Clinical Spectrum of Unicornuate Uterus with Noncommunicating Rudimentary Horn: Five-Year Analysis at a Tertiary Care Center Vani Malhotra, MBBS, MD, MICOG, Pinkey Lakra, MBBS, MS, Smiti Nanda, MBBS, MD, Meenakshi Chauhan, MBBS, MS, MICOG, Vandana Bhuria, MBBS, MS, and Sonali Dhillon, MBBS, DGO Abstract Objective: The aim of this study was to analyze gynecologic and obstetrical morbidities associated with uni- cornuate uterus with rudimentary horn and to plan future management strategies for patients with this condition. Materials and Methods: This was a retrospective study of 38 patients with unicornuate uterus with rudimentary horn found on laparotomy. The research was carried out at the Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India, from April 2007 to March 2012. The patients’ clinical details were reviewed and management of the cases was analyzed. Results: Of 38 patients, 4 were adolescents who presented with dys- menorrhea and had hematometra in a noncommunicating rudimentary horn on laparotomy. Eighteen patients had rudimentary horn pregnancy and 17 presented in the second trimester. All patients underwent laparotomy, 12 for hemoperitoneum and 5 for failed induction. Preoperative diagnosis was suspected clinically in 13/18 cases. Sixteen patients had pregnancy in the semiuterus, and diagnosis of unicornuate uterus with rudimentary horn was made incidentally during cesarean section. In all cases, excision of the rudimentary horn along with ipsilateral salpingectomy was performed. Conclusions: Unicornuate uterus with rudimentary horn is a rare clinical entity associated with many gynecologic and obstetrical morbidities. Early diagnosis and timely treatment is the key to better management. ( J GYNECOL SURG 30:87) Introduction U nicornuate uterus with rudimentary horn occurs because of incomplete development of one of the Mu ¨l- lerian ducts and defective fusion with the contralateral side. The rudimentary horn may consist of a functional endome- trial cavity or the horn may be a small solid lump of uterine muscle with no functional endometrium. The concern is its association with various gynaecologic and obstetrical com- plications, such as infertility, horn pregnancy, endometriosis, urinary-tract anomalies, abortions, preterm deliveries, mal- presentations, and dysfunctional labor. Pregnancy in the ru- dimentary horn is a rare form of ectopic pregnancy and the incidence of this condition is between 1/100,000 and 1/ 140,000 pregnancies. 1,2 Rupture of a rudimentary-horn pregnancy is the most dreaded complication as it can can be life-threatening to the mother. Because of the variations in the musculature constitution of the wall of the rudimentary horn, pregnancy can typically be accommodated until the second trimester, when rupture occurs, manifesting com- monly as acute abdominal pain with a high risk of maternal mortality. Diagnosis prior to rupture is unusual but can be life-saving. Ultrasonography (USG) and magnetic resonance imaging (MRI) are very helpful for making the diagnosis. Pregnancy in the semiuterus is also associated with com- plications, such as abortions, preterm labor, malpresenta- tions, and increased incidence of cesarean sections. This retrospective study was conducted to analyze the obstetrical and gynecologic implications of unicornuate uterus and rudimentary horn. Strategies for managing these cases are also offered. Materials and Methods This study was conducted in a tertiary-care teaching hospital, the Postgraduate Institute of Medical Sciences in Rohtak, Haryana, India. Thirty eight cases, which were di- agnosed as unicornuate uterus with a noncommunicating rudimentary horn at laparotomy (April 2007 to March 2012), were retrospectively analyzed. These cases were di- vided into three groups. Group 1 (n = 4) consisted of patients who presented with gynecologic complaints and in whom Department of Obstetrics and Gyncology, Postgraduate Institute of Medical Sciences (PGIMS), Haryana, Rohtak, India. JOURNAL OF GYNECOLOGIC SURGERY Volume 30, Number 2, 2014 ª Mary Ann Liebert, Inc. DOI: 10.1089/gyn.2013.0076 87