Pregnancy in a Unicornuate Uterus with Rudimentary Horn: A Case Report

A unicornuate uterus is a rare congenital Müllerian anomaly resulting from incomplete development of one Müllerian duct and accounts for approximately 2-13% of all uterine malformations. This anomaly is associated with a wide range of adverse reproductive outcomes, including recurrent pregnancy loss, ectopic pregnancy, preterm birth, malpresentation, fetal growth restriction, and increased rates of operative delivery. Consequently, pregnancies in women with a unicornuate uterus are categorized as high risk and require careful antenatal surveillance and individualized obstetric management. We report the case of a 29-year-old woman with a term breech pregnancy at 40 weeks and 1 day of gestation who presented in active labor and underwent emergency lower segment cesarean section. Intraoperatively, a right-sided unicornuate uterus with a non-communicating rudimentary horn was incidentally identified. The ipsilateral fallopian tube and ovary were normal, while the contralateral adnexa were attached to the rudimentary horn. A healthy female neonate weighing 3.0 kg was delivered with an immediate cry. The postoperative period was uneventful, and both maternal and neonatal outcomes were favorable. This case demonstrates that successful term pregnancy is achievable in women with a unicornuate uterus despite inherent obstetric risks. It underscores the importance of maintaining a high index of suspicion for uterine anomalies in women presenting with recurrent malpresentation or adverse obstetric history and highlights the role of vigilant antenatal monitoring and tailored obstetric care in optimizing outcomes.