Rudimentary uterine horn pregnancy. A case report on surviving twins delivered eight days apart.

BACKGROUND: Surviving twins were born to a woman with a unicornuate uterus having a noncommunicating rudimentary uterine horn; this was the first such case reported. Further, it is the first report on a multiple gestation with one twin delivered successfully by cesarean section and the second vaginally at a later date.

CASE: The first twin in a unicornuate uterus was delivered via cesarean section at 28 2/7 weeks due to intractable preterm labor with breech presentation. The ipsilateral hypogastric and ovarian arteries were ligated intraoperatively to arrest myometrial hemorrhage. Continuing preterm contractions resulted in contralateral rudimentary uterine horn rupture eight days later, allowing successful vaginal delivery of the second twin.

CONCLUSION: Neonatal survival in rudimentary uterine horn pregnancies is poor, occurring in only 11% of cases during the past half century. The probability of attaining a favorable outcome is increased if aggressive antenatal management is instituted after establishing an early prenatal diagnosis. In the case of dual-chamber uterine anomalies, it is possible to effect surgical delivery of one fetus while maintaining a second preterm fetus in utero. This maneuver can decrease preterm morbidity for later-born siblings and enhance neonatal survival.