A tale of two uteri: silent uterine rupture in a case of uterus didelphys

Abstract

Uterine rupture is a rare but life-threatening obstetric emergency, often associated with previous uterine surgery or trauma. However, in the absence of such history, congenital uterine anomalies such as a didelphys uterus can pose unique challenges in pregnancy and labor. A didelphys uterus results from incomplete fusion of the Müllerian ducts during embryogenesis, leading to two separate uterine cavities, each with its own endometrium and often a duplicated cervix and vagina. Although pregnancies can occur in one horn, the structural weakness and altered uterine architecture can predispose affected women to poor obstetric outcomes, including miscarriage, malpresentation, preterm labor, and in rare cases, uterine rupture. This report presents a rare and clinically significant case of silent uterine rupture in a didelphys uterus, emphasizing the importance of early diagnosis, careful monitoring, and tailored obstetric management in such anomalies.