Clinical outcomes and practical management implications in rudimentary horn pregnancies: a systematic review and pooled analysis (2010-2025)
Clinical Snapshot
PICO Framework
| P — Population | Women with rudimentary horn pregnancies (unicornuate uterus with rudimentary horn) |
| I — Intervention | Communicating horn pregnancies (CHP) vs non-communicating horn pregnancies (NCHP) |
| C — Comparator | Different types of rudimentary horn pregnancies and management approaches |
| O — Outcomes | Time of diagnosis, time of rupture, live birth rate, maternal complications |
Bottom Line
This systematic review of 190 rudimentary horn pregnancies suggests communicating horn pregnancies may have later diagnosis, later rupture, and higher live birth rates compared to non-communicating types. However, the evidence quality is low, based primarily on case reports, and the authors appropriately caution against causal inference. The overall live birth rate remains very low at 11.6%, with rupture occurring in over one-third of cases. For Australian clinicians, this reinforces current practice recommendations for early surgical termination when rudimentary horn pregnancy is diagnosed. If expectant management is considered, intensive monitoring with weekly ultrasounds and multidisciplinary care is essential. The study highlights the importance of detailed imaging to characterize horn type, which may inform counselling about outcomes, though surgical management remains the safest approach.
Key Findings
P Value: p = 0.02 for live birth rate comparison
Effect Size: Difference in live birth rates: 16.7 percentage points higher in CHP
Primary Outcome: Live birth rate 11.6% overall; CHP 25.9% vs NCHP 9.2%
Nnt Or Sensitivity: Number needed to treat not applicable; diagnostic accuracy not assessed
Confidence Interval: Not reported
Clinical Application
Requires advanced imaging capabilities and multidisciplinary expertise available in major Australian hospitals Relevant to Australian maternal-fetal medicine units; aligns with RANZCOG guidelines for high-risk pregnancy management; MBS items available for advanced ultrasound monitoring Women with suspected or confirmed rudimentary horn pregnancies in tertiary care settings
Abstract
PURPOSE: Rudimentary horn pregnancies are rare and carry significant maternal and fetal risks. This study aims to systematically review published cases of rudimentary horn pregnancies describing data about time of diagnosis, time of rupture, and live birth rate (LBR), with exploratory comparisons between communicating (CHP) and non-communicating horn pregnancies (NCHP). METHODS: A PRISMA-guided systematic search of PubMed, MEDLINE, and Cochrane (October 1, 2025) was performed with terms "unicornuate uterus pregnancy" OR "rudimentary horn pregnancy." Case reports, series, and reviews with defined clinical data were included; abstracts and unclear reports were excluded. Three independent reviewers extracted data using a standardized protocol. Descriptive statistics (means, medians, standard deviations, and ranges) and exploratory group comparisons (Fisher's exact test, Mann-Whitney U and Student's t test with p < 0.05 denoting significance) were performed. RESULTS: From 132 articles, 190 cases were included: 27 CHP (14.2%) and 163 NCHP (85.8%). Time of diagnosis was earlier in NCHP (15.9 ± 8.9 weeks) than CHP (22.1 ± 10.0 weeks, p = 0.01). Rupture occurred in 68 cases (35.8%), similarly in CHP (48.1%) and NCHP (33.7%, p = 0.19). Time of rupture was earlier in NCHP (18.7 ± 6.6 weeks) than CHP (23.0 ± 9.2 weeks, p = 0.02). Four cases attempted to continue pregnancy; all resulted in premature rupture. Reported live births were infrequent (11.6%) and more common in published CHP (25.9%) vs. NCHP cases (9.2%; p = 0.02). CONCLUSIONS: This descriptive synthesis indicates uterine horn communication may be associated with later diagnosis/rupture and reported live births were significantly more frequent in published CHP vs. NCHP cases. However, all comparisons are exploratory and must be interpreted with extreme caution, as data limitations preclude causal inference. Exhaustive imaging and diagnosis are essential to characterize horn type. Surgical termination is advised, but if expectant management is chosen, close monitoring and multidisciplinary care, including weekly ultrasounds, are advisable to mitigate complications.
References
- 1.Emrich, N. L. A., Padrón, L. T., Schröder, C., Mustea, A., Strizek, B., Gembruch, U., & Cruz, J. J. (2026). Clinical outcomes and practical management implications in rudimentary horn pregnancies: a systematic review and pooled analysis (2010-2025). Archives of Gynecology and Obstetrics. https://doi.org/10.1016/j.ajog.2024.10.026
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