Uterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section

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Kune, Simon Byonanuwe This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-3546580/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: Uterine didelphys is an extremely very rare Müllerian duct defect globally that if found coincidentally can be so disturbing to the attending clinician, the patient and her family members. Wepresent a case report of an undiagnosed uterus didelphys in a pregnant woman who was admitted at 39 weeks and 4 days of amenorrhea with a double uterus that was found coincidentally at her third delivery by elective caesarean section and had a good fetal outcome. Case presentation: We are presenting a 32 year old Gravida 4 Para 3+0 patient who was admitted at 39 weeks and 4 days of amenorrhea and reported a history of three previous caesarean scars. She was accordingly delivered by elective caesarean section. Intraoperatively, a second non gravid uterus with ipsilateral fallopian tube and ovary was coincidentally noted and a contralateral fallopian tube without ovary was also appreciated in the same uterus. Exploration revealed that each uterus had one fallopian tube and ovary, and that both uteri joined at one cervix. Conclusion: Careful assessment of all women scheduled for surgery is crucial to avoid such unnecessary disturbing phenomena Obstetrics & Gynecology Uterus Mullerian Didelphys Genital Figures Figure 1 Introduction Uterus didelphys denotes a congenital malformation of the woman’s genital tract that arises from total failure of the paramesonephric ducts to fuse during the embryonic time ( 1 , 2 ). It continues to haunt a significant number of both young and old females all over the world ( 3 ). It is one of the least common Mullerian abnormalities ( 4 ). The mean incidence has been reported to be 8.4% globally ( 5 ). Following failed fusion of the paramesonephric ducts early in the pregnancy, there is formation of a longitudinal vaginal septum, two vagina, and two hemi-uteri each with its separate ovary and fallopian tube. And because of the close proximity of the urinary system and the related genital embryological development, cases with maldevelopments involving the kidneys and the collecting duct system have been reported in some parts of the world ( 6 ). Most women do not usually present to healthcare facilities until when symptoms have begun to manifest ( 6 ). Although majority may be asymptomatic and may live undiagnosed for several years, the anomaly may present with serious manifestations which include painful menstruation, pain during coital activity, sub fertility problems, spontaneous early pregnancy losses, preterm labour and delivery, fetal malpresentations, intrauterine growth restriction, early rupture of the fetal membranes and increased rates of caesarean deliveries among others ( 3 ). In here we present a case report of an undiagnosed uterus didelphys in a term gestation with a double uterus found coincidentally at her third elective caesarean delivery and had a good fetal outcome. Case presentation A32 year old Gravida 4 Para 3 + 0 at 39 weeks and 4 days of amenorrhea with three previous caesarean scars presented at our facility, Garissa county referral hospital for a scheduled elective caesarean section. She had antenatal booking for this particular procedure done during one of her antenatal clinic visits at this facility. She had had three previous pregnancies delivered by caesarean section at term to 2.6kg, 3.0kg and 2.8kg babies respectively. On arrival, she was assessed and prepared for the elective surgery as per the hospital protocol, which among other things involves gestational age confirmation, patient admission, fetal well being assessment both clinically and ultrasonographically as well as the mother’s assessment for fitness for surgery including for anaesthesia by the anaesthetic team. Mother was admitted, an informed consent was obtained, blood work ups particularly for baseline hemoglobin levels and typing done. Under spinal anaesthesia, following aseptic technique an abdominal incision was made via the previous pfannestiel scar. An intact gravid uterus was noted and a lower segment cresenteric incision was made, upon which a single live male fetus 2.7kg was delivered without difficulties, with subsequent delivery of the placenta and membranes by controlled cord traction. Restoration of uterine anatomy on the incision was made using polyglactin 2 and haemostasis achieved. Upon returning the uterus however, a second non gravid uterus with ipsilateral fallopian tube and ovary was noted and a contralateral fallopian tube without ovary was also appreciated in the same uterus. Exploration revealed each uterus had one fallopian tube and ovary, and both uteri joined at one cervix. This is shown in Fig. 1 . The rest of the entire procedure went uneventful. The mother was discharged home with her baby in a stable condition after three days of postoperative management on ward Discussion Mullerian defects are among a group of abnormalities that affect the genital and urinary system given the fact that they both share a common embryological origin ( 5 , 6 ). Uterine didelphys belongs to Mullerian duct anomaly class III as defined by American society of reproductive medicine which includes adnexal adhesions and distal tubal occlusions among others ( 8 ). Müllerian defects generate from a failure of the Müllerian ducts to fuse at about the eighth week of pregnancy ( 9 ). The prevalence of congenital uterine anomalies in the general population has been reported to be 5.5% - 8.0% in women with infertility, 13.3% of the population with abortions, and up to 24.5% in patients with abortions and infertility ( 9 ). Majority of the patients with a double uterus have no symptoms and signs. A small proportion of women however may complain of painful coitus or painful menstrual periods ( 10 , 11 ). There may be haematocolpos or haematometrocolpos and the patient may present with chronic abdominal pain due to the obstructing vaginal septum( 12 , 13 ). Genital neoplasms and endometriosis have been reported in a few cases ( 4 ). The rate of premature deliveries, abnormal fetal presentations, abortions, early rupture of the fetal membranes, cervical incompetence, postpartum haemorrhage, intrauterine growth restriction and cesarean deliveries are generally increased ( 14 ). According to Banu and colleagues, this anomaly has been reported in about 3.5 percent in sub fertile couples and about 13 percent in women with history of recurrent abortions ( 15 ). Our patient had no such history throughout her life so far. Although she had delivered by cesarean section for all her previous pregnancies so far, it was all due to obstetric indications. Therefore, all her pregnancies had generally been uneventful. And surprisingly, all the previous assessments including ultrasound scan during pregnancy had not reported such an anomalous uterus. This is a clear indication that this anomaly can go uneventfully throughout a woman’s reproductive life Conclusion Careful assessment of all women scheduled for surgery is crucial to avoid such unnecessary disturbing phenomena. Declarations Patient consent An informed written consent to publish this case was obtained from the patient Conflict of interest None Acknowledgement To the entire medical team which participated in the management of this patient References Goulios C, McCuaig R, Hobson L WS. Management of a twin pregnancy in a didelphys uterus: one fetus in each uterine cavity. BMJ Case Rep. 2020;13(8):e235256. Cunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM. Williams Obstetrics. 25th ed. McGraw-Hill Education; 2018. Okafor I., Odugu B., Ugwu I., Oko D., Onyekpa IJ, Enyinna PK, et al. Undiagnosed Uterus Didelphys in a Term Pregnancy with Adverse Fetal Outcome: A Case Report. Divers Equal Heal Care. 2016;13(2):177–9. Shahanaj S, Didarul A, Farzana R. Uterine Didelphys with Pregnancy Outcomes: A Case Report. Chattagram Maa-O-Shishu Hosp Med Coll J. 2018;17(2):53–5. Namkha D, Sangay T, Tshering W. Uterus didelphys with double vagina diagnosed during third cesarean section: A case report. SAGE Open Med Case Reports. 2022;10(2):1–4. Ekanem E, Lalrinawmi L, Sinha A, Abdelrazik T. Pregnancy in a didelphic uterus: a case report of an unusual phenomenon and review of literature. Int J Reprod Contraception, Obstet Gynecol. 2021;10(3):1162–8. Maki Y, Furukawa S, Sameshima H IT. Independent uterine contractions in simultaneous twin pregnancy in each horn of the uterus didelphys. J Obs Gynaecol Res. 2014;40(3):836–9. Slavchev S, Kostov S. Pregnancy and Childbirth in Uterus Didelphys: A Report of Three Cases. Medicina (B Aires). 2020;56(198):1–9. Olutosin A, Ademola O, Gbolahan O. Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery. F1000Research. 2022;11(789):1–7. Crowley CM, Botros K, Hegazy IF OE. Uterine didelphys: diagnosis, management and pregnancy outcome. Uterine didelphys diagnosis, Manag pregnancy outcome. 2021;14(3):e242233. Dutta DC. DC Dutta’s Textbook of Obstetrics including Perinatology and Contraception. 8th ed. Jaypee Brothers Medical Publishers (P) Ltd; 2015. Linscheid C, Holoch K, Moran HK SL. Case Report: Uterine Didelphys and Cervical Agenesis in an 18 Year-Old Woman Presenting with a Pelvic Mass. J Pediatr Adolesc Gynecol. 2021;34(5):758–60. Arnold KC, Thai TC CL. Uterine Didelphys with Bilateral Cervical Agenesis in a 15-Year-Old Girl. J Pediatr Adolesc Gynecol. 2018;31(1):64–6. Borzyszkowska D, Golara A, Tuczy N, Kozłowski M, Cwiertnia A, Kwiatkowski S. The Impact of Uterus Didelphys on Fertility and Pregnancy. Int J Environ Res Public Health. 2022;19(10571):1–10. Banu Ö. 8th Term pregnancy in uterus didelphys: a rare case report. Case Reports Perinat Med. 2017;17(8):1–4. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-3546580","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":245341413,"identity":"a1d5fe30-5041-4600-b6c4-f20a497f61f7","order_by":0,"name":"Abdibasid Shariff Ali","email":"","orcid":"https://orcid.org/0009-0004-9025-1248","institution":"Department of Obstetrics and Gynaecology; Garissa County Referral Hospital, Garissa, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Abdibasid","middleName":"Shariff","lastName":"Ali","suffix":""},{"id":245341414,"identity":"0cedfc66-5e21-4d93-9088-4cda1a1fe6b3","order_by":1,"name":"Yakub Mohamud","email":"","orcid":"https://orcid.org/0009-0008-8779-5526","institution":"1Department of Obstetrics and Gynaecology; Garissa County Referral Hospital, Garissa, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Yakub","middleName":"","lastName":"Mohamud","suffix":""},{"id":245341415,"identity":"b8c54232-031e-4d28-8468-0fe41b6d2bc5","order_by":2,"name":"Yakub I. Kune","email":"","orcid":"https://orcid.org/0009-0005-8613-752X","institution":"1Department of Obstetrics and Gynaecology; Garissa County Referral Hospital, Garissa, Kenya","correspondingAuthor":false,"prefix":"","firstName":"Yakub","middleName":"I.","lastName":"Kune","suffix":""},{"id":245341416,"identity":"b56baa05-3766-47ea-a769-6138218f72d6","order_by":3,"name":"Simon Byonanuwe","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA0ElEQVRIiWNgGAWjYBACAzjJ3gBiWJCihecAiCFBrBYQkEgAk4S1mEskH3v4o2CbnLnk86sbfhRIMPC3dyfg1WI5Iy3dmMfgtrHl7Jyymz1Ah0mcObsBv8Nu5JhJMxjcTtxwOyftBg9Qi4FELmEtkj9AWm6eSbv5h1gtEjwgLTfYj90myhbLnmdp0iC/GJzJYbstYyDBQ9Av5uzJxyR//LktZ3D8+LObb/7YyPG39+LXwiCQAGPxgOOIB79yEOA/AGOxPyCsehSMglEwCkYkAADf7UhYM+OD1AAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-5360-556X","institution":"Department of Obstetrics and Gynaecology, Kampala International University Western Campus, Bushenyi, Uganda","correspondingAuthor":true,"prefix":"","firstName":"Simon","middleName":"","lastName":"Byonanuwe","suffix":""}],"badges":[],"createdAt":"2023-11-02 18:45:37","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":true,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false,"coiExplicitlySet":false},"doi":"10.21203/rs.3.rs-3546580/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-3546580/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":46018085,"identity":"4d1bcc9a-83cc-4621-85ae-eac9c0ef42c3","added_by":"auto","created_at":"2023-11-07 15:58:10","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":523568,"visible":true,"origin":"","legend":"\u003cp\u003eImages of didelphys uterus as noted intraoperatively\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-3546580/v1/87016e2fce086a3c81a67984.png"},{"id":46018086,"identity":"79bbe614-b2df-456a-b5ff-414c440a4d30","added_by":"auto","created_at":"2023-11-07 15:58:15","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":636783,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-3546580/v1/972dbd7f-e94b-4afa-b8b4-ac8b2b06376c.pdf"}],"financialInterests":"","formattedTitle":"\u003cp\u003e\u003cstrong\u003eUterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section \u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eUterus didelphys denotes a congenital malformation of the woman\u0026rsquo;s genital tract that arises from total failure of the paramesonephric ducts to fuse during the embryonic time (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). It continues to haunt a significant number of both young and old females all over the world (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is one of the least common Mullerian abnormalities (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The mean incidence has been reported to be 8.4% globally (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Following failed fusion of the paramesonephric ducts early in the pregnancy, there is formation of a longitudinal vaginal septum, two vagina, and two hemi-uteri each with its separate ovary and fallopian tube. And because of the close proximity of the urinary system and the related genital embryological development, cases with maldevelopments involving the kidneys and the collecting duct system have been reported in some parts of the world (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Most women do not usually present to healthcare facilities until when symptoms have begun to manifest (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Although majority may be asymptomatic and may live undiagnosed for several years, the anomaly may present with serious manifestations which include painful menstruation, pain during coital activity, sub fertility problems, spontaneous early pregnancy losses, preterm labour and delivery, fetal malpresentations, intrauterine growth restriction, early rupture of the fetal membranes and increased rates of caesarean deliveries among others (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In here we present a case report of an undiagnosed uterus didelphys in a term gestation with a double uterus found coincidentally at her third elective caesarean delivery and had a good fetal outcome.\u003c/p\u003e"},{"header":"Case presentation","content":"\u003cp\u003eA32 year old Gravida 4 Para 3\u0026thinsp;+\u0026thinsp;0 at 39 weeks and 4 days of amenorrhea with three previous caesarean scars presented at our facility, Garissa county referral hospital for a scheduled elective caesarean section. She had antenatal booking for this particular procedure done during one of her antenatal clinic visits at this facility. She had had three previous pregnancies delivered by caesarean section at term to 2.6kg, 3.0kg and 2.8kg babies respectively. On arrival, she was assessed and prepared for the elective surgery as per the hospital protocol, which among other things involves gestational age confirmation, patient admission, fetal well being assessment both clinically and ultrasonographically as well as the mother\u0026rsquo;s assessment for fitness for surgery including for anaesthesia by the anaesthetic team. Mother was admitted, an informed consent was obtained, blood work ups particularly for baseline hemoglobin levels and typing done. Under spinal anaesthesia, following aseptic technique an abdominal incision was made via the previous pfannestiel scar. An intact gravid uterus was noted and a lower segment cresenteric incision was made, upon which a single live male fetus 2.7kg was delivered without difficulties, with subsequent delivery of the placenta and membranes by controlled cord traction. Restoration of uterine anatomy on the incision was made using polyglactin 2 and haemostasis achieved. Upon returning the uterus however, a second non gravid uterus with ipsilateral fallopian tube and ovary was noted and a contralateral fallopian tube without ovary was also appreciated in the same uterus. Exploration revealed each uterus had one fallopian tube and ovary, and both uteri joined at one cervix. This is shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The rest of the entire procedure went uneventful. The mother was discharged home with her baby in a stable condition after three days of postoperative management on ward\u003c/p\u003e \u003cp\u003e \u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMullerian defects are among a group of abnormalities that affect the genital and urinary system given the fact that they both share a common embryological origin (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Uterine didelphys belongs to Mullerian duct anomaly class III as defined by American society of reproductive medicine which includes adnexal adhesions and distal tubal occlusions among others (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). M\u0026uuml;llerian defects generate from a failure of the M\u0026uuml;llerian ducts to fuse at about the eighth week of pregnancy (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). The prevalence of congenital uterine anomalies in the general population has been reported to be 5.5%\u003cb\u003e-\u003c/b\u003e8.0% in women with infertility, 13.3% of the population with abortions, and up to 24.5% in patients with abortions and infertility (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). Majority of the patients with a double uterus have no symptoms and signs. A small proportion of women however may complain of painful coitus or painful menstrual periods (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). There may be haematocolpos or haematometrocolpos and the patient may present with chronic abdominal pain due to the obstructing vaginal septum(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Genital neoplasms and endometriosis have been reported in a few cases (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). The rate of premature deliveries, abnormal fetal presentations, abortions, early rupture of the fetal membranes, cervical incompetence, postpartum haemorrhage, intrauterine growth restriction and cesarean deliveries are generally increased (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). According to Banu and colleagues, this anomaly has been reported in about 3.5 percent in sub fertile couples and about 13 percent in women with history of recurrent abortions (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). Our patient had no such history throughout her life so far. Although she had delivered by cesarean section for all her previous pregnancies so far, it was all due to obstetric indications. Therefore, all her pregnancies had generally been uneventful. And surprisingly, all the previous assessments including ultrasound scan during pregnancy had not reported such an anomalous uterus. This is a clear indication that this anomaly can go uneventfully throughout a woman\u0026rsquo;s reproductive life\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eCareful assessment of all women scheduled for surgery is crucial to avoid such unnecessary disturbing phenomena.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003ePatient consent An informed written consent to publish this case was obtained from the patient\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interest\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo the entire medical team which participated in the management of this patient\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eGoulios C, McCuaig R, Hobson L WS. Management of a twin pregnancy in a didelphys uterus: one fetus in each uterine cavity. BMJ Case Rep. 2020;13(8):e235256.\u003c/li\u003e\n \u003cli\u003eCunningham FG, Leveno KJ, Bloom SL, Dashe JS, Hoffman BL, Casey BM. Williams Obstetrics. 25th ed. McGraw-Hill Education; 2018.\u003c/li\u003e\n \u003cli\u003eOkafor I., Odugu B., Ugwu I., Oko D., Onyekpa IJ, Enyinna PK, et al. Undiagnosed Uterus Didelphys in a Term Pregnancy with Adverse Fetal Outcome: A Case Report. Divers Equal Heal Care. 2016;13(2):177\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eShahanaj S, Didarul A, Farzana R. Uterine Didelphys with Pregnancy Outcomes: A Case Report. Chattagram Maa-O-Shishu Hosp Med Coll J. 2018;17(2):53\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eNamkha D, Sangay T, Tshering W. Uterus didelphys with double vagina diagnosed during third cesarean section: A case report. SAGE Open Med Case Reports. 2022;10(2):1\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eEkanem E, Lalrinawmi L, Sinha A, Abdelrazik T. Pregnancy in a didelphic uterus: a case report of an unusual phenomenon and review of literature. Int J Reprod Contraception, Obstet Gynecol. 2021;10(3):1162\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eMaki Y, Furukawa S, Sameshima H IT. Independent uterine contractions in simultaneous twin pregnancy in each horn of the uterus didelphys. J Obs Gynaecol Res. 2014;40(3):836\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eSlavchev S, Kostov S. Pregnancy and Childbirth in Uterus Didelphys: A Report of Three Cases. Medicina (B Aires). 2020;56(198):1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eOlutosin A, Ademola O, Gbolahan O. Incidental finding of didelphys uterus in a multigravida woman at Caesarean delivery. F1000Research. 2022;11(789):1\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eCrowley CM, Botros K, Hegazy IF OE. Uterine didelphys: diagnosis, management and pregnancy outcome. Uterine didelphys diagnosis, Manag pregnancy outcome. 2021;14(3):e242233.\u003c/li\u003e\n \u003cli\u003eDutta DC. DC Dutta\u0026rsquo;s Textbook of Obstetrics including Perinatology and Contraception. 8th ed. Jaypee Brothers Medical Publishers (P) Ltd; 2015.\u003c/li\u003e\n \u003cli\u003eLinscheid C, Holoch K, Moran HK SL. Case Report: Uterine Didelphys and Cervical Agenesis in an 18 Year-Old Woman Presenting with a Pelvic Mass. J Pediatr Adolesc Gynecol. 2021;34(5):758\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eArnold KC, Thai TC CL. Uterine Didelphys with Bilateral Cervical Agenesis in a 15-Year-Old Girl. J Pediatr Adolesc Gynecol. 2018;31(1):64\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eBorzyszkowska D, Golara A, Tuczy N, Kozłowski M, Cwiertnia A, Kwiatkowski S. The Impact of Uterus Didelphys on Fertility and Pregnancy. Int J Environ Res Public Health. 2022;19(10571):1\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eBanu \u0026Ouml;. 8th Term pregnancy in uterus didelphys: a rare case report. Case Reports Perinat Med. 2017;17(8):1\u0026ndash;4.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"Garissa county referral hospital","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Uterus, Mullerian, Didelphys, Genital","lastPublishedDoi":"10.21203/rs.3.rs-3546580/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-3546580/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction:\u003c/strong\u003e Uterine didelphys is an extremely very rare Müllerian duct defect globally that if found coincidentally can be so disturbing to the attending clinician, the patient and her family members. Wepresent a case report of an undiagnosed uterus didelphys in a pregnant woman who was admitted at 39 weeks and 4 days of amenorrhea with a double uterus that was found coincidentally at her third delivery by elective caesarean section and had a good fetal outcome.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCase presentation:\u003c/strong\u003e We are presenting a 32 year old Gravida 4 Para 3+0 patient who was admitted at 39 weeks and 4 days of amenorrhea and reported a history of three previous caesarean scars. She was accordingly delivered by elective caesarean section. Intraoperatively, a second non gravid uterus with ipsilateral fallopian tube and ovary was coincidentally noted and a contralateral fallopian tube without ovary was also appreciated in the same uterus. Exploration revealed that each uterus had one fallopian tube and ovary, and that both uteri joined at one cervix.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e \u0026nbsp;Careful assessment of all women scheduled for surgery is crucial to avoid such unnecessary disturbing phenomena\u003c/p\u003e","manuscriptTitle":"Uterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-11-07 15:58:06","doi":"10.21203/rs.3.rs-3546580/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85b6036e-e531-45a4-8a83-7f3ff19634f4","owner":[],"postedDate":"November 7th, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":25906268,"name":"Obstetrics \u0026 Gynecology"}],"tags":[],"updatedAt":"2023-11-07T15:58:06+00:00","versionOfRecord":[],"versionCreatedAt":"2023-11-07 15:58:06","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-3546580","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-3546580","identity":"rs-3546580","version":["v1"]},"buildId":"_2-kVJe1T_tPrBINL-cwx","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}