Cervical Cancer Prevention and Training Centre, Catholic Hospital, Battor, Ghana.
Department of Obstetrics and Gynecology, Catholic Hospital, Battor, Ghana.
Pan Afr Med J. 2023 Apr 28;44:205. doi: 10.11604/pamj.2023.44.205.39546. eCollection 2023.
Uterus didelphys is a congenital anomaly of the female reproductive tract which arises from the abnormal fusion of the Mullerian ducts. We present, the first case to the best of our knowledge, of uterus didelphys with a unicavitary twin gestation to be documented in Ghana, a low-middle income country. A 24-year-old woman, gravida 3, para 0+2 miscarriages, was seen and admitted to our maternity ward due to elevated blood pressure with ++ proteinuria at 36 weeks of gestation. She attended an antenatal clinic regularly during the pregnancy but was mainly seen by midwives. Apart from multiple pregnancy, two 2D ultrasound examinations (one at 25 weeks gestation and another during admission) did not reveal any uterine malformations. At 37 weeks+2 days, she underwent emergency cesarean section on account of pre-eclampsia and a twin pregnancy with the leading twin in breech presentation. After delivering both babies and the placenta, the uterus was exteriorized and inspected, during which a non-gravid bulky left uterus was first found. Each uterus had a normal ovary and fallopian tube on its lateral end. Further postoperative examination revealed a normal-looking vulva, two vaginas, and two cervices. Both babies weighed 1.9 kg, each below the fifth percentile of weight for age. The elevated blood settled postoperatively and the postoperative period was uneventful. The patient and twins were found in a stable condition on review two weeks after delivery and the twins were healthy at 5 years. Despite being a rare presentation, we wish to create awareness among health workers in rural and low-resource settings of such cases and highlight the need to improve prenatal diagnostic capabilities, as this is key to determining the mode of delivery and achieving favorable maternal and fetal outcomes.
双子宫是一种女性生殖道的先天性异常，由苗勒管的异常融合引起。我们报告了加纳首例已知的双子宫单腔双胎妊娠病例，加纳是一个中低收入国家。一名 24 岁的妇女，妊娠 3 次，流产 0+2 次，因 36 周妊娠时血压升高和++蛋白尿而被收入我院产科病房。她在怀孕期间定期到产前门诊就诊，但主要由助产士接诊。除了多胎妊娠外，两次二维超声检查（一次在 25 周妊娠时，另一次在入院时）均未显示任何子宫畸形。在 37 周+2 天时，她因子痫前期和双胎妊娠（头位胎儿先露）而行急诊剖宫产。分娩两个婴儿和胎盘后，子宫被引出并进行检查，在此期间首先发现左侧非妊娠的大子宫。每个子宫的外侧均有一个正常的卵巢和输卵管。进一步的术后检查显示外阴正常，有两个阴道和两个宫颈。两个婴儿的体重均为 1.9 公斤，均低于年龄的第五百分位体重。术后血压下降，术后期间无异常。分娩后两周复查时，患者和双胞胎情况稳定，双胞胎在 5 岁时健康状况良好。尽管这种情况罕见，但我们希望引起农村和资源匮乏地区卫生工作者对这类病例的认识，并强调需要提高产前诊断能力，因为这是确定分娩方式和实现母婴良好结局的关键。
