Abstract
Congenital uterine anomalies result from Müllerian duct maldevelopment, affecting about 5.5% of the population, with higher rates in infertility and recurrent miscarriage. Often asymptomatic, they may remain undetected. We describe a rare case of spontaneous second-trimester uterine rupture in a primigravida with an unrecognized anomaly. At 21 weeks’ gestation, she arrived in hypovolemic shock after two weeks of cyclic abdominal pain. Emergency surgery revealed massive hemoperitoneum, a ruptured right rudimentary horn, and a left-sided unicornuate uterus, with the non-viable fetus free in the abdominal cavity. Excision of the rudimentary horn and ipsilateral tube was performed, and recovery was uneventful. The anomaly was classified as U4aC0V0 by ESHRE/ESGE criteria as a unicornuate uterus with a functional remnant by ASRM criteria. This case highlights the importance of early recognition of Müllerian anomalies to prevent catastrophic complications such as uterine rupture and supports including rare variants in the diagnostic workup for timely management.
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