The Impact of Uterus Didelphys on Fertility and Pregnancy

Abstract

Uterus didelphys occurs as a result of abnormal fusion of the paramesonephric ducts and is characterized by complete duplication of uterine horns, cervix, and very often also the vagina or presence of longitudinal vaginal septum. Most women with a uterus didelphys are asymptomatic; some cases may coincide with dyspareunia or dysmenorrhea. The anomaly is associated with a higher risk of miscarriage, preterm labor, breech delivery, and decreased live births. We present the case of a 26-year-old woman (primigravida) who was known to have uterus didelphys. The diagnosis was made when the patient was 23 years old using ultrasound and hysteroscopy. The patient became pregnant after 18 months of efforts. The patient was referred to prenatal care in the 13th week of pregnancy with vaginal bleeding. In the 23rd week of pregnancy, gestation cholelithiasis was diagnosed. The pregnancy progressed without obstetric complications and the fetus developed normally. Due to the vaginal septum and fact that the patient felt stressed, the pregnancy was terminated at term by cesarean section. We concluded that uterus didelphys can be asymptomatic making an early diagnosis difficult. A pregnancy belongs to a high-risk group and more attention should be paid to this case. Cesarean section should be considered, especially in case of the presence of vaginal septum.

Uterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section

“…Genital neoplasms and endometriosis have been reported in a few cases (4). The rate of premature deliveries, abnormal fetal presentations, abortions, early rupture of the fetal membranes, cervical incompetence, postpartum haemorrhage, intrauterine growth restriction and cesarean deliveries are generally increased (14). According to Banu and colleagues, this anomaly has been reported in about 3.5 percent in sub fertile couples and about 13 percent in women with history of recurrent abortions (15).…”

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births

“…Pregnancy with uterus bicornis unicollis can cause various maternal and perinatal outcomes, including miscarriage (21%), prematurity (24%), ectopic pregnancy (2%), intrauterine growth restriction (11%), and an increased incidence of caesarean section (84%) [ 1 ]. The fertility of women with untreated uterus bicornis unicollis is better than women with other Müllerian duct disorders [ 6 ]. Risk factors for uterus bicornis unicollis include an increased risk of spontaneous abortion, fetal growth retardation, and prematurity [ 10 , 22 ].…”

“…A study found that uterine didelphys does not necessitate a cesarean section, instead fetal presentation does [ 14 ]. In uterine didelphys, management of childbirth can be done either by vaginally or through cesarean section [ 6 , 25 ]. However, this condition is associated with fetal breech presentation and is the most common indication for cesarean delivery in women with uterine didelphys [ 1 , 4 , 13 , 21 , 26 ] Furthermore, if no coexistent symptom present, additional treatment to uterine disorder is deemed unnecessary [ 6 ].…”

“…In uterine didelphys, management of childbirth can be done either by vaginally or through cesarean section [ 6 , 25 ]. However, this condition is associated with fetal breech presentation and is the most common indication for cesarean delivery in women with uterine didelphys [ 1 , 4 , 13 , 21 , 26 ] Furthermore, if no coexistent symptom present, additional treatment to uterine disorder is deemed unnecessary [ 6 ]. In this present case, the patient showed no particular symptom prior and was decided to be given an emergency cesarean section based on her history with two previous cesarean deliveries and the fetus’ breech presentation as seen in the ultrasonography examination imagery.…”

A Successful Pregnancy in a Hemihysterectomized Patient–A Case Report

“…A recent systematic review and meta-analysis showed that didelphys uterus was not associated with an increased incidence of infertility or miscarriage, but it was mainly associated with a higher risk of preterm delivery, preterm premature rupture of membranes, fetal malpresentation, cesarean, fetal growth restriction, and small for gestational age [ 3 ]. Regarding the higher risk of cesarean in this CUA, Cwiertnia et al demonstrated that the decision to perform cesarean depends on several factors, including fetal presentation, patient preference, and vaginal septum features [ 6 ].…”