Background: Müllerian anomalies occur in 1%–5% of women. The unicornuate uterus occurs when one of the paramesonephric/Müllerian ducts fails to develop, resulting in a uterus with one Fallopian tube. Most unicornuate uteri have a rudimentary horn without communication to the uterine cavity. Management of pregnancy in women with Müllerian anomalies can be challenging. Case: The case of a 22-week pregnancy in a rudimentary detached horn is presented. After a thorough discussion with the patient, the decision was made to proceed with exploratory laparotomy and removal of the pregnancy. A decision was made not to perform resuscitation of the fetus after delivery. Results: The patient's postoperative course was uneventful and she was discharged to go home on postoperative day 3. Conclusions: Careful monitoring is required, as pregnancies in the rudimentary horn of the uterus may not develop adequately or provide the muscular and vascular support required to maintain the pregnancy. Ultrasound was helpful in this case, but was not definitive in the initial diagnosis. A magnetic resonance imaging (MRI) scan may be beneficial for managing such pregnancies. When a rudimentary horn pregnancy mimics an ectopic pregnancy, surgical intervention is mandatory. (J GYNECOL SURG 29:226)
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