Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery

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Many remain undiagnosed due to possibilities of successful pregnancies and vaginal deliveries in those without or with mild forms of associated cervical and/or vaginal anomalies. Due to this, data on didelphys uterus in pregnancy are rare, with most cases seen during routine ultrasound in pregnancies’ Caesarean section for other obstetric indications. This case was a 36-year-old G4P1+2 female who had successful vaginal delivery in her preceding pregnancy; in index pregnancy, she presented with fetal footling breech in labour and had an emergency caesarean section during which uterine didelphys was diagnosed. Many pregnant women with didelphys uterus will deliver vaginally and, as such, remain undiagnosed. Its presence is one of the possible reasons for persistent abnormal presentations like fetal breech presentation, especially in women with prior successful vaginal deliveries. Early recognition and availability of facilities for management of such incidentally found cases of uterine didelphys will prevent many of the complications associated with pregnancy with them." } { "@context": "http://schema.org", "@type": "BreadcrumbList", "itemListElement": [ { "@type": "ListItem", "position": "1", "item": { "@id": "https://f1000research.com/", "name": "Home" } }, { "@type": "ListItem", "position": "2", "item": { "@id": "https://f1000research.com/browse/articles", "name": "Browse" } }, { "@type": "ListItem", "position": "3", "item": { "@id": "https://f1000research.com/articles/11-789/v1/iparadigms", "name": "Case Report: Incidental finding of didelphys uterus in a multigravida..." } } ] } Home Browse Case Report: Incidental finding of didelphys uterus in a multigravida... ALL Metrics - Views Downloads Get PDF Get XML Cite How to cite this article Awolude O, Olutoye A and Obajimi G. Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.12688/f1000research.123141.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Case Report Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] Olutosin Awolude https://orcid.org/0000-0003-3365-0256 1,2 , Ademola Olutoye https://orcid.org/0000-0001-5211-856X 2 , Gbolahan Obajimi 1,2 Olutosin Awolude https://orcid.org/0000-0003-3365-0256 1,2 , Ademola Olutoye https://orcid.org/0000-0001-5211-856X 2 , Gbolahan Obajimi 1,2 PUBLISHED 13 Jul 2022 Author details Author details 1 Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Oyo, 241000, Nigeria 2 Obstetrics and Gynaecology Department, University College Hospital, Ibadan, Ibadan, Oyo, 241000, Nigeria Olutosin Awolude Roles: Conceptualization, Data Curation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ademola Olutoye Roles: Data Curation, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Gbolahan Obajimi Roles: Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Didelphys uterus is one of the rarest Müllerian duct anomalies (MDA) of the female genital tract. Many remain undiagnosed due to possibilities of successful pregnancies and vaginal deliveries in those without or with mild forms of associated cervical and/or vaginal anomalies. Due to this, data on didelphys uterus in pregnancy are rare, with most cases seen during routine ultrasound in pregnancies’ Caesarean section for other obstetric indications. This case was a 36-year-old G4P1 +2 female who had successful vaginal delivery in her preceding pregnancy; in index pregnancy, she presented with fetal footling breech in labour and had an emergency caesarean section during which uterine didelphys was diagnosed. Many pregnant women with didelphys uterus will deliver vaginally and, as such, remain undiagnosed. Its presence is one of the possible reasons for persistent abnormal presentations like fetal breech presentation, especially in women with prior successful vaginal deliveries. Early recognition and availability of facilities for management of such incidentally found cases of uterine didelphys will prevent many of the complications associated with pregnancy with them. READ ALL READ LESS Keywords uterine didelphys, pregnancy, caesarean section, breech presentation Corresponding Author(s) Olutosin Awolude ( [email protected] ) Close Corresponding author: Olutosin Awolude Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2022 Awolude O et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Awolude O, Olutoye A and Obajimi G. Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.12688/f1000research.123141.1 ) First published: 13 Jul 2022, 11 :789 ( https://doi.org/10.12688/f1000research.123141.1 ) Latest published: 13 Jul 2022, 11 :789 ( https://doi.org/10.12688/f1000research.123141.1 ) Introduction Müllerian duct abnormalities (MDA) are a spectrum of genital abnormalities arising from failure of fusion of the Müllerian ducts during the embryological stage of development. 1 The prevalence of congenital uterine anomalies varies and can range between 5.5% in the general population and 24.5% in patients treated for miscarriages and infertility. 2 The most common forms of uterine anomalies include unicornuate uterus, bicornuate uterus, arcuate uterus, septate uterus and didelphys uterus. Uterine didelphys belongs to MDA class III as defined by American Society of Reproductive Medicine (ASRM). This classification includes adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Müllerian anomalies and intrauterine adhesions that result from failure of Müllerian duct fusion at week eight of gestation. 3 , 4 Though uterine didelphys rarely affects fertility, it is commonly associated with adverse pregnancy outcomes such as recurrent miscarriages, preterm deliveries, intrauterine growth-restricted fetuses, low-birth-weight fetuses, and fetal malpresentations. While many cases will remain undiagnosed until evaluations for other gynaecological conditions, 5 , 6 fetal malpresentation diagnosed during pregnancy or at delivery is one of the commonest indications for Caesarean delivery. 7 We present a case of Caesarean section in a multiparous woman with uterine didelphys with breech presentation at term in our obstetric service. Case A 36-year-old G4P1 +2 1 alive Nigerian of Yoruba ethnicity, presented for antenatal service following spontaneous conception of singleton gestation at gestational age of 17 weeks. She was the third of her parents’ four children, including three females and one male. The older two sister were multiparous with no significant obstetric complaints. Obstetrics scan done at 23 weeks revealed live singleton fetus in breech presentation within the right horn and empty left horn of the uterus ( Figure 1 ). She was regular at clinic visits and her pregnancy period remained uneventful. Four years earlier, she had a vaginal delivery, at term, of a live neonate with a birth weight of 2.95 kg following spontaneous conception after two prior spontaneous pregnancies loss at about six weeks gestation each. Figure 1. Sonologist impression of the uterine didelphys with pregnancy in the right horn. Review at the antenatal clinic at 37 weeks revealed fetal cephalic presentation at clinical examination. However, at 38 weeks and four days of gestation she presented in labour and obstetrics examination revealed a singleton fetus in longitudinal lie with footling breech presentation. She subsequently had emergency lower segment Caesarean section and was delivered of a live neonate with a birth weight of 3.75 kg via breech extraction from the right horn, the left horn was bulky and equivalent to about 14 weeks size gestation ( Figure 2 ). Each horn had its adjoining normal looking fallopian tube and ovary. The urinary bladder was grossly normal. Her postoperative period was satisfactory and she was discharged on fourth day after surgery. Figure 2. Double uteri at caesarean section with suture right horn that contained the fetus (green arrow) and the empty left horn (blue arrow). Discussion Congenital malformations of the female genital tract are embryological maldevelopments of the Müllerian or paramesonephric ducts. 8 , 9 The prevalence of genital tract malformations has been reported to vary between 6.0-38%. 9 , 10 In the general population it was reported to range between 5-7%, 7-8% in the infertile population and 16-25% in the recurrent miscarriage and infertile population. 1 , 8 , 11 Malformations involving the uterus have been reported as the most common MDA with septate uterus being the commonest, and didelphys uterus the rarest. 12 In a 15-year retrospective analysis, septate uterus were found in 55.6% of cases of female genital tract anomaly, while uterine didelphys accounted for 22.7% of cases. 13 Presentations of genital tract anomalies also vary. In paediatric patients, presentation to emergency services with symptoms of severe abdominal pain, likely associated dysmenorrhea if menarche has been reached, obstructed hemivaginal septa, and abdominal swelling from haematometra with or without haematocolpos, are common. 1 , 14 Congenital malformation of the female genital tract is of special interest in the practice of obstetrics as the obstetrics performance is determined by the type of MDA. Some authors have reported increased risk of first- and second-trimester miscarriages, preterm birth, low birth weight, fetal mal-presentation, and ultimately abdominal delivery with uterine didelphys. 15 , 16 However, there have been many reported cases of successful pregnancies and deliveries in patients with uterine didelphys following appropriate pre-pregnancy surgical correction and appropriate obstetrics interventions like cervical cerclage. 1 , 17 In a prospective multicenter study of 286 pregnant women with uterine didelphys conducted in Saudi Arabia, 5.2% of the women had first trimester abortion, 27.5% had preterm labour which were managed conservatively with all delivering at term and of all delivering at term, 5.9% had spontaneous vaginal delivery, 13.3% had operative vaginal delivery and 80.8% of the women delivered by Caesarean section. 18 Our patient had two previous miscarriages prior to her first delivery. Delivery by Caesarean section is, generally, not primarily indicated in cases of uterine didelphys except for additional obstetric indication. 19 In our patient, she had successful vaginal delivery in her previous pregnancy and had Caesarean delivery in index case because of the fetal footling breech presentation at term. Conclusions Didelphys uterus is among the rarest of Müllerian duct anomalies and is commonly associated with successful pregnancies outcomes. Many will deliver vaginally and remain undiagnosed, as was the case for the first term pregnancy of the case we presented. However, its presence can be suspected in pregnant women with prior vaginal deliveries now presenting with malpresentations, like persistent fetal breech presentation as seen in this patient. Good antenatal care and management in a facility with adequate obstetric facilities for surgical intervention can prevent complications that can result from undiagnosed cases. This is especially important for cases showing malpresentations as seen in this case of fetal footling breech presentation. Data availability All data underlying the results are available as part of the article and no additional source data are required. Patient consent Consent was obtained from the patient for publication of this case. References 1. Jorgensen C, Lusiak M: Didelphys Uterus in Pregnancy, an Uncommon Mullerian Duct Anomaly: A Case Report. Clin. Pract. Cases Emerg. Med. 2021; 5 (4): 447–449. PubMed Abstract | Publisher Full Text 2. Chan Y, Jayaprakasan K, Zamora J, et al. : The prevalence of congenital uterine anomalies in unselected and high-risk populations: A systematic review. Hum. Reprod. Update. 2011; 17 : 761–771. PubMed Abstract | Publisher Full Text 3. The American Fertility Society The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil. Steril. 1988; 49 : 944–955. PubMed Abstract | Publisher Full Text 4. Grimbizis GF, Gordts S, Sardo ADS, et al. : The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum. Reprod. 2013; 28 : 2032–2044. PubMed Abstract | Publisher Full Text 5. Martínez-Beltrán M, Giménez JP: Uterus didelphys with septate cervix and unilateral endometrial carcinoma: A case report. J. Genit. Syst. Disord. 2012; 1 (1). Publisher Full Text 6. Rezai S, Bisram P, Alcantara I, et al. : Didelphys uterus: A case report and review of the literature. Case Report. Obstet. Gynecol. 2015; 2015 : 865821. PubMed Abstract | Publisher Full Text 7. Maiti GD, Tugnait P, Anand AK, et al. : Uterine Didelphys with Pregnancy and Cervical Incompetence. Med. J. Armed Forces India. 2006; 62 (2): 200–201. PubMed Abstract | Publisher Full Text 8. Gao J, Zhang J, Tian W, et al. : Endometrial cancer with congenital uterine anomalies: 3 case reports and a literature review. Cancer Biol. Ther. 2017; 18 (3): 123–131. Publisher Full Text 9. Laufer MR, De Cherney AH: Clinical Manifestations and Diagnosis of Congenital Anomalies of the Uterus. UpToDate. Waltham, MA, USA:Wolters Kluwer;2019. South Holland, The Netherlands. 10. Kim MA, Kim HS, Kim YH: Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis. J. Clin. Med. 2021; 10 (21): 4797. PubMed Abstract | Publisher Full Text 11. Saravelos SH, Cocksedge KA, Li TC: Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum. Reprod. Update. 2008; 14 (5): 415–429. PubMed Abstract | Publisher Full Text 12. Simón C, Martinez L, Pardo F, et al. : Müllerian defects in women with normal reproductive outcome. Fertil. Steril. 1991; 56 (6): 1192–1193. Publisher Full Text 13. Wang SJ, Oli M, Jinag L, et al. : Clinical analysis of 225 women with congenital uterine malformation. Zhonghua Fu Chan Ke Za Zhi. 2008; 43 (7): 493–496. PubMed Abstract 14. Karaca L, Pirimoglu B, Bayraktutan U, et al. : Herlyn-Werner- Wunderlich syndrome: a very rare urogenital anomaly in a teenage girl. J. Emerg. Med. 2015; 48 (3): e73–e75. PubMed Abstract | Publisher Full Text 15. Grimbizis GF, Camus M, Tarlatzis BC, et al. : Clinical implications of uterine malformations and hysteroscopic treatment results. Hum. Reprod. Update. 2001; 7 (2): 161–174. PubMed Abstract | Publisher Full Text 16. Venetis CA, Papadopoulos SP, Campo R, et al. : Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. RBM Online. 2014; 29 (6): 665–683. PubMed Abstract | Publisher Full Text 17. Heinonen PK: Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic mertoplasty or no surgical treatment. J. Am. Assoc. Gynecol. Laparosc. 1997; 4 (3): 311–317. Publisher Full Text 18. Othman M: Uterine Didelphys Pregnancy Management. J. Adv. Med. Med. Res. 2018; 26 : 1–5. Publisher Full Text 19. Lin PC, Bhatnagar KP, Nettleton GS, et al. : Female genital anomalies affecting reproduction. Fertil. Steril. 2002; 78 (5): 899–915. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Jul 2022 ADD YOUR COMMENT Comment Author details Author details 1 Obstetrics and Gynaecology Department, College of Medicine, University of Ibadan, Ibadan, Oyo, 241000, Nigeria 2 Obstetrics and Gynaecology Department, University College Hospital, Ibadan, Ibadan, Oyo, 241000, Nigeria Olutosin Awolude Roles: Conceptualization, Data Curation, Methodology, Project Administration, Resources, Supervision, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Ademola Olutoye Roles: Data Curation, Investigation, Methodology, Project Administration, Validation, Visualization, Writing – Original Draft Preparation, Writing – Review & Editing Gbolahan Obajimi Roles: Data Curation, Investigation, Methodology, Project Administration, Supervision, Validation, Visualization, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 13 Jul 2022, 11:789 https://doi.org/10.12688/f1000research.123141.1 Copyright © 2022 Awolude O et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Awolude O, Olutoye A and Obajimi G. Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.12688/f1000research.123141.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 13 Jul 2022 Views 0 Cite How to cite this report: Vimercati A. Reviewer Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r235209 ) The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-235209 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 12 Feb 2024 Antonella Vimercati , University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari,, Italy Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.135217.r235209 You present an interesting case of pregnancy in utero didelphys but limited by an insufficient comparison or discussion with the data present in the literature. you should add other recent bibliographical entries on the topic such ... Continue reading READ ALL You present an interesting case of pregnancy in utero didelphys but limited by an insufficient comparison or discussion with the data present in the literature. you should add other recent bibliographical entries on the topic such as at least the following 2: 1. ref [1] 2. ref [2] IN DISCUSSION (after first paragraph)-The mode of delivery should first be explored in more detail, because there are conflicting data in the literature. Indeed, reports are almost equal for those who prefer CS and those who prefer vaginal delivery. It is quite common to get abnormal presentations and malposition in patients with uterus didelphys, but there are reports of successful labor in this group of women. CS was the mode of delivery preferred by some Authors, considering also the strong fear of the patient for the baby, the major muscular component in the cervix, the presence of septum in the vagina should be considered above all if is thick and inelastic resulting in an increased risk for vaginal dystocia and prolongation of the second phase of labor. The drawing of figure 1 should be improved and made compatible as position (right and left horn) with the macroscopic figure 2. IN DISCUSSION (before the last paragraph)- As for as the diagnosis of uterus didelphys you should better stress the usefulness of MRI for differential diagnosis of other rare uterine pathologies, adding 2 bibliographic entries as suggested below: The diagnosis and consequently the management of pregnancy with uterus didelphys represent difficult and well-discussed topics in the literature. Confirming the diagnosis of uterine didelphys with obstructed hemi-vagina and unilateral renal agenesis is particularly challenging and diagnosis of uterine anomalies is often subjective. Although two-dimensional ultrasound is commonly utilized, it is considered the least accurate imaging investigation and when diagnosis is difficult to differentiate better Bicornuate, unicornuate, and didelphic uterus or other uterine pathologies or other rare obstetric complications such as Twin Pregnancies with Complete Hydatiform Mole and Coexistent Normal Fetus it may be useful to use the more accurate pelvic MRI. ref [3] ref [4] Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Ćwiertnia A, Borzyszkowska D, Golara A, Tuczyńska N, et al.: The Impact of Uterus Didelphys on Fertility and Pregnancy. International Journal of Environmental Research and Public Health . 2022; 19 (17). Publisher Full Text 2. Crowley CM, Botros K, Hegazy IF, O'Donnell E: Uterine didelphys: diagnosis, management and pregnancy outcome. BMJ Case Rep . 2021; 14 (3). PubMed Abstract | Publisher Full Text 3. Giorgione V, Cavoretto P, Cormio G, Valsecchi L, et al.: Prenatal Diagnosis of Twin Pregnancies with Complete Hydatidiform Mole and Coexistent Normal Fetus: A Series of 13 Cases. Gynecol Obstet Invest . 2017; 82 (4): 404-409 PubMed Abstract | Publisher Full Text 4. Scardapane A, Lorusso F, Bettocchi S, Moschetta M, et al.: Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography. Radiol Med . 2013; 118 (2): 323-38 PubMed Abstract | Publisher Full Text Competing Interests: No competing interests were disclosed. Reviewer Expertise: perinatal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Vimercati A. Reviewer Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r235209 ) The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-235209 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Akinfolarin AC. Reviewer Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r144392 ) The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-144392 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 05 Sep 2022 Adepiti Clement Akinfolarin , Department of Obstetrics, Gynecology, and Perinatology, The Obafemi Awolowo University, Ile-Ife, Nigeria Approved VIEWS 0 https://doi.org/10.5256/f1000research.135217.r144392 This is a succinctly described case report. It touched essentially on the presentation, examination, diagnosis and treatment. The description and discussion are detailed and have added to the body of knowledge on the subject of MDA. However, ... Continue reading READ ALL This is a succinctly described case report. It touched essentially on the presentation, examination, diagnosis and treatment. The description and discussion are detailed and have added to the body of knowledge on the subject of MDA. However, one is not convinced that in a didelphic uterus, which is usually smaller than normal uterus, an average sized fetus in cephalic presentation at 37 weeks would spontaneously convert to breech at 38 weeks. What is the cadre of the personnel that performed that examination at 37 weeks? Essentially, its a good case report. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests: No competing interests were disclosed. Reviewer Expertise: Gynaecological oncology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Akinfolarin AC. Reviewer Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r144392 ) The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-144392 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 13 Jul 2022 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 Version 1 13 Jul 22 read read Adepiti Clement Akinfolarin , The Obafemi Awolowo University, Ile-Ife, Nigeria Antonella Vimercati , University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari,, Italy Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Vimercati A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 12 Feb 2024 | for Version 1 Antonella Vimercati , University of Bari "Aldo Moro", Piazza Giulio Cesare 11, 70124 Bari,, Italy 0 Views copyright © 2024 Vimercati A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions You present an interesting case of pregnancy in utero didelphys but limited by an insufficient comparison or discussion with the data present in the literature. you should add other recent bibliographical entries on the topic such as at least the following 2: 1. ref [1] 2. ref [2] IN DISCUSSION (after first paragraph)-The mode of delivery should first be explored in more detail, because there are conflicting data in the literature. Indeed, reports are almost equal for those who prefer CS and those who prefer vaginal delivery. It is quite common to get abnormal presentations and malposition in patients with uterus didelphys, but there are reports of successful labor in this group of women. CS was the mode of delivery preferred by some Authors, considering also the strong fear of the patient for the baby, the major muscular component in the cervix, the presence of septum in the vagina should be considered above all if is thick and inelastic resulting in an increased risk for vaginal dystocia and prolongation of the second phase of labor. The drawing of figure 1 should be improved and made compatible as position (right and left horn) with the macroscopic figure 2. IN DISCUSSION (before the last paragraph)- As for as the diagnosis of uterus didelphys you should better stress the usefulness of MRI for differential diagnosis of other rare uterine pathologies, adding 2 bibliographic entries as suggested below: The diagnosis and consequently the management of pregnancy with uterus didelphys represent difficult and well-discussed topics in the literature. Confirming the diagnosis of uterine didelphys with obstructed hemi-vagina and unilateral renal agenesis is particularly challenging and diagnosis of uterine anomalies is often subjective. Although two-dimensional ultrasound is commonly utilized, it is considered the least accurate imaging investigation and when diagnosis is difficult to differentiate better Bicornuate, unicornuate, and didelphic uterus or other uterine pathologies or other rare obstetric complications such as Twin Pregnancies with Complete Hydatiform Mole and Coexistent Normal Fetus it may be useful to use the more accurate pelvic MRI. ref [3] ref [4] Is the background of the case’s history and progression described in sufficient detail? Partly Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Partly Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Partly Is the case presented with sufficient detail to be useful for other practitioners? Partly References 1. Ćwiertnia A, Borzyszkowska D, Golara A, Tuczyńska N, et al.: The Impact of Uterus Didelphys on Fertility and Pregnancy. International Journal of Environmental Research and Public Health . 2022; 19 (17). Publisher Full Text 2. Crowley CM, Botros K, Hegazy IF, O'Donnell E: Uterine didelphys: diagnosis, management and pregnancy outcome. BMJ Case Rep . 2021; 14 (3). PubMed Abstract | Publisher Full Text 3. Giorgione V, Cavoretto P, Cormio G, Valsecchi L, et al.: Prenatal Diagnosis of Twin Pregnancies with Complete Hydatidiform Mole and Coexistent Normal Fetus: A Series of 13 Cases. Gynecol Obstet Invest . 2017; 82 (4): 404-409 PubMed Abstract | Publisher Full Text 4. Scardapane A, Lorusso F, Bettocchi S, Moschetta M, et al.: Deep pelvic endometriosis: accuracy of pelvic MRI completed by MR colonography. Radiol Med . 2013; 118 (2): 323-38 PubMed Abstract | Publisher Full Text Competing Interests No competing interests were disclosed. Reviewer Expertise perinatal medicine I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Vimercati A. Peer Review Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r235209) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-235209 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2022 Akinfolarin A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 05 Sep 2022 | for Version 1 Adepiti Clement Akinfolarin , Department of Obstetrics, Gynecology, and Perinatology, The Obafemi Awolowo University, Ile-Ife, Nigeria 0 Views copyright © 2022 Akinfolarin A. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions This is a succinctly described case report. It touched essentially on the presentation, examination, diagnosis and treatment. The description and discussion are detailed and have added to the body of knowledge on the subject of MDA. However, one is not convinced that in a didelphic uterus, which is usually smaller than normal uterus, an average sized fetus in cephalic presentation at 37 weeks would spontaneously convert to breech at 38 weeks. What is the cadre of the personnel that performed that examination at 37 weeks? Essentially, its a good case report. Is the background of the case’s history and progression described in sufficient detail? Yes Are enough details provided of any physical examination and diagnostic tests, treatment given and outcomes? Yes Is sufficient discussion included of the importance of the findings and their relevance to future understanding of disease processes, diagnosis or treatment? Yes Is the case presented with sufficient detail to be useful for other practitioners? Yes Competing Interests No competing interests were disclosed. Reviewer Expertise Gynaecological oncology I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Akinfolarin AC. Peer Review Report For: Case Report: Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery [version 1; peer review: 1 approved, 1 approved with reservations] . F1000Research 2022, 11 :789 ( https://doi.org/10.5256/f1000research.135217.r144392) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/11-789/v1#referee-response-144392 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions Adjust parameters to alter display View on desktop for interactive features Includes Interactive Elements View on desktop for interactive features Competing Interests Policy Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality. 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