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Multimodality Study of a Twin Pregnancy Within a Rudimentary Horn

Pregnancies within rudimentary horns of unicornuate uteri are extremely rare. These pregnancies account for approximately 1 in 76 000 to 1 in 140 000 worldwide, with uterine rupture being the most concerning complication. A case is presented of a 24-year-old female, gravida 2, para 0, who underwent multiple sonograms pertaining to two gestations over a 3-year period. Both pregnancies occurred within the left rudimentary horn of a unicornuate uterus. The left rudimentary horn was confirmed, on magnetic resonance imaging, to have no communication with the right horn or endocervical canal. The first pregnancy resulted in a missed abortion, and the second pregnancy, 3 years later, was a twin gestation, which was carefully monitored. At 20 weeks, the uterus began to rupture, and an emergency C-section was attempted. Neither the fetus nor the rudimentary horn survived, which was excised. This case demonstrates a rare uterine finding, a pregnancy occurred twice within the horn that lacked communication with the cervix.