Uterus Didelphys or Double Womb

Recently a young Asian woman, 30 years of age and who had been for 9 years presented to ‘Conceive Hospital’ with a history of being unable to conceive a pregnancy for the 5 years she and her husband had been trying. Her gynaecological history included that of 2 miscarriages both of which occurred at just 3 months into the pregnancy.

She has undergone several investigations in her country of origin and had been diagnosed with a Bicornuate uterus or a womb with 2 horns.  Her hysterosalpingography (camera test of the womb) showed a single womb with a one-sided tubal block (these tubes carry the egg from the ovary to the uterus).

On examination of the patient, we found that she had a double vagina and double cervix (mouth of uterus) as well.  Strangely, one of the two vaginas had adequate space  (which was used for intercourse) while the other vagina had its hymen intact.

Her ultrasound scan confirmed the presence of double wombs.  Both ovaries were seen.

A hysteroscopy was performed and the video link is footage from her hysteroscopy showing clearly the presence of the 2 vaginas and 2 wombs.

The vaginal partition is clearly seen.  We had to introduce a Hysteroscope separately into the 2 wombs.  Some small polyps (growth from lining of uterus) were removed.  One opening of each fallopian tube was found in each cavity.

Incidence of this condition : 1 in 2000 women.

Uterus Didelphys :  It is a malformation of the womb where the womb is present as a paired organ – double womb with 2 separate cervix (mouth of womb)  and often a double vagina as well.

How does it occur?

In people with this condition, somewhere in the developmental process as a foetus the fallopian tubes did not come together resulting in formation of a double womb.

Most women aren’t even aware they have the condition until they become pregnant and get an ultrasound scan done. If she gets an ultrasound about eight weeks into her pregnancy, chances are the ultrasound technician would spot the extra womb.  But if the woman does not get an ultrasound until 20 weeks or more, the womb housing the fetus might have grown big enough to overshadow the extra womb in which case the ultrasound technician might not seen it.

Where do these double wombs sit in the body and what do they look like?

It is quite interesting to note that they are in the same place that a single womb would be – in the pelvis right behind the bladder and anterior (in front) of the rectum.  Assuming the woman is not pregnant, the twin wombs take up about as much space as a single uterus, which is about the size of a pear.  Together they resemble a valentine’s heart, each having a round top and a tapered bottom.

Babies coming from different wombs in the same mother are delivered at the same time as both the wombs go into labor at the same time.

Some of the symptoms of double wombs include:

1. Unusual pressure or cramping pain before or during a menstrual period.
2. Abnormal bleeding during a period, such as blood flow despite the use of a tampon.
3. This condition may be associated with kidney abnormalities, which suggests that something may influence the development of these related structures before birth.

Diagnosis:  

A double uterus may be diagnosed during a routine pelvic exam when your doctor observes a double cervix or feels an abnormally shaped uterus.

The following diagnostics tests are used to detect Uterus Didelphys:

1. Ultrasound.
2. Sonohysterogram.
3. Magnetic Resonance Imaging (MRI)
4. Hysterosalpingography.
5. 3-D Ultrasound sonography has been found to be very useful.

Management:

1. Surgery to unite a double uterus is rarely done  – although surgery may help you sustain a pregnancy if you have a partial division within your uterus and no other medical explanation for a previous pregnancy loss.
2. Patient with double womb may need special attention during pregnancy as premature birth is common. Cesarean section may be required in management of these patients during delivery.