Uterine Didelphys

Her name is Camella. I first met her in the Kudjip Emergency Room. She appeared to have an acute abdomen and was showing signs of shock with a blood pressure of 80/40 and a pulse of 118. She reported five days of pain but was now feeling weak. She also reported she was seven months pregnant with her first child. She is age 19.

A quick look with the portable ultrasound revealed an abdomen full of fluid and what seemed to be an extra (outside the) uterine pregnancy. The baby was moving, but had a heart rate of only 80. It looked to be 27 weeks and the fetal heart rate should have been about 150. A STAT CBC was requested along with a type and crossmatch for four units of blood. IV’s were started and oxygen was given. Her legs were elevated and she was prepped for an emergency laparotomy. The hemoglobin came back as 9.6, but she looked much worse!

Camella was taken to surgery and was found to be swimming in blood. I estimated blood loss of 2200 cc. She was given three units during surgery. Her uterus was ruptured and the baby had been expelled into the abdomen. The baby was dead at delivery; 27 weeks is beyond the abilities of our nursery for salvage, anyway.

On careful exam, Camella was found to have a complete uterine didelphys, or duplicate female system. I suspect she lacked adequate uterine muscle to carry her pregnancy to term and her cervix as too long to expect a vaginal delivery. Please see my drawing to explain her anatomy.

I have come across this several other times, but most go undiagnosed and deliver naturally without complication. This situation will often result in malpresentation and breech delivery and has a much greater likelihood of cesarean birth or complications similar to what Camella had.

At surgery, the pregnancy had been in the left uterus and the fundus had been pretty much destroyed. I chose to remove the left side. This should leave the right side to function in the future, though she will be at a great risk for a repeat performance. I made a nice diagram to place in her medical record and I instructed her to seek a physician’s help early on and plan on a cesarean delivery next time. She was also instructed not to allow herself to labor the next time around.

I am very thankful to have an ultrasound (Thanks to the generosity of many.) to evaluate the problem and a good lab to get the blood ready so quickly.

Camella was able to go home in four days and although she lost this baby, she is still alive and able to try for a second pregnancy. I pray everything will work out for her in the future.

Lukim yu bihain

Dr. P

ps.  Pray for Camella.