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Introduction: Uterine abnormalities although are not very common, 25% of women have been noted to have miscarriages and /or premature deliveries. This is a case report of a 26 year old female with uterus didelphys. Aims and objectives: To discuss an unusual case of a primigravida at 11 weeks with uterus didelphys, who had a spontaneous rupture of right horn of the uterus and presented in hemorrhagic shock. This case discusses about how to efficiently diagnose and manage such an emergency. Materials n methods: Case report of a 26 year old female, married for 9 months with 11 weeks amenorrhea presented in emergency department with 1 day history of vomiting, abdominal cramps. She had didelphys uterus and was 11 weeks pregnant with pregnancy in the right horn in previous scan. On arrival, she was in hypovolemic shock. She clinically appeared pale, had a distended and tender abdomen. USG confirmed haemoperitoneum. She was taken to theatre immediately after obtaining consent for hysterectomy. Results: Patient was resuscitated with fluids, blood products and inotropes. Intraoperatively, she had a 3 litres haemoperitoneum and 11 weeks' size baby was found in the abdominal cavity. There was a ruptured right horn of the uterus. Excision of the right horn was performed. Patient had a hemoglobin of 4 and INR of 1.9 preoperatively. Intraoperatively, coagulation was corrected. Immediate post op was in ICU with elective intubation. Patient then recovered well and was discharged home. Conclusions: She has been advised to use a reliable contraceptive and to not plan a pregnancy in the future. These following questions need to be addressed to effectively counsel a patient before embarking on a pregnancy. What is the risk ratio of congenital uterine anomalies rupturing nearly at the end of first trimester? Do we let this patient conceive in the future? If not, how do we counsel about her fertility options?