Background: Unicornuate uterus with pregnancy in a rudimentary horn is a rare clinical entity with an incidence of 1 in 76000. Its diagnosis requires a high index of suspicion as it can be very easily missed during a routine ultrasound scan. Management involves laparoscopically or open resection of the rudimentary horn and ipsilateral fallopian tube.
Case report: We present a case of a 28-year old female with pain abdomen and history of intake of abortion pills twice and previous history of normal vaginal delivery. Initial ultrasound scans from remote centers were normal. After a thorough clinical examination, patient was again subjected to a final scan which revealed ectopic pregnancy. A definitive diagnosis of leftrudimentary horn pregnancy was made during laparotomy and resection of a rudimentary horn with ipsilateral salpingooopherectomy was done.
Conclusion: Diagnosis of the rudimentary horn is a challenge. Early diagnosis is necessary to decrease maternal morbidity and mortality.
Nahum GG. Uterine anomalies. How common are they, and what is their distribution among subtypes? The Journal of Reproductive Medicine. 1998;43:877-887.
Engmann L, Schmidt D, Nulsen J, Maier D, Benadiva C. An unusual anatomic variation of a unicornuate uterus with normal external uterine morphology. FertilSteril 2004;82:950-953.
Handa Y, Hoshi N, Wada S, Kudo M, Tsuda et al. Tubal pregnancy in a unicornuate uterus with rudimentary horn: a case report. Fertil Steril 1999;72:354-356.
Johansen K. Pregnancy in a rudimentary horn. Obstet Obstet Gynecol 1983;61:565-567.
Nahum GG.Rudimentary uterine horn pregnancy:the 20th century worldwide experience of 588 cases. J Reprod Med 2002;47:151-163.
Caserta D, Mallozi M, Melodelsi C, Bianchi P, Moscarini M. Pregnancy in a unicornuate uterus: a case report. J Med Case Rep 2014;8:130.
American Fertilty Society. Classification of mullerian anomalies. FertilSteril 1988;49:952.
Jayasinghe Y, Rane A, Stalewski H, Grover S. The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol 2005;105:1456-1467.
Mauriceau F. Traite des maladaies des femmes grosses. In: Mauriceau F, ed. A Book. 1st ed. Paris, France:Compaigne des libraries; 1721.
Tsafir A, Rojansky N, Sela HY etal. Rudimentary horn pregnancy: first trimester pre rupture sonographic diagnosis and confirmation by magnetic resonance imaging. J Ultrasound Med 2005;24:219-223.
ShinJW, Kim HJ. Case of live birth in a non communicating rudimentary horn pregnancy. Journal of Obstetrics and Gynecology Research. 2005;31:329-331.
Ó Gráda Famine Enquiry Commission. Repoprt on Bengal. New Delhi: Govt. Of India Press; July 15th 1994. pg 1-254. Ordinance no. XXVII of 1944. pp. 21-22.
Maharatna Famine Enquiry Commission. Repoprt on Bengal. New Delhi : Govt. Of India Press; July 15th 1994. pp. 1-254. Ordinance no. XXVII of 1944.
Mokyr Ó Gráda; Famine Enquiry Commission. Repoprt on Bengal. New Delhi: Govt. Of India Press; July 15th 1994. Ordinance no. XXVII of 1944. pp. 1-254.
Ferrier DR. The Feed- Fast cycle. In. Richard A. Harvey, Editor. Lippincott’ s illustrated reviews- Biochemistry: New Delhi; 2015. p. 333.
Dr Brandt. Starvation and Diabetes. Endocrine. P 71-88. Available from http://www.rose-hulman.edu > Chem330
Fedorov VB, Goropashnaya AV, Ø.Tøien et al., “Preservation of bone mass and structure in hibernating black bears (Ursus americanus) through elevated expression of anabolic genes,” Functional and Integrative Genomics. 2012;12(2):357-365.
Chow BA, Donahue SW, Vaughan MR, McConkey B, Vijayan MM, “Serum immune-related proteins are differentially expressed during hibernation in theAmerican black bear,” PLoS ONE. 2013;8(6).
Virginia B. A Tale of Two Colonies: What Really Happened in Virginia and Bermuda? University of Missouri Press 2011. ISBN 0826272576 pp. 112.
Bydlowska J. Drunk Mom: A Memoir. Doubleday Canada. Penguin Random House publications 2013 ISBN 0385677812 pp. 91.
Pojman P, Pojman L. Food Ethics. Cengage Learning US. Wadsworth Publishing 2011. pp. 128. ISBN 1111772304.
With spirulina, and togethers, we will end child malnutrition in the world Now.” Available from http://www.indiegogo. com/projects/with- spirulina-and-togethers-we-will-endchild- malnutrition-in-the-world-now. Retrieved Dec 16, 2014.
Lucas A, “Programming by early nutrition in man,” in The Childhood Environment and Adult Disease, G. R. Bock and J. Whelan, Eds., Ciba Foundation Symposium 156, JohnWiley & Sons, Chichester, UK, 1991 pp. 38-55.
McCance RA, Widdowson EM. “The determinants of growth and form,” Proceedings of the Royal Society of London B— Biological Sciences 1974;185(1078):1-17.
Hermanussen M, M de Los Angeles Roi de Lama, Romero AP, Ruiz CA, Burmeister J, Tresguerres JAF. “Differential catch-up in body weight and bone growth after short-term starvation in rats,” Growth Regulation 1996;6(4):230-237.
Banu MJ, Orhii PB, Mejia W et al.“Analysis of the effects of growth hormone, voluntary exercise, and food restriction on diaphyseal bone in female F344 rats,”Bone. 1999; 25(4):469-480.
Banu J, Orhii PB, Okafor MC, Wang L, Kalu DN. “Analysis of the effects of growth hormone, exercise and food on diaphyseal bone in female F344 rats,” Bone 1999; 25(4): 469-480.
Janiszewski P. Obesity Panacea – [News nutrition, peer reviewed research]:[Janiszewski]; [may 13, 2011] - The Science of Starvation: How long can humans survive without food or water?Available from http://blogs.plos.org/obesitypanacea/ about this blog.
Beresford D. Ten Men Dead. New York: Atlantic Press. 1997. ISBN 0-87113-702-X.
Srimat Bhagvatam. SB 4.8.71 - SB 4.8.79
Attia E. “Anorexia nervosa: current status and future directions,”Annual Review of Medicine 2010;61(1) 425-435.
Rosen JC, Reiter J, and Orosan P, “Assessment of body image in eating disorders with the body dysmorphic disorder examination,” Behaviour Research and Therapy 1995; 33(1):77–84.
Grinspoon S, Miller K, Coyle C et al., “Severity of osteopenia in estrogen-deficient women with anorexia nervosa and hypothalamic amenorrhea,” Journal of Clinical Endocrinology and Metabolism 1999;84(6):2049-2055.
Biller BMK, Saxe V, Herzog D.B., Rosenthal DI, Holzman S, Klibanski A. “Mechanisms of osteoporosis in adult and adolescent women with anorexia nervosa,” Journal of Clinical Endocrinology and Metabolism 1989; 68(3): 548-554.
Grinspoon S, Thomas E, Pitts S et al., “Prevalence and predictive factors for regional osteopenia in women with anorexia nervosa,” Annals of Internal Medicine 2000;133(10): 790-I42.
Rigotti NA, Neer RM, Skates SJ, Herzog DB, Nussbaum SR, “The clinical course of osteoporosis in anorexia nervosa. A longitudinal study of cortical bone mass,” The Journal of the American Medical Association 1991;265(9): 1133-1138.
Baker D, Roberts R, Towell T, “Factors predictive of bone mineral density in eating-disordered women: a longitudinal study,” International Journal of Eating Disorders 2000;27(1): 29-35.
Khosla S, Lufkin EG, Hodgson SF, Fitzpatrick LA, Melton LJ III, “Epidemiology and clinical features of osteoporosis in younindividuals,” Bone 1994;15(5):551-555.
Zipfel S, Seibel MJ, Löwe B, Beumont PJ, Kasperk C, Herzog W. “Osteoporosis in eating disorders: a follow-up study of patients with anorexia and bulimia nervosa,” Journal of Clinical Endocrinology and Metabolism 2001;86(11):5227–5233.
Soyka LA, Grinspoon S, Levitsky LL, Herzog DB, Klibanski A. “The effects of anorexia nervosa on bone metabolism in female adolescents,” Journal of Clinical Endocrinology and Metabolism 1999;84(12):4489-4496.
LA Soyka, M. Misra, A. Frenchman et al., “Abnormal bone mineral accrual in adolescent girls with anorexia nervosa,”Journal of Clinical Endocrinology and Metabolism 2002; 87(9):4177-4185.
MM LaBan, JC Wilkins, AH Sackeyfio, and RS Taylor, “Osteoporotic stress fractures in anorexia nervosa: etiology, diagnosis, and review of four cases,” Archives of Physical Medicine and Rehabilitation 1995;76(9):884-887.
Y Maugars, J.-M. Berthelot, S. Lalande, C. Charlier, and A. Prost, “Osteoporotic fractures revealing anorexia nervosa in five females,” Revue du Rhumatisme (English Edition) 1996; 63(3):201–206.
Golden NH et al. Resumption of Menses in Anorexia Nervosa. Arch Pediatr Adolesc med 1997;151:16-21.
Audi L et al. Leptin in Relation to Resumption of Menses in Women with Anorexia Nervosa. Mol Psychiatry 1998;4:544-547.
Mehanna HM, Moledina J, Travis J. “Refeeding syndrome: what it is, and how to prevent and treat it”. BMJ 2008; 336: 1495 8. doi:10.1136/bmj.a301.PMC 2440847. PMID 18583681.
“The Physiology and Treatment of Starvation”. US national library of medicine. Retrieved 17 August 2012. chromeextension://mhjfbmdgcfjbbpaeojofohoefgiehjai/index.html
Kreipe R et al. Eating Disorders in Adolescents and Older Children. Pediatrics in Review 1999; 20:12.
Pike KM et al. Cognitive Behavior Therapy in the Posthospitalization. Treatment of Anorexia Nervosa. Am J Pyschiatry 2004; 11:2046-2049.
Bender DA. Carbohydrates of Physiologic Significance. Murray RK, Bender DA, Botham KM, Kenelly PJ, Rodwell VW, Weil PA.. Harpers Illustrated Biochemistry 28th ed. New York:Mc Graw Hill publications; 2009. p 113-120.
Koffler M, Kisch ES. Starvation diet and very-low-calorie diets may Induce insulin resistance and overt diabetes mellitus. J Diabetes Complications.1996;10(2):109-12.
Hales CN, Barker DJ The thrifty phenotype hypothesis. Br Med Bull. 2001;60:5-20.
Hales CN, Barker DJ (July 1992). “Type 2 (non-insulindependent) diabetes mellitus: the thrifty phenotype hypothesis”. Diabetologia. 35 (7): 595-601.
Barker, D.J.P. (1997). “Maternal Nutrition, Fetal Nutrition, and Disease in Later Life”. Nutrition, ‘13’, pp. 807.
Martin, Paul; Bateson, Patrick (1999). Design for a life: How behaviour develops. London: Jonathan Cape. ISBN 0-224- 05064-8 pp. 110-111.
Barker, DJP. ed. (1992). Fetal and infant origins of adult disease. London: British Medical Journal. ISBN 0-7279-0743-3.
Robinson R (February 2001). “The fetal origins of adult disease: No longer just a hypothesis and may be critically important in south Asia”. Editorial
Mazur A. Why were “starvation diets” promoted for diabetes in the pre-insulin period? Nutrition Journal 2011;10:23.
Goodacre CJ, Kan JY, Rungcharassaeng K. Clinical complications of osseointegrated implants. J Prosthet Dent 1999 May;81(5):537-552.
Evans CD, Chen ST. Esthetic outcomes of immediate implant placements. Clin Oral Implants Res 2008 Jan;19(1):73-80.
Romeo E, Lops D, Rossi A, Storelli S, Rozza R, Chiapasco M. Surgical and prosthetic management of interproximal region with single-implant restorations: 1-year prospective study. J Periodontol 2008 Jun;79(6):1048-1055.
Nagaraj KR, Savadi CR, Savadi AR, Prashanth Reddy GT, Srilakshmi J, Dayalan M, John J. Gingival biotype— prosthodontic perspective. J Indian Prosthodont Soc 2010 Mar;10(1):27-30.
Jung RE, Sailer I, Hämmerle CH, Attin T, Schmidlin P. In vitro color changes of soft tissues caused by restorative materials. Int J Periodontics Restorative Dent 2007 Jun;27(3): 251-257.