Double uterus, Uterus didelphys
Embryonically, the two Müllerian ducts have failed to fuse, the partition between them is still present. The cause of the fusion failure is not known nevertheless, this error makes uterus become a paired organ with two separate cervices, and often a double vagina as well. In this case, one vaginal opening is usually blocked and the external appearance of the genitalia is normal. Each uterus has a single horn linked to the ipsilateral fallopian tube that faces its ovary.
In the United States, uterus didelphys is reported to occur in 0.1–0.5% of women. It is difficult to know the exact occurrence of this anomaly, as it may go undetected in the absence of medical and reproductive complications. Often it occur as a part of a syndrome, more specifically called, Herlyn-Werner-Wunderlich (HWW) syndrome.
A pelvic examination is essential and may also reveal a double vagina or double cervix that should be further investigated. The modalities for correct diagnosis frequently used to include highly invasive methods such as hysteroscopy, hysterosalpingography, and laparoscopy/laparotomy. However, these methods rely on the clinician’s subjective interpretation rather than strict diagnostic criteria. Usually the first type of imaging done is the 2D/3D ultrasound. Benefits of MRI are used as well.
When diagnosed, thorough pregnancy screening is strongly recommended.
Associated diseases
Complications
Risk factors
Uterine malformations are associated with genetic and teratogenic factors. Seen as problematic can be contact with any substance with teratogenic potential during pregnancy. Fetus is the most vulnerable in the period of 2 to 12 weeks.
The condition may not be known to the affected individual and not result in any reproductive problems. Nevertheless, it is generally accepted that having a uterine anomaly is associated with poorer pregnancy outcomes such as increased chances of spontaneous abortion, premature labor, cesarean delivery due to breech presentation, and decreased live births, compared to a normal uterus.
None recognized, except for avoiding contact with teratogenic factors.
None possible.
Pharmacotherapy
It is mostly additional to surgical solution, to help epithelization processes, against adhesion development, antibiotic therapy.
Surgical therapy
Surgical correction of a didelphys uterus (metroplasty) is not usually indicated and the literature on women with didelphys uterus who underwent metroplasty is very limited. With that said, metroplasty would only be considered on a case by case basis after all other ways in which reproductive performance could be improved are exhausted.
After getting pregnant, didelphys uterus is not an indication for cesarean delivery unless the vaginal septum is thick and inelastic resulting in an increased risk for vaginal dystocia.
Multiple pregnancies may have a negative impact on the likelihood of a full term pregnancy, increase the risk of low birth weight in infants. This can affect survival and well-being of newborns and because of complications endanger mother’s life. Therefore a singleton pregnancy should be ensured by eSET (elective single embryo transfer) - procedure in which one embryo, selected from a larger number of available embryos derived from ICSI, is placed in the uterus. The patient should be carefully monitored during pregnancy.
A state in which pieces of the tissue alike to the lining of the uterus (endometrium) grow in other parts of the body.
A type of female genital malformation resulting from an abnormal development of the Müllerian duct(s) during embryogenesis.
A form of a congenital malformation where the uterine cavity is partitioned by a longitudinal septum. It is one of Müllerian duct anomalies.
A form of a congenital malformation where the uterus is partially divided by a longitudinal septum. It is one of Müllerian duct anomalies.
Congenital uterine anomaly (one of the Müllerian duct anomalies) usually associated with communicating or non-communicating rudimentary horn.
Inborn morphological deviation of the uterus - one of the Müllerian duct anomalies where the uterine cavity is divided in the upper part.
The narrow inferior portion of the uterus that projects into the vagina.
Two very fine tubes that transport sperm toward the egg, and allow passage of the fertilized egg back to the uterus for implantation.
The ovum-producing organs of the internal female reproductive system
The uterus is the largest and major organ of the female reproductive tract that is the site of fetal growth and is hormonally responsive
Sex organ that is a part of the female genital tract having two primary functions: sexual intercourse and childbirth.
Cells composing an inner layer of the uterine lining.
The innermost layer of uterus forming the uterine lumen where the implantation of an oocyte happens.
The fusion of an ovum with a sperm to initiate the development of a new individual organism.
The process in which a human embryo or fetus gestates during pregnancy, from fertilization until birth.
The very early stage of pregnancy at which the embryo adheres to the wall of the uterus.
Longitudinal division of the vagina into two separate organs.
The failure to achieve a clinical pregnancy after 12 months or more of regular unprotected sexual intercourse.
A birth of the baby before 37 completed weeks of gestational age.
A disease distinct from infertility, defined by two or more failed pregnancies.
Process by which a woman donates eggs for purposes of assisted reproduction or biomedical research.
The procedure of transfer one single good quality embryo in cleavage stage or in stage of blastocyst that was selected as the most appropriate.
A micromanipulative fertilization technique in which a single sperm is injected directly into an egg.
The procedure in which a man (sperm donor) provides his sperm for fertility treatment.
A process in which an egg is fertilised by sperm outside the body: in vitro. Own or donated gametes may be used.
