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Background. The American College of Obstetricians and Gynecologists (ACOG) recommends that most women with one prior low-transverse cesarean delivery should be offered a trial of labor after cesarean (TOLAC). However, very little is known about TOLAC in women with uterine anomalies. Case. A 32-year-old gravida-2 para-1 female with a history of uterine didelphys and one prior low-transverse cesarean section in the left uterine horn presented with a subsequent pregnancy in the left uterine horn. After extensive counseling on TOLAC versus repeat cesarean delivery, the patient decided to proceed with TOLAC and had a spontaneous vaginal delivery of a healthy infant at 38 3/7 weeks of gestation. Conclusion. TOLAC can be considered in women with uterine anomalies using ACOG’s standard TOLAC guidelines with informed consent and shared decision-making between the patient and obstetrician.