Uterine Didelphys Pregnancy Management

Introduction: Didelphys uterus is a rare Mullerian duct abnormality, which affects 1-3 in 3000 women worldwide. It is usually asymptomatic. There are many patients with this condition in Saudi Arabia, and this compelled us to study this condition.

Aims: To describe the management and outcomes of pregnant women diagnosed with uterus didelphys.

Study Design: This is a multicenter prospective cohort study.

Place and Duration of Study: This study was conducted in Saudi Arabia in 4 cities; 8 hospitals over a period of five years.

Methodology: 286 patients were enrolled in this study, all diagnosed previously to have didelphys uterus, pregnant and willing to join, follow up and deliver in one of the research hospitals. Patients consented to join the search and every 2 weeks follow up and management was done accordingly.

Results: 15 (5.2%) patients aborted during the first half of the pregnancy. 139 (48.6%) patients had cervical cerclage done. 79 (27.6) patients had preterm labor which was managed conservatively. 231 (80.8%) patients delivered by cesarean section and 17 (5.9%) delivered spontaneous vaginal delivery. Added to that, 38 (13.3%) had operative vaginal delivery. 271 neonates delivered. Unfortunately, three (1.1%) had intrauterine fetal death (IUFD) at 30-32 weeks of gestational age due to multiple congenital anomalies. All remaining neonates were normal and healthy except 25 (9.2%) who were admitted to NICU for various causes, but eventually discharged in good condition.

Conclusion: Antenatal care in patients with uterine didelphys is challenging, but given proper care, they can compete pregnancy with good neonatal outcome. Preterm labor and operative deliveries in the form of cesarean section and instrumental delivery were found to be high though.