Non-communicating contralateral tubular ectopic in a unicornuate uterus

Ectopic pregnancy describes any pregnancy occurring outside of the uterine endometrial cavity and is the leading cause of maternal mortality during the first trimester. There are several recognised factors that increase a woman's risk of ectopic pregnancy, including Müllerian duct anomalies (MDAs). The following case describes a unique diagnostic scenario in which a patient with a known MDA presented with an ectopic pregnancy. Intraoperative findings confirmed a left unicornuate uterus with normal left fallopian tube and left ovary. Unexpected findings included a right rudimentary horn and right intra-abdominal ovary adjacent to a right remnant fallopian tube encasing a ruptured ectopic pregnancy. This case highlights the complexity in diagnosis and management of ectopic pregnancy in women with uterine anomalies. It identifies the potential for delays in operative management, and as such, underlines the possibility of increased risk of maternal morbidity and mortality in this patient population.