EC Gynaecology

Uterus didelphys, or double uterus, is a congenital malformation of the female reproductive tract. It is estimated that between 0.5 - 6% of women may have a uterine anomaly. It occurs when the two Mullerian ducts fail to fuse, thus producing duplication of the reproductive structures. This is a case of a twin pregnancy in a 27-year-old patient with uterus didelphys. With obstructed hemivagina and ipsilateral renal agenesis. This is rare entity and referred to as Herlyn-Werner-Wunderlich syndrome (HWW). The patient was already diagnosed with uterus didelphys. Ultrasound imaging revealed fetus B had findings suspicious for ventriculomegaly with a lateral ventricle of 26.8 mm and oligohydramnios. Fetus A showed no anatomical abnormalities. This was a challenging caesarean section given the patients congenital uterine abnormality, further complicated by an almost fully dilated cervix in the first uterus. A transverse incision was made in the first uterus; a male infant was delivered cephalically with a moderate amount of clear liquor. The second uterus was incised; a female infant was delivered via forceps. Both placentas were delivered via controlled cord traction and each uterus was sutured in two layers. She was given prophylaxis for postpartum haemorrhage and Haematuria which resolved postoperatively prompted renal USS and CT urogram, which exhibited a right sided renal agenesis. Postpartum recovery was uneventful.

Keywords: Twin Pregnancy; Uterus Didelphys; Congenital Malformation; Female Reproductive Tract

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