A Rare Case of Uterus Didelphys Diagnosed in a Primigravida Woman

Abstract

Uterus didelphys is a rare congenital Müllerian duct anomaly characterized by complete duplication of the uterus and cervix. It is often asymptomatic and may remain undiagnosed until pregnancy or evaluation for reproductive concerns. We report the case of a 33-year-old primigravida who presented at 3 weeks of gestation for routine antenatal evaluation. First trimester obstetric ultrasonography revealed two completely separate uterine cavities with two distinct cervices, confirming the diagnosis of uterus didelphys. The patient had no prior history of abortion or significant drug exposure. She was managed conservatively with folic acid and progesterone supplementation and was counselled regarding potential obstetric risks, including preterm birth, fetal growth restriction, and the possibility of cesarean delivery. Early diagnosis and appropriate antenatal care are essential in optimizing maternal and fetal outcomes in such cases.

Keywords

Introduction

 

 

 

 

 

 

Management

The patient was managed conservatively with:

Folic acid supplementation to support fetal development

Progesterone therapy to support early pregnancy

In addition to pharmacological management, detailed counselling was provided regarding her condition.

Patient Counselling

The patient was educated about uterus didelphys and its implications on pregnancy. She was informed about potential risks, including:

Preterm labor and premature birth

Fetal growth restriction

Malpresentation

Increased likelihood of emergency cesarean section

Need for close antenatal monitoring

The importance of regular follow-up and adherence to medical advice was emphasized.

Outcome and Follow-up

At the time of reporting, the patient is under regular antenatal follow-up. She is stable, compliant with medications, and undergoing periodic monitoring to assess fetal growth and pregnancy progression.

DISCUSSION

Uterus didelphys is a rare congenital Müllerian duct anomaly resulting from complete non-fusion of the paired Müllerian ducts during embryological development. This leads to the formation of two separate uterine cavities, each with its own cervix, and occasionally a longitudinal vaginal septum. Reported prevalence ranges between 0.1% and 0.5% in the general female population, making it an uncommon but clinically significant condition.

Several studies have demonstrated that women with uterus didelphys may have relatively preserved fertility compared to other Müllerian anomalies; however, they are at increased risk for adverse obstetric outcomes. According to studies by Heinonen and colleagues, reproductive performance in such patients is often associated with complications such as preterm labor, malpresentation, and increased cesarean section rates. Similarly, Rackow and Arici reported that uterine anomalies, including uterus didelphys, are linked to higher incidences of fetal growth restriction and pregnancy loss, although many patients can still achieve successful pregnancies with appropriate care.

Early diagnosis plays a crucial role in optimizing pregnancy outcomes. Imaging modalities such as ultrasonography and magnetic resonance imaging (MRI) are commonly used to identify structural anomalies. In the present case, the diagnosis was made incidentally during a first trimester obstetric scan, which is consistent with previous reports where many cases remain undetected until pregnancy or evaluation for infertility.

Management of uterus didelphys during pregnancy is generally conservative, focusing on close antenatal surveillance rather than surgical correction. Progesterone supplementation, as given in this case, is often used to support early pregnancy, although its routine use depends on clinical judgment. Regular monitoring is essential to detect complications such as preterm labor or fetal growth abnormalities at an early stage.

Patient counselling is a critical component of management. Women should be informed about potential risks, including premature delivery, malpresentation, and the likelihood of operative delivery. However, it is equally important to reassure patients that favorable outcomes are achievable with proper antenatal care, as supported by multiple case series in the literature.

This case aligns with previously reported findings, demonstrating that uterus didelphys can be incidentally diagnosed in a primigravida with no prior reproductive complications. It underscores the importance of routine antenatal imaging and individualized patient management to ensure optimal maternal and fetal outcomes.

CONCLUSION

Uterus didelphys is a rare congenital anomaly that may remain undetected until pregnancy. Early diagnosis through routine antenatal imaging allows for appropriate counselling and careful monitoring to minimize adverse outcomes. With proper management, favorable maternal and fetal outcomes can be achieved.

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