Abstract

Background: Pregnancy in a non-communicating rudimentary horn of a unicornuate uterus is an extremely rare obstetric complication with significant risks, including uterine rupture and maternal mortality. This condition poses diagnostic and management challenges, especially in resource-limited settings.

Case Presentation: We report the case of an 18-year-old woman from Wardak Province, Afghanistan, presenting with severe abdominal pain, hypotension, and a history of amenorrhea for four months. Clinical and ultrasound findings revealed a ruptured ectopic pregnancy with hemoperitoneum. Surgical exploration confirmed pregnancy in a non-communicating rudimentary horn of a unicornuate uterus, leading to uterine rupture. The patient underwent a successful laparotomy, including evacuation of a deceased fetus, excision of the rudimentary horn, and abdominal lavage. She received multiple blood transfusions and was discharged in stable condition after three days.

Discussion: This case highlights the diagnostic challenges and life-threatening complications associated with rudimentary horn pregnancies. Early diagnosis using imaging and timely surgical intervention are critical to optimizing maternal outcomes. The unique challenges posed by this condition in resource-limited settings underscore the importance of awareness among healthcare providers and prompt referral systems.

Conclusion: Pregnancy in a rudimentary horn of a unicornuate uterus is a rare and life-threatening condition. This case demonstrates the importance of early recognition, timely surgical management, and postoperative care to prevent severe maternal morbidity and mortality.

Keywords: Unicornuate uterus, Rudimentary horn pregnancy, Uterine rupture, Ectopic pregnancy, Resource-limited settings.

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