Second Trimester Spontaneous Fundal Rupture of Unscarred Bicornuate Uterus in Primipara: A Case Report and Literature Review; Jigjiga University Sheik Hassen Yabare Comprehensive Specialized Hospital, Jigjiga, Ethiopia.

Background: Primary rupture of an unscarred uterus is rare. Spontaneous rupture of an unscarred bicornuate uterus is a life-threatening obstetric emergency with high morbidity and mortality in the mother and fetus; however, it most commonly occurs in the first trimester of pregnancy.

Case: A 20-year-old primigravid woman at 22 weeks of gestation, with no prior surgery, presented with severe abdominal pain, anemia, and hemodynamic instability. With a preoperative diagnosis of uterine rupture, she was transfused with three units of cross-matched whole blood and underwent emergency laparotomy. Intraoperative findings showed a ruptured bicornuate uterus and a dead fetus in the abdomen with huge hemoperitoneum. Postoperative recovery was smooth, and the patient was discharged after being counselled on family planning and subsequent pregnancy.

Conclusion: A bicornuate uterus may be an independent risk factor for uterine rupture, which can occur in primigravid women at any stage of pregnancy. Each obstetrician should have a high index of suspicion for a rare condition like ruptured bicornuate uterus, especially for a pregnant woman presenting with acute abdominal pain and hemodynamic instability. Early ultrasonography plays a key role in the evaluation, follow-up, and management of these patients.