Diagnosis and management of a ruptured 20-week anencephalic cornual ectopic pregnancy undergoing termination: implications of interstate travel due to restrictive abortion law

•A primigravida from a state of the USA with limited abortion access.•Parturient traveled to another state for the legal abortion of an anencephalic fetus.•It was not known she also had a cornual ectopic pregnancy.•Delivery resulted in uterine rupture and cesarean hysterectomy.•Significant morbidity may have occurred had the patient remained in her home state. In the changing legal environment of obstetric care in the USA, with laws in many states banning termination at all stages of pregnancy with narrow exemptions, healthcare providers are encountering cases in which risk to maternal safety is increased. This report presents a case of a 28-year-old primigravida with an anencephalic fetus who was legally unable to pursue termination in her home state. She traveled to another state in order to pursue safe and legal abortion of a non-viable fetus. Due to an unrecognized cornual ectopic gestation, the delivery resulted in uterine rupture, the need for hysterectomy, and significant morbidity in a patient with a strong desire for future fertility.