English

Abstract

Uterus didelphys belongs to class iii of American society of mullerian anomalies. Incidence is about 1/3000 women which accounts to 0.1 to 0.5% of total women. Congenital uterine anomalies result from the abnormal formation, fusion or resorption of the Mullerian ducts during fetal life. A uterus didelphys results when bilateral Mullerian Ducts do not fuse but develop side by side resulting in a double uterus. Although pregnancies can occur in patients with Mullerian duct anomalies, most of them have been linked to infertility, recurrent pregnancy loss, pre term deliveries, fetal mal-presentations and other obstetrics complications, making successful pregnancy outcome a rare situation in this condition. Uterine anomalies with successful pregnancy outcomes are rare. We report a case of successful pregnancy outcome in a case of uterus didelphys bicollis for its rarity. CASE DESCRIPTION: 22-year-old fourth gravida with no live issues was referred at 32 weeks+1 day with a singleton gestation in one horn of a uterus didelphys. A diagnosis of IUGR with severe oligohydramnios was made outside. Her first pregnancy was a missed abortion at 3 months of amenorrhea for which she underwent suction evacuation. The diagnosis of uterus didelphys was made during this procedure, and was mentioned in the discharge summary. Patient doesn't have any scan images, HSG reports. As the blood typing indicated Rh negativity, Anti-D injection was given. Her second pregnancy was a pre term delivery at home at 7 months of amenorrhea. The fetus was born dead. Anti-D was not administered. Her third pregnancy was a twin pregnancy, terminated at 20 weeks and 6 days as an USG diagnosis of omphalocele and meningomyelocele was made. Manual removal of placenta was done. Anti-D injection was administered. She underwent infertility treatment for a year before conceiving for the fourth time. She was referred at 32 weeks due to complications of severe oligohydramnios (AFI 2), intra uterine growth restriction detected in the third trimester scan. Patient was planned for caesarean section after investigations and ultrasound scan as per vaginal examination was unfavourable. Non stress test indicated fetal distress & hence the patient was shifted for an emergency Caeserean section after adequate counseling of the patient & her relatives. On table uterus didelphys & pregnancy in the left uterus was noted. The fetus was in a breech presentation. The decision to do a Classical caesarean section was made as the lower segment of the left pregnant uterus was very narrow.