Failure of intrauterine contraception in a multigravida lady with an undiagnosed uterus didelphys: a case report

Abstract

Uterus didelphys remains one of the rarest uterine anomalies partly because; majority women experience no symptoms with an uneventful reproductive life. Despite the cost-effectiveness and efficacy paired with fewer side effects and convenience of using an intrauterine contraceptive device, it is most likely to prove futile in an unsuspected case of didelphic uterus resulting in an unintended pregnancy. Hence, intrauterine contraception is generally considered a contraindication in cases of uterine malformations. We present a case of a multigravida mother (G7 P3 L3 A3) with a history of three term vaginal deliveries, with an undiagnosed uterus didelphys, carrying a single live intrauterine pregnancy of approximately 6 weeks period of gestation, in the right uterine horn and a copper containing intrauterine contraceptive device in the left uterine horn, willing to undergo medical termination of pregnancy. A high index of suspicion, on the part of the gynaecologist as well as the radiologist, is required to investigate concurrent pregnancy with a history of an intrauterine contraceptive device insertion, in order to rule out rarer uterine malformations like uterus didelphys. Thorough history taking and clinical examination accompanied by improved imaging techniques should be performed at the time of first pregnancy in order to avoid an unsuitable placement of an intrauterine contraceptive device.