Maternal death from ruptured rudimentary horn pregnancy: a rare case report

Pregnancy in a rudimentary horn is rare but can lead to severe complications, including life-threatening complication like rupture of the rudimentary horn. Herein, we report a case of maternal death due to massive hemorrhage from a ruptured non-communicating rudimentary horn pregnancy. A 26-year-old female died at home after experiencing severe abdominal cramps three hours prior to her death. She contemplated seeking medical attention at the beginning of her cramps but decided to wait as her pain initially subsided. Tragically, her condition worsened suddenly, and she collapsed before accessing medical care. The autopsy revealed approximately 4,000 ml of blood in the abdominal cavity, with significant clots lining the mesenteric surface of the colon. A dead fetus, measuring 18 cm in crown-to-heel (CHL), attached to the placenta, was discovered in the left paracolic gutter. Based on the CHL measurement, the fetal gestational age was estimated to be around 4 months. There was a ruptured rudimentary uterine horn connected to a centrally located unicornuate uterus by a non-communicating fibrous band. The unicornuate uterus had a normal mucosal surface and was continuous with the cervix and vagina. This case highlights the tragic consequences of delayed presentation during acute medical conditions of pregnancy, and underscores the importance of patient education regarding symptom recognition and seeking care. It also emphasizes the importance of considering ruptured rudimentary horn pregnancy as a potential cause of maternal mortality especially in cases of sudden and unexplained deaths in women of reproductive age group, even when pregnancy is not immediately apparent. Thorough forensic evaluations and reporting are crucial in maternal deaths to identify such rare but fatal conditions.