn with yolk sac and a corpus luteum cyst in the ipsilateral ovary. A nonpregnant horn on the left side was observed. Nonpregnant horn shows the typical shape of the uterus with extreme lateral flexion.

Figure 2

Three-dimensional ultrasound in coronal view clearly demonstrates unicornuate uterus on the left side and presence of pregnancy in the right horn. Myometrium surrounding the gestational sac with no thinning and no communication between the two horns. There is no continuity between the cavities containing the gestational cavity with the cervical canal.

Figure 3

Laparoscopic picture showing left unicornuate uterus and an unruptured right rudimentary horn pregnancy with attached tube and ovary. Globular shape of the pregnant form can be made out with wide separation and no communication between the cavities.