Second Trimester Dilation &amp; Evacuation in a Patient with Uterus Didelphys

Haley Glatthorn,Glenmarie Matthews

doi:10.34257/gjmrevol20is5pg23

Abstract

Uterus didelphysis one of the rarest of the Mullerian duct anomalies and can lead to unique obstetric and gynecologic outcomes and considerations. This case describes a patient with known uterus didelphys and intact longitudinal vaginal septum who desired termination of pregnancy at 17 weeks gestation due to fetal anomaly. She underwent dilation and evacuation (D&E) under ultrasound guidance and the pregnancy was removed from the right-sided uterus. Preoperative mifepristone and misoprostol were used for cervical ripening.This case demonstrates that second trimester D&E can be safely performed on patients with uterus didelphys and is aided by the adjunctive use of prostaglandins, mifepristone, and ultrasound guidance to avoid intraoperative complications.

Highlights

Introduction pregnancyShe elected to undergo chorionic villus sampling for genetic testing and planned for terminationMullerian duct anomalies include a wide range of congenital structural abnormalities of the female reproductive tract
She presented to our practice at 16 underwent dilation and evacuation (D&E) under ultrasound guidance and the pregnancy was removed from the rightsided uterus
Attempt was made to place laminaria prior to the procedure but the right cervix was not embryogenesis, the Mullerian ducts fuse completely to identified on exam

Summary

Introduction

Introduction pregnancyShe elected to undergo chorionic villus sampling for genetic testing and planned for terminationMullerian duct anomalies include a wide range of congenital structural abnormalities of the female reproductive tract. The patient is a 32 year old gravida 2 para 1 describes a patient with known uterus didelphys and intact with a known history of didelphys uterus diagnosed at longitudinal vaginal septum who desired termination of age 14, and a prior cesarean section on the pregnancy at 17 weeks gestation due to fetal anomaly. She presented to our practice at 16 underwent dilation and evacuation (D&E) under ultrasound guidance and the pregnancy was removed from the rightsided uterus.

Results

Conclusion