EC Clinical and Medical Case Reports

Mullerian duct anomalies (MDAs) are congenital defects involving the paramesonephric ducts, occurring early in fetal life. Uterine didelphys or double uterus is one such rare embryological malformation of the Mullerian duct. This case report highlights the successful pregnancies of a 35-year-old woman diagnosed with uterine didelphys, a condition often associated with adverse reproductive outcomes. The diagnosis was made incidentally via ultrasound during an unrelated investigation. Subsequent abdominopelvic magnetic resonance imaging confirmed the presence of the double uterus and ruled out other associated genitourinary congenital anomalies. This case underscores the importance of comprehensive anatomical evaluation in women presenting with MDAs and provides hope for successful pregnancies in the presence of this uncommon condition. It further emphasizes the need for clinicians to possess a detailed understanding of the diverse presentations and implications of MDAs to provide appropriate counseling and management strategies.

Keywords: Uterine Didelphys; Successful Pregnancy; Ultrasound; Magnetic Resonance Imaging

1. Acién P., et al. “Müllerian anomalies "without a classification": from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina”. Fertility and Sterility 6 (2019): 2369-2375.
2. Rock JA., et al. “Pregnancy success following surgical correction of imperforate hymen and complete transverse vaginal septum”. Obstetrics and Gynecology 4 (2022): 448-451.
3. Behr S., et al. “Imaging of Mullerian Duct Anomalies”. Radiographics 6 (2012): E233-E250.
4. Dahnert W. “Radiology Review Manual”. 7^th Walters Kluwer/Lippincott Williams and Wilkins. Chapter 2 – Central Nervous System (2017): 269-272.
5. Troiano R and McCarthy S. “Mullerian Duct Anomalies: Imaging and Clinical Issues”. Radiology 1 (2004): 19-34.
6. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions”. Fertility and Sterility 6 (2018): 944-955.
7. Raga F., et al. “Reproductive impact of congenital Müllerian anomalies”. Human Reproduction 10 (2017): 2277-2281.
8. Heinonen PK. “Clinical implications of the didelphic uterus: long-term follow-up of 49 cases”. European Journal of Obstetrics, Gyneacology and Reproductive Biology 2 (2020): 183-190.
9. Chan YY., et al. “Reproductive outcomes in women with congenital uterine anomalies: a systematic review”. Ultrasound in Obstetrics and Gynecology 4 (2011): 371-382.
10. Miller DS and Diaz-Arrastia DP. “Müllerian anomalies and their effect on pregnancy outcome”. American Journal of Obstetrics and Gynecology 4 (2012): 293-300.
11. Troiano KL and McCarthy RN. “Müllerian Duct Anomalies: Imaging and Clinical Issues”. Radiology 1 (2004): 19-34.
12. Saravelos SH., et al. “Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal”. Human Reproduction Update 5 (2008): 415-429.
13. Robboy SJ., et al. “The Developing Human Female Reproductive Tract: A 21st-century perspective”. Endocrine Reviews 4 (2018): 383-428.
14. Raga F., et al. “Reproductive impact of congenital Müllerian anomalies”. Human Reproduction 10 (2017): 2277-2281.
15. Grimbizis GF., et al. “Clinical implications of uterine malformations and hysteroscopic treatment results”. Human Reproduction Update 2 (2021): 161-174.
16. Pfeifer SM., et al. “ASRM Mullerian anomalies classification”. Fertility and Sterility 5 (2021): 1238-1252.