Spontaneous Uterine Cornual Rupture in the Second Trimester of Dichorionic-Diamniotic Twin Pregnancy

Background: Uterine rupture is a rare but life-threatening obstetric emergency, usually associated with labor in patients with a prior cesarean delivery. Spontaneous rupture remote from a uterine scar, particularly at the cornua in the second trimester, is exceedingly uncommon. Case: We report a 30-year-old gravida 2 para 1 at 25 3/7 weeks of gestation with a dichorionic–diamniotic twin pregnancy who presented with abrupt abdominal pain and hemoperitoneum of unclear etiology. Despite reassuring imaging, progressive maternal deterioration and non-reassuring fetal status prompted emergent laparotomy and cesarean delivery. A 3 × 3 cm full-thickness left cornual rupture was identified. Conclusion: In pregnant patients with unexplained hemoperitoneum, clinical status must override reassuring imaging, and prompt surgical intervention is essential.