King Alison Laura, Pixton Sarah, Lanzarone Valeria
Department of Obstetrics and Gynaecology, Nepean Hospital, Penrith, Australia.
Case Rep Womens Health. 2020 Apr 3;27:e00199. doi: 10.1016/j.crwh.2020.e00199. eCollection 2020 Jul.
Uterine didelphys is a rare type of congenital uterine anomaly resulting from incomplete fusion of the paramesonephric ducts during embryogenesis. We report the case of a 27-year-old multiparous woman who presented with ovulation-induced dicavitary dichorionic diamniotic twins in known uterine didelphys. At 29 + 5 weeks of gestation, the patient had preterm prelabour rupture of membranes followed by threatened preterm labour in the right uterus only, which settled with tocolysis. The pregnancy continued for a further 9 days, at which time uterine tightenings returned and the right cervix was fully dilated, resulting in successful vaginal delivery of the first twin, leaving the placenta in situ. The left uterus and cervix remained quiescent for a further 24 h before contractions returned, resulting in emergency caesarean section, with the successful delivery of the second twin. As a rare phenomenon, there is sparse literature on the management of dicavitary twin gestation in uterine didelphys. This case report adds to the evidence for independent functioning of uteri and cervices in cases of uterine didelphys which may enable interval delivery delay in this cohort with known increased risk of preterm birth.
双子宫是一种罕见的先天性子宫畸形，由胚胎发育过程中副中肾管不完全融合所致。我们报告一例27岁经产妇，已知为双子宫，因促排卵出现双腔双绒毛膜双羊膜囊双胎妊娠。妊娠29 + 5周时，患者发生胎膜早破，随后仅右侧子宫出现先兆早产，经宫缩抑制剂治疗后缓解。妊娠又持续了9天，此时子宫收缩恢复，右侧宫颈完全扩张，成功经阴道分娩出第一个胎儿，胎盘未娩出。左侧子宫和宫颈在又平静了24小时后出现宫缩，行急诊剖宫产，成功娩出第二个胎儿。作为一种罕见现象，关于双子宫双腔双胎妊娠管理的文献较少。本病例报告为双子宫病例中子宫和宫颈独立功能的证据增添了内容，这可能使该早产风险已知增加的队列能够延迟间隔分娩。
