Didelphys Uterus - Causes, Symptoms, and Treatment

What Is Didelphys Uterus?

Uterus didelphys is a congenital anomaly of the womb, affecting 0.03-0.1 percent of the population. It is a less common malformation of the uterus when compared to other malformations, such as the septate uterus or bicornuate uterus. Didelphys uterus is also known as a double uterus. The uterus is part of the female reproductive system, which is a pear-shaped organ and hollow where the development and growth of an unborn baby happens. People with didelphys uterus have two separate uteruses and two cervices (the lower end of the uterus connecting the vagina). People with didelphys uterus might also have a longitudinal vaginal septum (a tissue dividing the vagina into two sections and two openings). This condition is called a double vagina.

What Is the Cause of Uterus Didelphys?

Doctors are not certain about the development of a double uterus in some fetuses. It is considered that a genetic component may be a factor for didelphys uterus because this condition sometimes runs in families. It can also happen when the fetus is in the mother’s womb. When babies develop in the uterus, two separate tubes known as the Mullerian ducts fuse together to form the uterus. If there is any disruption in the formation, it can lead to female reproductive system abnormalities called Mullerian duct anomalies. Uterus didelphys is also a Mullerian duct anomaly that occurs when the tubes remain separate and do not fuse at all. This can result in two separate uteruses. It is observed that babies growing with only one kidney can have a malformation of reproductive organs. Uterine didelphys is seen linked with some rare conditions and other irregularities, including

• Cervical agenesis is a condition without a cervix.

• Herlyn-Werner-Wunderlich syndrome is a rare Mullerian duct anomaly causing one side of a double vagina to block pelvic pain.

• Small kidneys.

• Congenital vesicovaginal fistula, causing a hole between the bladder and the vagina that causes leaking urine.

• Vaginal agenesis, absence of the vagina.

What Are the Symptoms of Didelphys Uterus?

Most people with a didelphys uterus do not experience any symptoms, and it is only found during a pelvic examination or during ultrasound testing for other diseases. One main symptom is uncontrollable bleeding during menstruation when using a tampon. This is a common vaginal septum; it can be thin and flexible or thick and rigid. So the bleeding occurs when the tampon is inserted in one vagina, and the bleeding comes out from the other uterus and vagina. ‌The other symptoms of didelphys uterus include

• Pain before and after periods.

• Pain during intercourse.

• Frequent miscarriage.

• Early labor.

• Severe abdominal cramps before and after the periods.

• Heavy bleeding during menstruation.

How Does Didelphys Uterus Affect Pregnancy?

Didelphys uterus normally does not affect the ability to become pregnant. However, it can cause some complications like preterm labor (labor occurring before 37 weeks of pregnancy) and an increased risk of miscarriages. The healthcare provider will monitor both the mother and the baby with frequent tests and scans to avoid these complications. Uterus didelphys have a high chance of causing a breach position in the fetus, which is not ideal for vaginal delivery. So, cesarean sections are recommended for 80 percent of cases. It can also cause restrictions in the baby's growth, leading to low birth weight.

What Are the Diagnostic Methods Used for Diagnosing Didelphys Uterus?

During a routine pelvic examination, the healthcare provider may identify abnormalities such as a didelphys uterus and a double vagina. To confirm the diagnosis, additional tests will be required that may include:

• Ultrasonography - Normally, ultrasound will be the first imaging test the doctors will use to check the uterus. High-frequency sound waves are used to create images of the inner body organs, but this test may not be helpful in telling the difference between certain conditions. In such cases, a 3D ultrasound helps in providing more detailed information.

• Hysterosalpingography (HSG) - During this test, the health care provider will inject a specialized dye into the uterus through the cervix. X-rays are then taken that provide images of the size and shape of the uterus and the structure of the fallopian tubes. This can be very helpful, but in some cases, additional tests will be required to check the outer shape of the uterus.

• Magnetic Resonance Imaging (MRI) - The MRI machine is a tunnel-like machine that has both ends open. A patient is made to lie down on a movable table that slides into the tunnel opening. This procedure is painless and uses radio waves and magnetic waves to create cross-sectional images of the organs of the body.

• Sonohysterogram - During this procedure, fluid is injected into the uterus through the vagina and the cervix. Then ultrasound is performed to check the problems and the shape of the uterus. This test is more effective than a regular ultrasound.

What Is the Treatment for Didelphys Uterus?

If a person has a double uterus but does not have signs or symptoms, then treatment is rarely needed. Most people with a didelphys uterus do not need surgery to correct the shape of the uterus. But in case of recurrent pregnancy loss, a procedure known as Strassman metroplasty may be performed, which joins the divided uteruses to make one single uterus. If a person becomes pregnant with a didelphys uterus, the healthcare provider will closely monitor the pregnancy with frequent tests and scans to provide the best chance at a healthy pregnancy. In case of vaginal septum causes painful periods and pain during sex, the healthcare provider may suggest surgery to remove the wall of tissue dividing the two vaginas. This septum removal will make childbirth a little easier, depending on the thickness of the tissue.

What Are the Complications of Didelphys Uterus?

Didelphys does not affect the ability to get pregnant, but it can cause many complications during pregnancy. The complications caused due to didelphys uterus include

• Early labor.

• Breech position of the baby leading to C-section.

• Vaginal tissue tears between the two vaginas during labor.

• Frequent miscarriage.

• Intrauterine growth restrictions.

• Low-weight babies.

• Problems with kidney.

Conclusion -

Didelphys uterus is a congenital malformation of the uterus. The actual cause is not clearly known; it can be due to the underdevelopment of the Mullerian ducts; genetics also plays a role in the malformation of the uterus. Most people do not experience any symptoms, but painful menstruation and pain during sex are reported in some people. If there are no signs, then the treatment is not necessary; if there are symptoms consulting a doctor will be needed for adequate treatment.