Vaginal birth after two previous caesarean deliveries in a patient with uterus didelphys and an interuterine septal defect

Abstract

Uterus didelphys is a congenital abnormality characterised by double uteri, double cervices and a double or single vagina that affects 0.3% to 11% of the general female population. A 23-year-old woman, gravida 3 para 3003, with uterus didelphys, acquired an iatrogenic interuterine septal defect during an otherwise routine primary caesarean delivery for fetal malpresentation. The defect was repaired but noted to have dehisced during her second pregnancy. A repeat caesarean section was performed due to fetal malpresentation after an unsuccessful external cephalic version. The dehisced defect was left unrepaired. During her third pregnancy, the placenta implanted in the right uterus, but the fetus migrated to the left uterus at approximately 28 weeks gestation. The umbilical cord traversed the interuterine septal defect. With the fetus in the vertex presentation at term gestation, the patient underwent a vaginal birth after two previous caesarean deliveries without any major perinatal complications.

Keywords: obstetrics and gynaecology; pregnancy.

Figure 1

Uterus didelphys: class III paramesonephric duct abnormality (source: American Fertility Society/American Society for Reproductive Medicine1).

Figure 2

MRI study performed around the 26th week of the second pregnancy in 2013. T2-weighted coronal image obtained using a 1.5 T magnet (Siemens Medical Solutions, Malvern, Pennsylvania, USA) showing two fully formed and non-fused uterine horns separated by an indentation measuring approximately 9 cm from the fundus to the communicating septum through which fetal parts appear to traverse (indicated by the yellow arrow).