| Laparoscopic management of pregnancy in a patient with uterus didelphys, obstructed hemivagina, and ipsilateral renal agenesis. | |
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MedLine Citation:
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PMID: 21545963 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Pregnancy in a rudimentary uterine horn is a rare and potentially lethal condition. The highest risk of rupture is reported to be during the late first and second trimester. The risk of rupture correlates with the thickness of the myometrium surrounding the fetal pole. In 2005, a 20-year-old woman was incompletely diagnosed by imaging studies and laparoscopy to have an absent right kidney, a bicornate uterus with a right rudimentary uterine horn and a single cervix, a transverse vaginal septum with hematocolpos, and endometriosis caused by reflux menstruation. The transverse vaginal septum was excised, and the surgeon observed a single cervix. Oral contraceptives were prescribed as complementary treatment for the endometriosis and associated dysmenorrhea. In 2009, magnetic resonance imaging confirmed resolution of hematocolpos and revealed a right cervix connected to the right horn of a uterus didelphys and covered by a partial longitudinal vaginal septum. The patient had a contraception failure and presented in 2010 at 9(6/7) weeks' gestation. By ultrasonography and subsequent magnetic resonance imaging, the pregnancy was in the right uterus and the corpus luteum was on the left ovary. The myometrium was thinned to 2 to 3 mm atop the gestational sac. Using the Harmonic ACE, laparoscopic excision of the right fallopian tube and a supracervical right hysterectomy with an intact pregnancy was performed. This case supports the Acién hypothesis that the vagina forms from both Müllerian and Wolffian duct elements, and it illustrates the risk for uterine rupture when pregnancy forms in a rudimentary structure; presumed transperitoneal migration of an ovum that was captured by the opposite fallopian tube; and surgical management of the in situ pregnancy by laparoscopic supracervical excision of the rudimentary uterine body. |
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Authors:
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A Karim Nawfal; Charla M Blacker; Ronald C Strickler; David Eisenstein |
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Publication Detail:
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Type: Case Reports; Journal Article |
Journal Detail:
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Title: Journal of minimally invasive gynecology Volume: 18 ISSN: 1553-4669 ISO Abbreviation: J Minim Invasive Gynecol Publication Date: 2011 May-Jun |
Date Detail:
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Created Date: 2011-05-06 Completed Date: 2011-10-24 Revised Date: 2012-04-05 |
Medline Journal Info:
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Nlm Unique ID: 101235322 Medline TA: J Minim Invasive Gynecol Country: United States |
Other Details:
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Languages: eng Pagination: 381-5 Citation Subset: IM |
Copyright Information:
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Copyright © 2011 AAGL. Published by Elsevier Inc. All rights reserved. |
Affiliation:
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Department of Gynecology, Obstetrics, and Women's Health, Henry Ford Hospital, Detroit, Michigan 48202, USA. anawfal1@hfhs.org |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Abnormalities, Multiple
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surgery* Abortion, Therapeutic Adult Cervix Uteri / abnormalities Female Humans Kidney / abnormalities Laparoscopy / methods* Magnetic Resonance Imaging Pregnancy Pregnancy Complications / surgery* Uterus / abnormalities*, surgery* Vagina / abnormalities Young Adult |
| Comments/Corrections | |
Comment In:
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J Minim Invasive Gynecol. 2012 Mar-Apr;19(2):266; author reply
[PMID:
22381976
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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