Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

In This Article

Didelphic Uterus

The incidence of the didelphic uterus is also uncommon at 6.3%.[2] The literature is observational, with a low number of subjects. Two studies looked at a total of 86 subjects. By compiling the data, we found an ectopic rate of 2.3%, miscarriage rate of 20.9%, preterm delivery rate of 24.4%, and live birth rate of 68.6%[2,21] ( Table 1 ). Because the didelphic uterus was thought to be a complete duplication of a single uterus, it has been assumed that pregnancy outcome would be similar. This is clearly not the case when compared with known historical controls.

Once pregnant, cesarean section rates are higher secondary to dystocia and malpresentation. In addition, didelphic uterus is commonly associated with a patent or obstructed vaginal septum. Such a septum has no impact on fertility and is asymptomatic but rarely can cause dyspareunia and vaginal discharge. During vaginal delivery, vaginal dystocia theoretically can occur but has not been reported. When completely obstructed unilaterally, a hematometra can occur as a pelvic mass with or without pelvic pain. Presentation can be insidious, as the menstrual blood can be reabsorbed and the resulting pelvic pain can be tolerated. Because of retrograde menstruation, endometriosis is commonly associated with a didelphic uterus.


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