Background <p>A unicornuate uterus with a non-communicating rudimentary horn is a rare mullerian anomaly that arises from the incomplete development or hypoplasia of either of the mullerian ducts, affecting approximately 0.4% of women. Pregnancy in the non-communicating horn is exceedingly rare, with an incidence between 1 in 76,000 and 1 in 140,000 cases. Uterine rupture occurs in approximately 80% of cases, with most of these ruptures taking place during the second trimester, typically before the 20th week of gestation. Although rare, such cases can progress to term and result in live birth with timely management, highlighting the need for individualized care in such high-risk pregnancies.</p> Case Presentation <p>Here, we present the case of a 28-year-old primigravida with a non-communicating rudimentary horn pregnancy complicated by placenta percreta. A female baby weighing 2.4 kg was delivered via breech extraction from the left gravid non-communicating rudimentary horn, which, along with the placenta, left fallopian tube, and ovary, was excised following delivery. The patient’s postoperative recovery was uneventful.</p> Conclusion <p>Non-communicating RHP is a rare, high-risk condition frequently leading to severe complications. Clinicians must remain vigilant, and once diagnosed, prompt life-saving interventions such as timely laparotomy and immediate removal of the horn are crucial to prevent maternal morbidity and mortality.</p>