Management of a Triplet Gestation Complicated by Uterus didelphys

Abstract

Background: Assisted reproductive technologies are making it possible for women to conceive when it was otherwise impossible. One of the side effects is multiple gestations. This may be especially disadvantageous when it occurs within an anomalous uterus. Patient and Methods: A 36-year-old women with the help of gamete intrafallopean transfer conceived triplets in a uterus didelphys. This pregnancy was further complicated by anencephaly of one of the triplets. The patient was managed by a combination of chorionic villi sampling and selective reduction that ended with the successful delivery of a term infant. Conclusion: Pregnancy reduction can be safely performed in a twin pregnancy on one side of a uterus didelphys. More reports will be required to determine whether this is the most optimal choice.

Spontaneous Triplet Pregnancy Complicated by Uterus Didelphys: A Case Report

“…Perinatal outcomes reported in triplet pregnancy and didelphys uterus are discouraging. Three previous cases of triplet pregnancy in a didelphys uterus have been published: two of them after ovulation induction and one after gamete intrafallopian transfer [9][10][11] . Fetal demise was reported both in utero and early in the neonatal period [9][10][11] .…”

“…Three previous cases of triplet pregnancy in a didelphys uterus have been published: two of them after ovulation induction and one after gamete intrafallopian transfer [9][10][11] . Fetal demise was reported both in utero and early in the neonatal period [9][10][11] . This mortality is mainly related to prematurity, although malformations have been also described [9,10] .…”

“…Fetal demise was reported both in utero and early in the neonatal period [9][10][11] . This mortality is mainly related to prematurity, although malformations have been also described [9,10] . Only two term births with delivery of a healthy fetus have been reported; in both cases the living fetus was alone in one of the horns.…”

“…Only two term births with delivery of a healthy fetus have been reported; in both cases the living fetus was alone in one of the horns. The first one took place at 38 weeks after embryo reduction of two fetuses in early pregnancy [10] . The second one took place at 37 weeks [11] .…”

“…In the previous cases reported, all of which followed ART, active management of pregnancy resulted in healthy term fetuses [10,11] . In our case, expectant management until the 31st and 36th weeks probably allowed us to reach lung maturity and achieve weight gain, leading to morbidity reduction.…”