Double pregnancy in a uterus duplex unicollis

Abstract

Mrs. B. P., a 22-year-old, white, female, para l-O-0-1, was seen during her second pregnancy at 8 weeks’ gestation on Aug. 16, 1965. Her last menstrual period was June 17, 1965. On examination the uterus measured 8 cm. above the symphysis and no abnormality was detected. Past history revealed one previous uneventful term delivery on Feb. 12, 1962, of a 6 pound, 13 ounce male infant. No uterine abnormality was detected with this pregnancy. One month later asymmetrical enlargement of the uterus was noted without fetal heart tones being detectable and twins or a left ovarian cyst were suspected. In succeeding months the uterine horns enlarged rapidly and fetal heart tones were detected separately in each horn. The prenatal course was uneventful except for threatened premature labor in the twenty-fifth week. In the thirty-fifth week on Feb. 18, 1966, the membranes ruptured prematurely. Poor quality labor ensued. After 15 hours, intravenous Pitocin augmentation was started. After 2 hours of Pitocin stimulation under continuous caudal analgesia, the head descended to the perineum and the cervix was completely dilated. Brow anterior position was ascertained and with forceps it was flexed, rotated to LOA position and a healthy 5 pound, 14 ounce female infant was delivered from the left horn over a left mediolateral episiotomy. The placenta was delivered easily and without excess blood loss. Pitocin stimulation was continued for 30 minutes during which time examination through the widely dilated external cervical OS revealed the vertex of the baby in the right horn PO be floating high with membranes intact and its separate internal OS to be only 3 to 4 cm. dilated. Only poor contractions every 2 to 3 minutes were noted. Intravenous Pitocin was stopped, contractions ceased and the internal OS closed to 2 cm. The episiotomy was repaired and the patient was returned to her bed and subsequently dismissed after an uneventful postpartum course. Two weeks later the involuting left horn of the uterus had prolapsed and the edematous cervix was visible at the introitus. One month after delivery of the first infant, vaginal examination revealed that the prolapsed left horn of the uterus occupied the posterior pelvis and was not displaceable upward. The external OS of the cervix was still very redundant and open. The internal OS of the right horn was 1 to 2 cm, dilated. The presenting part had not entered the pelvis because of the obstructing prolapsed left horn of the uterus. The estimated date of confinement was March 23, 1966. Induction with sparteine sulfate on March 19 failed. After Pitocin the membranes ruptured and moderately good contractions every 3 minutes failed to advance the head. Cesarean section was performed with delivery of an 8 pound, 2 ounce male infant scoring 10 on the Apgar scale. The region below the internal OS was examined and the communication between the two horns was located just above the external OS of the cervix. A decidual cast measuring approximately 6 x 4 x 3 cm. was removed with sponge forceps from the involuting left horn through its 2 cm. dilated internal OS. The tube and ovary attached to each horn were grossly normal. The postpartum course was uneventful.