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EJO 00081
P.K. Heinonen
HEINONEN, P.K. (1984): Uterus didelphys: a report of 26 cases. Europ. J. Ohstet. Gyttec. reprod. Biol.,
17/5, 345-350.
Twenty-six female patients with uterus didelphys were observed over a period of 21 yr. All the patients
also had a longitudinal vaginal septum. Dysmenorrhea, dyspareunia and leukorrhea were the most
common symptoms among the symptomatic cases. Eighteen women had a total of 40 pregnancies with a
fetal survival rate of 67.5%. and perinatal mortality rate of 3.6%. Premature delivery occurred in 21% of
the pregnancies. Breech presentation occurred in 43% and cesarean section was performed in 82% of the
cases. Of the 17 intravenous pyelograms performed six (35%) showed abnormalities and four had the
absence of a kidney. Women with uterus didelphys belong to a high-risk group, although pregnancy
outcome is comparatively good.
introduction
Uterus didelphys is the result when two mullerian ducts do not reach each other
and develop side by side. This genital anomaly has been the subject of many case
reports of simultaneous pregnancies in each uterus, pregnancy wastage and obstetric
complications, but the interpretation of such reports is difficult, since no uniform
criteria for case definition have been used. For example, the didelphic and un-
icornuate uteri are often grouped together with a hemiuterus. Didelphic uterus is
often associated with a longitudinal vaginal septum which may cause dyspareunia,
dystocia, leukorrhea and hemivagina if it is completely obstructed.
The aim of this study was to analyse in more detail the gynecologic and obstetric
implications in 26 females with uterus didelphys.
Results
The mean age of the patients was 24.8 yr (range, 17 to 45 yr). Menarche ranged
from 11 to 18 yr (mean, 12.9 yr). All except 5 women had a history of normal regular
menses. Sixteen (62%) of the 26 patients had dysmenorrhea.
Twenty-four women had a complete longitudinal vaginal septum and 2 women
had a partial vaginal septum. Hemivagina caused by an obstructed vaginal septum
was not found in any of the cases, although a partially obstructed septum was found
in 4 cases. Six patients suffered from dyspareunia, which indicated excision of the
vaginal septum. In addition the septum was excised in 1 case because it caused
dystocia, and in 1 case leukorrhea indicated removal of the vaginal septum. A
rectovesical ligament was found during the operation in 10 cases (Fig. 1.).
Two women had primary infertility. The reason for infertility was hormonal in
both cases. Both of them conceived after diagnostic curettage without any treatment.
An intrauterine device in both uterine cavities was used in 2 cases without complica-
tions. Metroplasty was not performed in any case.
Eighteen of the women had been pregnant and 8 women had not been pregnant.
One woman had 4 pregnancies, 6 women had 3 pregnancies, 7 women had 2
pregnancies and 4 women had 1 pregnancy. Table II summarizes the outcome of the
pregnancies. The fetal survival rate was 67.5% and the perinatal mortality rate 3.6%
Threatened abortion occurred in 9 (32%) cases, and hemorrhage was mostly from the
nonpregnant uterus caused by decidual reaction in the same uterus. Pregnancy was
in the right uterus in 12 women, in the left uterus in 5 women, and in both uteri in
turns in 2 cases.
Cervical cerclage was applied in 2 patients, both of whom had a history of
second-trimester miscarriage. In the first case, the cerclage was applied around both
cervices, and in the second case only around the cervix of the pregnant uterus. The
TABLE I
Complaint No. of
patients
Pregnancy
Routine examination
Abdominal pain
Dyspareunia
Bleeding
Leukorrhea
Pelvic tumor
Primary infertility
Fig. 1. Uterus didelphys photographed at cesarean section. Rectovesical ligament folds between the uteri
attach to the sigmoid which is partially adhered to the right uterus where the pregnancy was.
frequency of breech presentation was 4356, which is high when compared with the
overall annual incidence of breech deliveries in our hospital (3.0-4.1s). The rate of
cesarean section was very high (82%). Besides the genital anomaly, indications for
TABLE II
Obstetric complications and pregnancy outcome in 18 patients with uterus didelphys
No. of pregnancies 40
Abortions 12 (30)
I trimester 8
II trimester 3
Ectopic pregnancy 1
Deliveries 28 (70)
Threatened abortion 9
Cerclage applied 2
Toxemia 1
Breech presentation 12 (43)
Cesarean section 23 (82)
Premature 6 (21)
Small for date 3 (II)
Perinatal mortality 1 (3.6)
348
Discussion
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