Pregnancy in a didelphic uterus: a case report of an unusual phenomenon and review of literature


  • Emmanuel Ekanem Department of Obstetrics and Gynaecology, Great Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
  • Lalrinawmi Lalrinawmi Department of Obstetrics and Gynaecology, Great Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
  • Anita Sinha Department of Obstetrics and Gynaecology, Great Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom
  • Tamer Abdelrazik Department of Obstetrics and Gynaecology, Great Western Hospital NHS Foundation Trust, Swindon, SN3 6BB, United Kingdom



Didelphys, Uterus, Mullerian, Anomalies, Pregnancy


Mullerian anomalies are defects in the embryological development of the urogenital systems as these organs begin to form at about the 5 and 6th week of intrauterine life. Uterine didelphys is one of the Mullerian or paramesonephric duct anomalies occurring as a result of duplication of the uterine canal with two cervical canals and a single vagina. The incidence uterine didelphys has been quoted as 1 in 2000 women. This case report elucidates the presentation of a multiparous lady with uterine didelphys who had a previous successful pregnancy in of the uterine canals but presented in the second pregnancy with a missed miscarriage at 12 weeks gestational age. She also had a single right kidney. These were all diagnosed on ultrasound scan. She had an initial unsuccessful surgical management of miscarriage with uterine perforation of one of the uterine cavities diagnosed on hysteroscopy and diagnostic laparoscopy. She subsequently had examination under anaesthesia and an attempt at evacuation of retained products and a second look laparoscopy. This was particularly challenging as the cervix was flushed with the vaginal vault making delineation and dilatation of the cervical OS difficult hence sustaining a perforation at the left uterine cavity. The second attempt of surgical management was successful, and she was subsequently discharged. This is one of the few case reports in literature and will further add credence to the body of knowledge of a different aspect to the presentation and management of cases of Mullerian anomalies.


Heinonen PK. Uterus didelphys: a report of 26 cases. Eur J Obstetr Gynecol Reprod Biol. 1984;17:345-50.

Rezai S, Bisram P, Lora Alcantara I, Upadhyay R, Lara C, Elmadjian M. Didelphys Uterus: A Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2015;2015:1-5.

Edmonds DK, Rose GL. Outflow tract disorders of the female genital tract. Obstet Gynaecol. 2013;15(1):11-7.

Keith L More, T.V.N. Persaud MGT. The Developing Human Clinically Oriented Embryology. Developing Human Brain. 2016;524.

Sadler TW. Langman’s Medical Embryology, Lippincott Williams and Wilkins, 14th Edition. 2019;209.

Boehnke M, Zaretsky MV, Soranno DE, Dannull KA, Tucker BD, Marwan AI. Uterine didelphys with concomitant renal anomalies in both mother and fetus. J Pediatr Surg Case Reports. 2016;14:19-21.

Acien P, Acien M S-FM. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod. 2004;19:2377-84.

The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions. Fertil Steril. 2016;49(6):944-55.

Heinonen PK. Longitudinal vaginal septum. Eur J Obs Gynec reprod Biol. 1982;13:253-8.

Subhadra Devi V. Inderbir Singh’s Human Embryology, Jaypee Brothers Medical Publishers; 11th edition. 2018;362.

Reichman DE, Laufer MR. Congenital uterine anomalies affecting reproduction. Best Pract Res Clin Obstet Gynaecol. 2010;24(2):193-208.

Saravelos SH, Cocksedge KA, Li TC. The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage. Reprod Biomed Online. 2010;20(3):416-22.

Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reproduction Update. 2001;7:161-74.

Simon C, Martinez L, Pardo F, Tortajada M, Pellicer A. Mullerian defects in women with normal reproductive outcome. Fertil Steril. 1991;56(6):1192-3.

Jurkovic D, Gruboeck K, Tailor A, Nicolaides KH. Ultrasound screening for congenital uterine anomalies. BJOG An Int J Obstet Gynaecol. 1997;104(11):1320-1.

Letterie GS. Management of congenital uterine abnormalities. Reprod Biomed Online. 2011;23(1):40-52.

Rezai S, Bisram P, Alcantara IL, Upadhyay R, Lara C, Malvina E. Didelphys Uterus: A Case Report and Review of the Literature. Case Rep Obstet Gynecol. 2015;1-5.

Nicolini U, Bellotti M BB. Can ultrasound be used to screen uterine malformations? Fertil Steril. 1987;47(1):89-93.

Pellerito JS, McCarthy SM DM. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography. Radiology. 1992;183(3):795-800.

Reuter KL. Septate versus bicornuate uteri: errors in imaging diagnosis. Radiology. 1989;172(3):749-52.

Smith NA LM. Obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) syndrome: management and follow-up. Fertil Steril. 2007;87:918-22.

Mandava A. OHVIRA Syndrome (obstructed hemivagina and ipsilateral renal anomaly) with Uterus Didelphys, an Unusual Presentation. J Pediatr Adolesc Gynecol. 2012;25(2):e23-5.

Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Sim´on C. Reproductive impact of congenital Mullerian anomalies. Hum Reprod. 1997;12(10):2277-81.

Green LK, Harris RE. Uterine anomalies: frequency of diagnosis and associated obstetric complications. Obs GynecoL. 1976;47(4):427-9.

Harger JH. Etiology of recurrent pregnancy loss and outcome of subsequent pregnancies. Obs Gyneco. 1983;62(5):574-81.

Heinonen PK. Reproductive performance ofwomen with uterine anomalies. Acta Obs Gynecol Scand. 1982;61(2):157-62.

Golan A, Langer R BI, Bukovsky I, Caspi E. Congenital anomalies of the mullerian system. Fertil Steril. 1989;51(5):747-55.

Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: A meta-analysis of comparative studies. Reprod Biomed Online 2014;29(6):665-83.

Yang MJ, Tseng JY, Chen CY, Li HY. Delivery of double singleton pregnancies in a woman with a double uterus, double cervix, and complete septate vagina. J Chinese Med Assoc. 2015;78(12):746-8.

Post RJ, Templeman RMB. Twin gestation in a uterus didelphys with only one functional cervix: A case report. Case Reports Women’s Heal. 2019;22.

Jackson JR, Williams B, Thorp J. Spontaneous Triplets Carried in a Uterus Didelphys. Case Reports Women’s Heal. 2014;3-4:1-2.

Pankaja S, Ip P OF. Successful Pregnancy with Uterus Didelphys. J Androl Gynecol. 2016;4(2):3.

Turocy JM, Rackow BW. Uterine factor in recurrent pregnancy loss. Seminars in Perinatol. 2019;43:74-9.

Acien P. Reproductive performance of women with uterine malformations. Hum Reprod. 1193;8(1):122-6.

Chandrasekhar C. Report of two cases of uterus didelphys and rare ectopic (cornual and cervical) pregnancies. Clin Imaging. 2007;31(1):57-61.

Cohen AW, Chhibber G. Obstetric complications of congenital anomalies of the paramesonephric ducts. Semin Reprod Endocrinol. 1986;4(1):59-66.






Case Reports