© 2019 |Published by Scholars Middle East Publishers, Dubai, United Arab Emirates 58 Scholars International Journal of Obstetrics and Gynecology Abbreviated Key Title: Sch Int J Obstet Gynec ISSN 2616-8235 (Print) |ISSN 2617-3492 (Online) Scholars Middle East Publishers, Dubai, United Arab Emirates Journal homepage: http://saudijournals.com/sijog/ Case Report Rudimentary Uterine Horn Pregnancy; Pre-rupture Diagnosis and Management: Case Report Elham Al Mardawi, Rawda Al Bahyan, Tahira Jamil Choudhary, Alaa Al Olayet, Aida Bismar, Thamer Al Ghamdi, Ohoud Al Yousef, Ahmad Talal Chamsi * Department of Obstetrics and Gynecology, Security Forces Hospital, Riyadh, Saudi Arabia *Corresponding author: Ahmad Talal Chamsi | Received: 01.03.2019 | Accepted: 03.03.2019 | Published: 30.03.2019 DOI:10.21276/sijog.2019.2.3.2 Abstract Introduction: Rudimentary horn is a developmental anomaly of the uterus. Pregnancy in a rudimentary horn is rare. The Diagnosis of the rudimentary horn pregnancy is very difficult and needs high index of suspicion. Case: We present a case of pregnancy in a non-communicating rudimentary horn that was difficult to diagnosis in the 1 st presentation. The diagnosis was suspected when the case did not respond to the medical termination of pregnancy by misoprostol; and also by mechanical methods. Following that a suspicion of an abnormally located pregnancy was made and confirmed by radiology modalities. Patient had surgical resection of the rudimentary horn. Conclusion: Despite recent advances in ultrasound, the diagnosis of pregnancy in the rudimentary horn remains difficult, and high index of suspicion is needed in these cases. Keywords: Rudimentary Horn, Pregnancy, Abortion, Ectopic. Copyright @ 2019: This is an open-access article distributed under the terms of the Creative Commons Attribution license which permits unrestricted use, distribution, and reproduction in any medium for non-commercial use (NonCommercial, or CC-BY-NC) provided the original author and source are credited. INTRODUCTION Rudimentary horn pregnancy is a rare obstetric entity and carries grave consequences for the mother and fetus. The diagnosis and management may pose some problems. We report our experience in diagnosing and managing a case of missed miscarriage in a rudimentary horn. CASE DESCRIPTION A 28- year old lady, G3 P2 L2, GA= 21 weeks by LMP but 15 weeks by ultrasound, diagnosed to have a missed miscarriage, referred to Security Forces Hospital (SFH) in Riyadh after a failed trial of medical TOP for further assessment and management. Her 1 st pregnancy ended with full term vaginal delivery, the 2 nd was full term cesarean section for fetal heart rate abnormalities on CTG. In this pregnancy, she was followed in Afif – a small City in Saudi Arbia, till she was diagnosed to have a missed miscarriage, For that, she had a trial of medical TOP but failed and was referred to SFH in Riyadh. Ultrasound was done and showed a single non viable intrauterine pregnancy going with 15 weeks, and was to start medical Termination of Pregnancy (TOP) by misoprostol 100 microgram vaginally every 6 hours for 4 doses. The Medical TOP was not successful. The patient was counseled for another trial, which was completed but with no response again. The cervix was closed and no bleeding. At that time, the decision was to discharge her and re admit after 2 weeks. During The 2 nd admission She received another course of misoprostol of 4 doses, 200 microgram each. In spite of that, no progress was observed. Mechanical dilatation was tried using Laminaria tent, 2 rods were inserted in the cervix (4 mm each). The other day, the cervix was 1 cm dilated so 3 rods of 5 mm size were used and kept for 24 hours. Another form of Mechanical dilatation was used by Intracervical Foly’s Cather. All modalities failed. Ultrasound was repeated and it showed a suspicious biornuate uterus with a missed miscarriage in the left horn. An MRI was done and showed a Bicornuate uterus, Right horn is empty and communicating with the cervix, Left horn is the gravid one with the dead fetus inside (Picture-1). No renal abnormalities. The condition was explained to the couple, surgical option was discussed, and patient taken for laparotomy and excision of left uterine horn.