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OJHAS Vol. 9, Issue 4:
(Oct-Dec, 2010) |
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| Twin Pregnancy
in a Woman with Uterus Didelphys |
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Sohini Bhattacharya, Associate Professor,
Pallab Kumar
Mistri, Assistant Professor,
Dept of Obstetrics and Gynecology, North Bengal Medical College, Shushrutanagar, Darjeeling, India. |
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Address For Correspondence |
76, Rashbehari Sarani,
Khelaghar
More,
Hakimpara, Siliguri,
Darjeeling -734001,
West Bengal, India.
E-mail:
drsohinibhattacharya@yahoo.co.in |
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Bhattacharya S, Mistri PK. Twin Pregnancy
in a woman with uterus didelphys. Online J Health Allied Scs.
2010;9(4):24 |
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Submitted: Oct 3,
2010; Accepted: Dec 31, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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Uterus didelphys is one
of the congenital uterine anomalies due to defective medial fusion of
mullerian ducts. This anomaly is known to have poor reproductive outcome
and women with this condition often have to be treated for infertility.
Multiple gestation is rare with this condition. An 18 years old primigravida
presenting with threatened abortion at eight weeks, was found to have
uterus didelphys. She was managed conservatively, aborted one of the
fetuses at 16weeks of gestation, and went till term to deliver a healthy
baby by cesarean section.
Key Words:
Uterus didelphys; Congenital
uterine anomaly; Twin pregnancy
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Complete failure of medial
fusion of the two mullerian ducts may result in duplication of uterus
and cervix with single or double vagina. Often uterus didelphys remains
asymptomatic and hence undetected. So the exact incidence of this uterine
anomaly is not known. Women with uterus didelphys more frequently require
infertility treatment than women with other uterine anomalies (1) and
multiple gestation is unusual in women with this condition.(2)
On
12.3.2010, an
eighteen year old primi gravida attended the Obstetrics outpatients
department of our hospital with the complaint of two months amenorrhoea
and bleeding per vagina for one day. She was married for a year and
had received no treatment for infertility.
On examination, her vitals
were all stable. Vaginal examination revealed a longitudinal septum
with a cervix at the cephalic end of each vaginal half. (Fig 1) On speculum
examination, the os was closed in both the cervices and very scanty
uterine bleeding was seen. Bimanual examination was withheld in the
light of threatened abortion. She was admitted promptly and advised
rest. Investigations revealed the following: Hemoglobin-8.1gm%, ESR-
46mm/1st hour, total leucocyte count-6900/mm3,
differential leucocyte count-N68L22M4E6B0,
random plasma glucose- 68mg/dl. Ultrasonography revealed a double
uterus with two gestational sacs and a live fetal pole in each sac.
(Fig 2) The fetal maturity corresponded with 8 weeks of gestation. Uterus didelphys with twin gestation was diagnosed and the patient was discharged
after a week with advice to attend the antenatal clinic every month.
She was put on natural micronized progesterone 300µg vaginal suppository
and folic acid tablets, 5mg daily.
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Fig 1: Speculum examination
reveals a double vagina with two cervices (the right cervix is partly
visible) |
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Fig 2: Transabdominal
scan showing double uterus with a gestational sac (GS1 and GS2)
in each half |
On 20.5.2010, she was admitted
again in gynaecological emergency ward with severe bleeding per vagina
and expulsion of a fetus at home. Internal examination confirmed the
diagnosis of incomplete abortion in the left hemiuterus. An exploration
under anaesthesia was done on the same day to arrest bleeding. Two units of
blood were transfused. She was discharged after two days and was followed up
closely in the antenatal clinic. On 20.9.2010, she developed rupture of
membranes and gave birth to a 2.45 kg term baby by cesarean section
Although the true prevalence
of congenital uterine anomalies in the population is unknown, it is
known to vary from 0.1% to 10%. In one study, the 24.2% of the women
with uterine anomalies had uterus didelphys.(1) Congenital uterine
anomalies are associated with the highest incidence of reproductive
failure and obstetric complications. Authors are not unanimous in predicting
the obstetric outcome of uterus didelphys. According to some, women
with this form of congenital anomaly required infertility treatment
more frequently than women with other uterine anomalies.(1) and the
overall reproductive performance of uterus didelphys is poor.(3)
Others feel that didelphic
uterus offers the best chance for a successful pregnancy(57%) (4) with
a fetal survival rate as high as 64%.(5)
Multifetal gestation is
rare in women with uterus didelphys.(2) It has been reported in the
literature. But the preferred route of termination of pregnancy in these
patients is not clear. Spontaneous vaginal delivery as well as cesarean
section at term has been reported.(6-10) There has also been
a triplet pregnancy with uterus didelphys with 72 days lapse between
the delivery of the first two fetuses and the third.(6)
- Zhang Yan, Zhao
Yang-yu, Qiao Jie. Obstetric
outcome of women with uterine anomalies in China. Chinese Medical Journal. 2010;123(4):418-422.
- Olah
KS. Uterine torsion and ischemia of one horn of a bicornuate uterus:
A rare cause of failed second trimester termination of pregnancy. Br
J Obstet Gynecol 2002;109:585.
- Raga F, Bauset C, Remohi
J et al. Reproductive impact of congenital mullerian anomalies. Hum Reprod 1997;12(10):2277-2281.
- Musich JR, Behrman SJ.
Obsteric outcome before and after metroplasty in women with uterine
anomalies. Obstet Gynecol.1978;52:63.
- Heinohen PK, Saarikoski
S, Pystynen P. Reproductive performance of women with uterine anomalies.
Acta Obstet gynecol Scand 1982;61:157.
- Mashiach S, Ben-Rafael Z, Dor
J, Serr DM. Triplet
pregnancy in uterus didelphys with delivery interval of 72 days. Obstet Gynecol. 1981 Oct;58(4):519-521.
- Ahmad FK, Sherman SJ, Hagglund KH. Twin
gestation in a woman with a uterus didelphys. A case report. J Reprod
Med. 2000 Apr;45(4):357-359.
- Kekkonen R, Nuutila M, Laatikainen T. Twin pregnancy with a fetus in each
half of a uterus didelphys. Acta Obstet Gynecol Scand. 1991;70(4-5):373-374.
- Nhân VQ, Huisjes HJ. Double
uterus with a pregnancy in each half. Obstet Gynecol. 1983 Jan;61(1):115-117.
- Lewenthal H, Biale Y, Ben-Adereth N. Uterus didelphys with a pregnancy in
each horn. Case report. Br
J Obstet Gynaecol. 1977 Feb;84(2):155-158.
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