5th International Conference on Gynecology and Obstetrics

Ashish Singh holds an MBBS degree and is currently a Royal College of Obstetricians and Gynaecologists (RCOG) Overseas Trainee at ST2 level at Max Healthcare, India. He is also pursuing a Postgraduate Certificate in Infectious Diseases through distance learning at the London School of Hygiene and Tropical Medicine in 2026.

Background: Rudimentary horn pregnancy has high morbidity, with 80–90% rupturing by the second trimester due to limited muscularity and distensibility. Progression into the third trimester with fetal survival is rare and diagnostically challenging.

Case: An unbooked, hemodynamically unstable primigravida in her twenties presented at 33 weeks’ gestation to the emergency department with severe abdominal pain and reduced fetal movements for 7 to 8 hours. She appeared anxious, with tachycardia (pulse 130 bpm) and hypotension (100/58 mmHg). Per abdominal examination revealed generalised tenderness. Emergency bedside ultrasound showed a large retroplacental clot, with FHR of 118–122 bpm. FHR was confirmed by stethoscope. A potential diagnosis of abruption, uterine rupture, and bleeding from placenta percreta was made, and the patient was taken up for emergency laparotomy. On opening the abdomen, approximately 500 mL of hemoperitoneum was seen and suctioned. A 1.85-kg male fetus in transverse lie was delivered by breech extraction from the upper abdomen. The placenta was attached to the right rudimentary horn and tube. Apgar scores were 5, 7, and 9/10 at 5, 7, and 10 minutes, respectively; positive pressure ventilation was required at birth. Mother and baby were discharged uneventfully after 7 days.

Discussion: Rudimentary horn pregnancy is a rare, catastrophic event, with an incidence of 1 in 760,000–150,000 pregnancies. Its clinical and sonographic features may mimic uterine rupture, placental abruption, or placenta percreta. Advanced cases are difficult to diagnose preoperatively, and diagnosis is confirmed intraoperatively, as seen in our case, highlighting the diagnostic challenges of this rare condition.

Conclusion: Diagnostic dilemmas and high perinatal mortality associated with such cases underscore the importance of maintaining a high index of clinical suspicion, particularly in unbooked pregnancies presenting to the obstetric emergency unit, as was seen in our case. Prompt timely surgical intervention can lead to favorable outcomes for both mother and neonate, as in our case.