Twin pregnancy in each half of a didelphys uterus with delayed delivery and review of literature

Abstract

Didelphys uterus results from an incomplete fusion of mullerian ducts and corresponds to the class III of mullerian abnormalities of the American Fertility Society. We describe the case of a spontaneous twin pregnancy developed in each cavity of a didelphys uterus. At 29 weeks of gestation and 6 days, the patient had preterm rupture of membranes in the right horn. She went into spontaneous labor and delivered vaginally the first “right” twin. Delivery was complicated with post-partum hemorrhage on uterine atonia treated with a Bakri balloon. She was tocolyzed to pursue the fetal lung maturity of the second twin. She had a rupture of the second membranes at 30 weeks and 3 days and had a preterm vaginal delivery at 32 weeks and 1 day of the second twin. Twin pregnancy in both horns of a uterus is extremely rare, about 1 in 1,000,000. Pregnancies on congenital abnormalities of the paramesonephric duct present frequently poor obstetrical outcomes and many complications. There are no guidelines about the follow-up of these high-risk patients or the mode of delivery.

Dicavitary twin pregnancy in patient with bicornuate bicollis uterine anomaly

“…In the absence of contraindication to vaginal delivery, successful vaginal delivery for both twins have been reported. 6 , 11 , 15 , 17 , 20 , 22 In rare cases, a cesarean may be required for delivery of one twin, while the other is able to be delivered via the vaginal route, and vice versa. 5 , 13 , 18 , 23 , 26 , 28 …”

Complications of Multiple Pregnancy: Conception to Delivery

“…Uterine didelphys is a rare type of anomaly with estimated prevalence of 0.3%, caused by failure of fusion of the inferior parts of the paramesonephric ducts resulting in separate uterine cavities with 2 cervices and a double or single vagina (Figures 6 and 7). Uterine didelphys with dicavitary (Figure 8) twin pregnancy is exceedingly rare; the reported incidence is 1 in 1,000,000 pregnancies [22,23]. The complications in uterine didelphys is similar to ones in unicornuate uterus as they are related to accommodation restriction.…”