Didelphys Uterus: A Case Report and Review of the Literature

Abstract

Background. Mullerian duct anomalies (MDAs) are congenital defects of the female genital system that arise from abnormal embryological development of the Mullerian ducts. A didelphys uterus, also known as a “double uterus,” is one of the least common amongst MDAs. This report discusses a case of didelphys uterus that successfully conceived, carried her pregnancy to term, and delivered vaginally without any significant complications. Case. Patient is a 29-year-old G2P0010 from Bangladesh, initially came a year prior in her first pregnancy, with spontaneous abortion (SAB). Pelvic Sonogram at that time showed a diagnosis of bicornuate versus didelphys uterus. There were no renal anomalies on subsequent abdominal CT scan. Patient presented with the second pregnancy and had uncomplicated prenatal care and did not have signs of preterm labor; fetus showed appropriate growth and the pregnancy was carried in the left uterus. Patient presented at 38 4/7 wks with Premature Rupture of Membrane and underwent induction of labor with Cytotec. Antibiotics were started for chorioamnionitis. Patient had a vaginal delivery with left mediolateral episiotomy and complete tear of vaginal septum. Third stage of labor was complicated with retained placenta, which was removed manually in the operating room with total EBL of 600 cc.

Unilateral Singleton Pregnancy with Rural Vaginal Delivery in a Woman with Uterus Didelphys

“…A longitudinal vaginal septum is associated with 75% of these anomalies and no communication is present between the two endometrial cavities and the two horns [2] [3] [4] [5]. The remaining MDAs include: Class I-vaginal agenesis, Class II-unicornuate, Class IV-bicornuate, Class V-septate, and Class VI-arcuate.…”

“…Since the Müllerian ducts develop in close association with the Wolffian ducts, renal anomalies can be found in association with MDAs [2]. The incidence of MDAs is estimated to range from 0.5% -5%, while the prevalence ranges from 5.5% -9.8% in the general population [2] [3] [6].…”

“…The incidence of MDAs is estimated to range from 0.5% -5%, while the prevalence ranges from 5.5% -9.8% in the general population [2] [3] [6]. UD results from nearly complete failure in fusion of the Müllerian ducts and remains the second least common type of MDA, comprising 5% -8.3% of all MDAs [2] [4].…”

“…The diagnosis becomes apparent when patients present with concerns of infertility, dyspareunia, dysmenorrhea, leukorrhea often in association with a thick partial or complete obstructing vaginal septum on examination [2] [3] [7]. MRI and the developing three-dimensional ultrasound are currently considered as the best imaging modalities for detecting and classifying MDA's [5] [8] [9] [10] [11].…”

“…Menses is most often regular in these women [2]. The obstructing septum can produce a complete or incomplete obstructive hemivagina [1].…”