Uterus didelphys is a rare congenital condition in which a person is born with two uteruses, or a double uterus. The abnormal anatomy can be a cause of symptoms such as painful menstruation and exacerbation of pregnancy complications. There are instances where surgery can be done, but in most instances, treatment is not required.

Knowledge of the aetiology, signs, and risk factors of uterus didelphys is necessary for early diagnosis and proper long-term treatment. Moreover, if you are a NEET PG medical student, it is essential to study this disorder to increase your clinical skills and offer better patient care.

Keep reading for a detailed insight into uterus didelphys.

What is Uterus Didelphys?

Uterus didelphys (uterine didelphys) is a prenatal congenital condition where a female is born with two distinct uterine compartments rather than one. During the typical development of a female fetus, two narrow tubes known as Müllerian ducts (which later form the uterus, fallopian tubes, cervix, and upper portion of the vagina) are meant to fuse into a single uterus. 

However, in cases where the ducts fail to merge completely, they may each evolve into distinct uterine structures, resulting in a double uterus. In others, the individual with uterine didelphys will also possess two cervixes (the lower segment of the uterus that opens into the vagina) and even two vaginal canals. 

Vagina is a muscular tube connecting the external genitalia with the cervix, and in this instance, it can be duplicated along with the uterus.

What are the Causes of Uterine Didelphys?

Sexual and reproductive organs begin developing during weeks 6 to 22 of fetal growth. A double uterus develops when Müllerian ducts do not fuse; hence, two distinct uterine cavities are produced. 

While the precise reason for this non-fusion is not known, it is speculated that there must be some genetic factors involved. The abnormality at times may be associated with other congenital malformations or uncommon syndromes such as:

• Herlyn-Werner-Wunderlich Syndrome: A rare Müllerian anomaly that can block one side of a double vagina and cause pelvic pain.
• Cervical Agenesis: Inability of the cervix to develop at birth.
• Renal Anomalies: This involves being born with one small or absent kidney.
• Congenital Vesicovaginal Fistula: A rare defect where a connection forms between the bladder and vagina, leading to continuous urine leakage.
• Bladder Exstrophy: A critical defect in which the bladder grows outside of the body during gestation.
• Vaginal Agenesis: This is when you’re born without a vagina.

Even with these disorders, the aetiology of uterine didelphys is unknown in most cases.

What are the Risk Factors of Uterine Didelphys?

The etiologic risk factors in the pathogenesis of a double uterus are unknown because, first and foremost, the disease is rare and not correctly diagnosed. However, genetics is suspected to play a role, particularly since uterine abnormalities sometimes run in families. Beyond genetic predisposition, other contributing factors remain uncertain.

What are the Symptoms of Uterus Didelphys?

Many people who have this condition are unaware, since uterus didelphys can develop without any outward symptoms. It is frequently found incidentally during routine gynaecological examination or when an individual comes in for medical consultation because of complaints such as frequent miscarriage or severe cramping with menstruation.

However, if symptoms are present, they may include:

• Discomfort or pain during sexual intercourse
• Menstrual bloating or cramping, particularly around or during menstruation
• Heavy bleeding or profuse bleeding during menstruation
• Bleeding while using a tampon (since the tampon blocks only one of the vaginal canals)
• History of repeated miscarriages
• Premature labour or complications in pregnancy

What is the Diagnosis of Uterine Didelphys?

Uterine didelphys is also often detected during a pelvic examination, commonly at times such as Pap smear examination, or any other evaluation of menstrual irregularities or fertility difficulties. 

A doctor may suggest further diagnostic procedures to verify the condition in case he or she notices abnormal anatomy. Diagnostic tests employed are as follows:

• Magnetic Resonance Imaging (MRI): This is a type of imaging that is done using magnetic fields and radio waves, focusing on giving detailed images of the inner reproductive organs. It assists in the evaluation of the existence and morphology of the double uterus.
• Hysterosalpingography (HSG): A contrast dye is injected into the uterus via the cervix, and X-rays are taken. This assists in imagining the contour of the uterus and fallopian tubes and detecting any defects or anatomical duplications.
• Ultrasound (Sonography): Real-time imaging of the inner organs is made by the application of high frequency sound waves by use of ultrasound. Ultrasound, either abdominal or transvaginal, may be carried out to see the structure of the uterus.
• Sonohysterogram: The ultrasound examination includes the introduction of contrast medium or saline through the cervix into the uterus. An ultrasound machine is used for accurate imaging, which facilitates the making of decisions regarding the inner structure and form of the uterus more accurately.

What is the Treatment for Uterine Didelphys?

Symptomatic patients or those with complications may need treatment. But if the patient with uterus didelphys experiences recurrent pregnancy loss without a clear cause, they may opt for treatment such as corrective surgery.

Treatment may be geared to optimising fertility and ensuring a healthier pregnancy. This may involve additional testing and close supervision during pregnancy of the developing fetus.

FAQs about Uterine Didelphys

1. Is uterus didelphys hereditary?

Genetics might be involved, as uterus didelphys is a rare condition that has sometimes been seen to run in families.

2. How does uterus didelphys impact menstruation?

Uterus didelphys is a not very common birth defect where an individual is born with two uteruses. Also referred to as a double uterus, it can lead to menstrual cramps and pregnancy issues.

3. Can you have a normal delivery with a uterus didelphys?

The outcome of pregnancy in a uterus didelphys is around 57%, and the fetal outcome is around 64%. Commonly referred to as a double uterus, it may lead to menstrual pain and pregnancy complications. Some people opt for surgery, but most don’t need treatment unless symptoms arise.

4. What are the complications of uterus didelphys?

The success rate for pregnancy with a uterus didelphys is around 57%, while fetal survival is about 64%. There is no standard rule for delivery. Both natural and cesarean births have been reported in previous research.

5. Can you have twins with a uterus didelphys?

It is extremely rare to give birth to twins with a double uterus, which is further associated with some pregnancy problems. Although a cesarean is not always required, the condition might raise the risk of one.

Conclusion

Uterus didelphys is a fetal congenital abnormality. In case one is pregnant or intends to get pregnant, it is always necessary to see a doctor to have a safe and healthy pregnancy experience. While some individuals may need medical intervention, many people with a double uterus experience successful pregnancies without complications.

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