A RARE CASE OF TWIN PREGNANCY IN BICORNUATE UTERUS

DR.S.Manikya rao,M.D,LLB,FICOG,FIAOG,Professor of obstetrics

and gynecology

Dr.C.Suneetha,M.D,Assistant Professor of obstetrics and

gynecology

Dr.B.Devi priya,PG,Dept of OBG,GGH,KURNOOL.

This is an interesting case of twin pregnancy in bicornuate uterus of term gestation with one twin
located in each horn of uterus and pregnancy conceived spontaneously.

CASE HISTORY

A 23 year old G3P1L1A1 , known case of bicornuate uterus with twins of term gestation, previous
normal vaginal delivery and spontaneous abortion presented to delivery room complaining of pain
abdomen. On general examination no abnormality was detected.

Per abdomen: USG findings:

Per
speculum shows single cervix and single vagina. MRI was not done.

Operative findings:

Uterus is bicornuate unicollis with well developed right and left horns. Both fallopian tubes and
ovaries are normal. Incision is given on the anterior wall of uterus, twin A of birth weight 3.3 kg is
delivered by vertex presentation from right horn of uterus, incision is extended laterally towards left
side and twin B of birth weight 2.9 kg in left horn of the uterus delivered by breech extraction Both
twins have APGAR of 8-10. Two placenta are present separately in both horns and it is diamniotic
and dichorionic. No communication is found between them.
 TWIN A in right horn of uterus
DISCUSSION : Bicornuate uterus results
from incomplete fusion of two uterine horns
(Müllerian tubes) leading to varying degrees of
separation between the cavities. Complete
bicornuate uterus has two separate uterine
cavities without any communication. Uterine
anomalies have been associated with an
increased incidence of spontaneous abortion,
malpresentation, placental abruption, preterm
Mode of delivery could be abdominal or
vaginal which is supported by previous vaginal
delivery. In our case, there was no sign of
spontaneous labour at 38 weeks gestation. We
delivered twins by abdominal delivery as
dystocia, malpresentations and possible risk of
uterine rupture are major handicaps to avoid in
vaginal delivery.
TWIN B in left horn of uterus with
cord in right horn in situ
delivery, intrauterine growth restriction, and
the need for operative delivery. There are no
guidelines about the follow up of pregnancy or
selecting the mode of delivery,because the
incidence is very low. To date there are only
12 reported cases of twin pregnancy in
bicornuate uterus.
CONCLUSION: Pregnancies of women with
Müllerian anomalies have some potential
obstetric complications. The management of
twin pregnancy in uterus bicornis should be
individualized because of the possible risk and
the rare occurrence of these cases.
REFERENCES:

[1] A. L. Stein and C. M. March, “Pregnancy outcome in women with mullerian duct anomalies,” ¨
The Journal of Reproductive Medicine, vol. 35, pp. 411–415, 1990.

[2]M. Arora, N. Gupta, N. Neelam, and S. Jindal, “Unique case of successful twin pregnancy after
spontaneous conception in a patient with uterus bicornis unicollis,” Archives of Gynecology and
Obstetrics, vol. 276, no. 2, pp. 193–195, 2007.