DOI - 10.21276/obgyn.2019.6.1.18 ISSN Print – 2454-2334; ISSN Online – 2454-2342 Pregnancy in the rudimentary horn - the culprit behind a catastrophical outcome Mayuri Ahuja, Ruchi Srivastava, Shehla Jamal Correspondence: Dr Mayuri Ahuja, Flat no 203, old staff quarters, Sharda campus, knowledge park 3. Greater Noida, India; Email - soniaahuji@rediffmail.com Distributed under Attribution – NonCommercial – Share Alike 4.0 International (CC BY-NC-SA 4.0) ABSTRACT Pregnancy in a non-communicating rudimentary horn is of very rare occurrence. Delayed and initial misdiagnosis can result in catastrophic outcome both for the fetus as well as the mother. We present a case of 24 years old G 3 P 2 L 1 with ruptured pregnancy in a rudimentary horn which due to misdiagnosis resulted in maternal near miss. Keywords: Rudimentary horn, pregnancy, ultrasound. Pregnancy in the rudimentary horn of unicornuate uterus occurs in 1: 76000 to 1:150000 of all pregnancies. 1 The rudimentary horn is non-communicating in 83% of cases. 2 Ultrasound detection rate is of only 26% and the rate of detection decreases as the gestational age advances. 3 The initial misdiagnosis can result in significant morbidity and mortality. With the advancement of ultrasound technology, the role of paracentesis in cases of distended abdomen cannot be bypassed. The detection of hemoperitoneum on paracentesis provided an aid to the final diagnosis which eventually prevented maternal mortality. Case Report A 24-year-old G 3 P 2 L 1 presented to the hospital with four month amenorrhea, pain lower abdomen on and off for the past 2 days, breathlessness and dizziness since one day. Her previous child birth was a still born male at 7 months of gestation. Her other issue was also a preterm birth at 8 months of gestation five years back. Pregnancy was confirmed by positive home urinary pregnancy test. No scans were done during this pregnancy. At the time of presentation, she was conscious and oriented but had severe pallor. Pulse was 140/min, blood pressure was 80 / 40 mm Hg and abdomen was distended. Uterus was diverted to the right side, fundal height and exact size could not be estimated on per vaginal examination. Her investigations revealed Hb: 5 g/dl, TLC: 23,000/cumm, platelet count: 50 thousand and viral markers were negative. Her USG revealed gross ascites and intrauterine fetal demise at 13 weeks of gestation. With a presumptive diagnosis of sepsis with ascites with IUD, parentral fluids, nor-adrenaline drip, two units packed red blood cells arranged and transfused. Broad spectrum antibiotic coverage was also done. After 5 hours of initial resuscitation the patient condition further deteriorate. Patient was intubated. Noradrenaline drip was accelerated from 2.5 ml/hr to 10 ml/hr. The increasing abdominal distension prompted the performance of CASE REPORT Received: 25 th May 2019. Accepted: 13 th June 2019. Ahuja M, Srivastava R, Jamal S. Pregnancy in the rudimentary horn - the culprit behind a catastrophical outcome. The New Indian Journal of OBGYN. 2019; 6(1): 71-3.