Twin Gestation in a Septate Bicornuate Uterus

Henry Osazuwa,David Tolulope Ejenobo

doi:10.1155/2012/563085

Henry Osazuwa, David Tolulope Ejenobo

Open Access

https://doi.org/10.1155/2012/563085

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Abstract

Bicornuate and septate uteri are among the commonest Mullerian anomalies. They are sporadic and fairly distinguished, but hybrid deformities can occur. This combination creates aetiological and clinical difficulties. The alternative theory of concurrent fusion and septal resorption of the Mullerian duct is seen as the basis of the altered foetal embryology, while the favourable outlook of a bicornuate uterus may be offset by the suboptimal implantation across the avascular septum. Obstetric care is based on empirical interventions deduced from case series, with varied and inconsistent outcomes. We present a 32-year-old primipara with a dizygotic twin gestation in separate compartments of a septate bicornuate uterus. She had an elective bilateral caesarean delivery at term with an accidental septal resection for morbidly adherent placenta. Although a summation of obstetric risks is a possibility, an excellent outcome was observed.

Highlights

Mullerian anomalies may be relatively uncommon, but the disproportionate interest in these clinical entities is due to their link to a myriad of poor pregnancy outcomes, which include miscarriages, preterm deliveries, malpresentation, prelabour rupture of membranes, intrauterine growth restriction, postpartum haemorrhage, and retained placenta [1]
A prior uneventful pregnancy in obstetric settings is often viewed as a good indicator of subsequent outcomes, so the diagnosis of a major uterine malformation in the pregnancy is almost always a profound finding, in addition to twin gestation
On transabdominal scan (TAS), a septate uterus appears as two cavies without the sagittal notching and without the fundal myometrium

Summary

Introduction

Mullerian anomalies may be relatively uncommon, but the disproportionate interest in these clinical entities is due to their link to a myriad of poor pregnancy outcomes, which include miscarriages, preterm deliveries, malpresentation, prelabour rupture of membranes, intrauterine growth restriction, postpartum haemorrhage, and retained placenta [1]. The uterine segment fuses and subsequently becomes canalized with regression of the central septum through a process of apoptosis regulated by the Bcl-2 gene. This development occurs mainly in sequence, as shown by the variation in observed anomalies, but concurrent lateral fusion and septal resorption have been suggested [5, 6]. Abnormal uterine anatomy predisposes to malpresentation and related vascular aberrations involving the uterine or ovarian arteries may cause intrauterine growth restriction. As such we highlight empirical antenatal interventions and an accidental surgical resection of a septum at caesarean delivery

Case Presentation

Discussion

Conclusion