Abstract Background: Unicornuate uterus with a rudimentary horn is a rare Mullerian abnormality, which may cause many gynecologic and obstetric complications. Rupture of the pregnant rudimentary horn in the second trimester is the usual presentation, resulting in severe hemoperitoneum with increased maternal morbidity, and at times, mortality. Case: A rare case of an unsuspected 19+3 weeks' rudimentary horn pregnancy in a 17-year-old primigravida was referred to Jawaharlal Institute of Postgraduate Medical Education and Research as a case of miscarriage with failed medical and surgical evacuation. Exploratory laparotomy revealed a ruptured noncommunicating rudimentary horn pregnancy. Prior to surgery, the case had been misdiagnosed as a secondary abdominal pregnancy. Results: The rudimentary horn was excised, and the postoperative period was uneventful. Conclusions: The diagnosis and treatment of rudimentary horn pregnancy is varied, posing a serious diagnostic dilemma. A high index of suspicion is necess...
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