Materiały źródłowe

• #1 Bicornuate uterus, double uterus or uterus didelphys: what is it? How can it affect fertility and pregnancy?

  https://www.institutobernabeu.com/en/blog/bicornuate-uterus-double-uterus-or-uterus-didelphys-what-is-it-how-can-it-affect-fertility-and-pregnancy/

  A so-called double uterus or uterus didelphys is currently known as a complete bicornuate uterus based on the most recent categorisation developed by the European Society of Human Reproduction and Embryology (ESHRE) in 2013. It is produced by a defect in the fusion of the paramesonephric ducts. According to the ESHRE nomenclature, it is a Class U2b and anomalies in the cervix can also be present. There may be a double cervix or double vagina and a longitudinal septum separating them in two. […] During pregnancy, patients with a bicornuate uterus are at a greater risk of pregnancy loss in the first and second terms, premature birth, a low weight at birth and an abnormal position of the foetus. Therefore, strict controls during pregnancy, particularly of the length of the cervical canal, are required in order to avoid the birth of a premature child.

• #2 Successful Vaginal Delivery of Naturally Conceived Dicavitary Twin in Didelphys Uterus: A Rare Reported Case

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5591991/

  Didelphys uterus, or double uterus, is an embryological developmental malformation of the mllerian ducts with the incidence of approximately 8.3% of all mllerian duct abnormalities (MDAs). […] Natural twin conception in each cavity of didelphys uterus is a very rare entity and only a handful of cases are reported in the literature to date. […] The overall incidence of dicavitary twin gestation (ART/Natural conception) in uterus didelphys has been reported approximately 1 in 1,000,000. […] Didelphys uterus is associated with varieties of obstetric complications including early and late miscarriages, malpresentation, intrauterine growth restriction, preterm delivery, and preterm rupture of membrane. […] Cervical incompetence is not commonly occurred with didelphys uterus so cervical cerclage is not routinely recommended unless there is an evidence of cervical incompetence or dilation either by clinical examination or ultrasonography during early second trimester.

• #3 Uterus Didelphys: Causes, Symptoms, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/diseases/23301-uterus-didelphys

  You cant prevent uterus didelphys because its congenital, which means it formed during development in the womb. Healthcare providers do not know why uterine abnormalities happen or if its hereditary. […] Uterus didelphys is a condition that happens before youre born and isnt caused by anything you did wrong. If youre pregnant or wish to become pregnant, talk to your healthcare provider about your condition to make sure you can have a safe pregnancy. They may recommend treating your double uterus. Many people with this condition have healthy pregnancies and babies.

• #4 Uterus Didelphys: What Are the Causes and Right Treatments?

  https://www.toplinemd.com/doral-beach-gynecology/uterus-didelphys-what-are-the-causes-and-right-treatments/

  Prevention of the “two vaginas” condition is not possible because it is congenital and it occurs during the development of the baby in utero. It is still unknown whether these characteristics are ancestral and why they happen. […] Many experts and healthcare professionals advise not treating uterus didelphys if no symptoms occur. The surgery carries its risks and can have a significant effect on the strength and functionality of your repaired uterus. […] So, to summarize, uterine didelphys is a condition that might be risky and cause issues during pregnancies, but it is not a rule. Many women have stable pregnancies and complication-free labor with healthy babies even though they suffer from this condition.

• #5 Bicornuate Uterus (Double Uterus): Symptoms & Treatment

  https://my.clevelandclinic.org/health/diseases/22798-bicornuate-uterus

  There is nothing you can do to prevent a heart-shaped uterus. Its a condition that is present at birth and was not caused by anything your parents did or didnt do. […] If treatment for a bicornuate uterus is recommended, your healthcare provider will explain the procedure, its risks and your chances of having a successful pregnancy.

• #6 Uterus Didelphys: Causes, Signs, Pregnancy, Treatments | RoRoRo

  https://ro.co/fertility/uterus-didelphys/

  Most people have two eyes, two ears, two legs, and two arms—but two uteruses? If you have uterus didelphys, you know that can happen, but most people haven’t heard of this condition. If you were born with two uteruses, you likely have some concerns about how that might impact your ability to start a family. […] Fortunately, treatment is available that can help make sex easier (and more enjoyable!), and your healthcare provider can help you have a healthy pregnancy. […] Uterus didelphys (also called double uterus) is a rare congenital uterine anomaly, meaning your uterus didn’t properly develop before you were born. […] Finding out you have this condition can come as a shock, but if you have it, it’s something you’ve had your whole life, and there was nothing you could have done to prevent it.

• #7 Uterus Didelphys: Causes, Symptoms, Diagnosis & Treatment

  https://risaaivf.com/uterus-didelphys-causes-symptoms-diagnosis-treatment/

  Uterus Didelphys is a rare condition where a woman is born with two uteruses instead of one. […] Since this condition forms before birth, there are no known ways to prevent it. However, early diagnosis can help in managing any related symptoms or complications. […] Its essential to consult with your doctor to determine the most appropriate treatment plan based on individual circumstances.

• #8 Double Uterus – Causes, Symptoms, Diagnosis, and Treatment

  https://www.apollohospitals.com/diseases-and-conditions/double-uterus

  While there is no guaranteed way to prevent a double uterus, certain strategies may help reduce the risk of complications: […] Regular Check-Ups: Routine gynecological exams can help monitor reproductive health. […] Vaccinations: Vaccines, such as the HPV vaccine, can prevent infections that may impact reproductive health. […] Hygiene Practices: Maintaining good hygiene can reduce the risk of infections. […] Healthy Lifestyle: A balanced diet, regular exercise, and avoiding smoking can support overall reproductive health.

• #9 Painful Periods and a Double Uterus: A Teen’s Struggle With Mullerian Anomalies > News > Yale Medicine

  https://www.yalemedicine.org/news/mullerian-anomalies-ohvira

  At her first appointment with Dr. Vash-Margita, Emily was told she had a complex condition called OHVIRA (Obstructed Hemi-Vagina with Ipsilateral Renal Agenesis). OHVIRA is a congenital, or present at birth, condition; it occurs when a girl has a double uterus, a missing kidney, and a wall of tissue that divides the vagina. […] However, if Emily had been diagnosed with OHVIRA earlier, she could have been spared the pain and psychological distress she endured once her period started. […] There is a push now in my subspecialty to work with nephrologists and urologists to remind them that if they see a girl with a single kidney, they should perform a pelvic ultrasound to see if she has a normal uterus, Dr. Vash-Margita says. Its not going to change what she has, but instead of developing this collection of blood and being in severe pain after menses onset, we can know ahead of time that this might happen and take steps to treat it.

• #10 Double uterus in young women delivered by Caesarean Section: five cases from South Sudan and Ethiopia

  http://www.southsudanmedicaljournal.com/archive/february-2022/double-uterus-in-young-women-delivered-by-caesarean-section-five-cases-from-south-sudan-and-ethiopia.html

  Didelphic or double uterus as one of the rare congenital anomalies of the female genital tract is associated with some Wolffian duct malformations and therefore should be suspected and investigated in young patients who present with primary amenorrhoea secondary to menstrual outflow obstruction or in a patient diagnosed with vaginal septum, unilateral renal agenesis or in a patient for which two cervices visualized on speculum examination. Investigations include pelvic ultrasonography, hysteroscopy and MRI. […] Although infertility and poor pregnancy outcomes have been reported in association with double uterus, many cases have been reported to have successful pregnancy outcomes with no history of fertility impairment. […] Unless indicated, uterus didelphys by itself is not an indication for Caesarean delivery, although its presence increases rates of Caesarean Section. All five cases we report underwent Caesarean Section as indicated by obstetric complications (placenta praevia for the 1st case and malpresentation associated with labour dystocia and with footling breech in the 3rd and 4th cases respectively), transverse lie associated with low lying placenta in the 5th case and presence of thick inelastic vaginal septum for the 2nd case. […] The presence of uterus didelphys does not commonly affect fertility rate. However, it does increase pregnancy complications such as preterm delivery, fetal malpresentation and placenta praevia, which in turn increase rates of Caesarean Section delivery.

• #11 Double Uterus: Symptoms, Pregnancy, Treatment, and More

  https://www.healthline.com/health/double-uterus

  Having a double uterus doesn’t usually cause a woman any problems for actually getting pregnant. […] If you’ve had recurrent miscarriages, you may be offered surgery, which can increase your chances of carrying to term. […] Women with a double uterus generally have smaller uteri, which can lead to preterm labor. […] If you have a double uterus and are pregnant, your doctors will want to monitor your pregnancy very closely to ensure that all is well with your baby. […] There is an increased risk of miscarriage, poor growth in the womb, and prematurity. Research shows that the chances of having a premature birth increase by up to 45 percent for women with a double uterus.

• #12 Uterus didelphys (double uterus): Symptoms and more

  https://www.medicalnewstoday.com/articles/uterus-didelphys

  Uterus didelphys, or double uterus, is a rare condition where a person is born with two uteruses. It can affect menstruation and pregnancy. In some cases, it may require surgery. […] Researchers associate the condition with pregnancy issues. These can include preterm labor, pregnancy loss, and other pregnancy complications. […] Treatment often focuses on improving fertility and improving pregnancy outcomes for the person. This can include additional testing and monitoring of the fetus development in utero. […] Once doctors identify uterus didelphys, they can focus on helping keep a person pregnant and prevent pregnancy loss. […] Uterus didelphys can negatively affect pregnancy outcomes. However, some people with a double uterus can carry a pregnancy to full term with no issues. […] A person experiencing issues during pregnancy should consider working with a doctor to help ensure a successful term.

• #13 Successful Vaginal Delivery of Naturally Conceived Dicavitary Twin in Didelphys Uterus: A Rare Reported Case

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5591991/

  The overall obstetric outcome of uterus didelphys is poor but still better than the other MDAs like the septate or bicornuate uterus. […] The successful pregnancy rate with didelphys uterus is 57%, and the fetal survival rate is documented around 64%. […] If both fetal presentations are cephalic and there are no other associated risk factors, then vaginal delivery can be considered as the mode of delivery. […] The early detection of this anomaly of the uterus and accompanying pregnancy by ultrasonography is of great value. Close monitoring of fetal growth, biophysical profile, and the cervical condition is recommended throughout the pregnancy.

• #14 Successful Vaginal Delivery of Naturally Conceived Dicavitary Twin in Didelphys Uterus: A Rare Reported Case

  https://pmc.ncbi.nlm.nih.gov/articles/PMC5591991/

  Didelphys uterus, or double uterus, is an embryological developmental malformation of the mllerian ducts with the incidence of approximately 8.3% of all mllerian duct abnormalities (MDAs). […] Natural twin conception in each cavity of didelphys uterus is a very rare entity and only a handful of cases are reported in the literature to date. […] The overall incidence of dicavitary twin gestation (ART/Natural conception) in uterus didelphys has been reported approximately 1 in 1,000,000. […] Didelphys uterus is associated with varieties of obstetric complications including early and late miscarriages, malpresentation, intrauterine growth restriction, preterm delivery, and preterm rupture of membrane. […] Cervical incompetence is not commonly occurred with didelphys uterus so cervical cerclage is not routinely recommended unless there is an evidence of cervical incompetence or dilation either by clinical examination or ultrasonography during early second trimester.

• #15 Postpartum Hemorrhage: Prevention and Treatment | AAFP

  https://www.aafp.org/pubs/afp/issues/2017/0401/p442.html

  The most effective strategy to prevent postpartum hemorrhage is active management of the third stage of labor (AMTSL). AMTSL also reduces the risk of a postpartum maternal hemoglobin level lower than 9 g per dL (90 g per L) and the need for manual removal of the placenta. Components of this practice include: (1) administering oxytocin (Pitocin) with or soon after the delivery of the anterior shoulder; (2) controlled cord traction (Brandt-Andrews maneuver) to deliver the placenta; and (3) uterine massage after delivery of the placenta. […] The individual components of AMTSL have been evaluated and compared. Based on existing evidence, the most important component is administration of a uterotonic drug, preferably oxytocin. […] An alternative to oxytocin is misoprostol (Cytotec), an inexpensive medication that does not require injection and is more effective than placebo in preventing postpartum hemorrhage. […] The benefits of controlled cord traction and uterine massage in preventing postpartum hemorrhage are less clear, but these strategies may be helpful.

• #16

  https://www.amerikanhastanesi.org/mayo-clinic-care-network/mayo-clinic-health-information-library/diseases-conditions/double-uterus

  Double uterus Last Updated on July 25, 2024 Overview A double uterus is a rare condition that is present at birth in some women. […] Women who have a double uterus often have successful pregnancies. But the condition can make you more likely to have a miscarriage or premature birth. […] Treatment often isn’t needed for a double uterus if you have no symptoms or other problems. Surgery to join a double uterus isn’t usually done. […] But sometimes surgery can help. If the uterus is partially divided, and you’ve had a pregnancy loss with no other medical explanation for the loss, your doctor might recommend surgery. This may help you keep a future pregnancy.

• #17 Uterus didelphys | Pathology Learning Centre

  https://health.uct.ac.za/pathology-learning-centre/disease-themes-when-things-go-wrong-congenital-anomalies/uterus-didelphys

  PREVENTION TREATMENT: In cases of uterus didelphys where there is hemi-vaginal obstruction, surgical correction of the septate vagina is indicated. […] Reconstructive surgery to unify the uterus (metroplasty) is controversial and seldom performed, but may benefit selected patients who have been unable to carry a pregnancy. […] Many obstetricians opt for caesarean section delivery in women with didelphys uterus.

• #18 Uterus Didelphys(Double Uterus): Causes and Symptoms

  https://www.prepladder.com/neet-pg-study-material/obstetrics-and-gynaecology/uterus-didelphysdouble-uterus-causes-symptoms-diagnosis-treatment-and-complications

  Double-uterine mothers often have successful pregnancies. However, the disease may increase your risk of miscarriage or early birth. […] If you don’t have any symptoms or other issues, treatment for a double uterus is frequently unnecessary. It is uncommon to have a double uterus surgically joined. […] But occasionally, surgery is beneficial. Your doctor may advise surgery if your uterus is partially divided and you’ve lost a pregnancy without a clear medical reason. You could keep a future pregnancy if you do this. […] Many women who have a second uterus have active sex lives. They might also experience regular pregnancies and successful births. However, occasionally having a second uterus along with other uterine conditions might result in: Infertility, Miscarriage, Premature Birth.

• #19 How Uterine Anomalies Can Affect Fertility – TRIO Fertility Treatment Practice

  https://triofertility.com/uterine-anomalies-affect-on-fertility/

  A didelphys uterus (also known as a double uterus) occurs when the uterus develops into two separate cavities. Each of these cavities may also have its own cervix and vaginal canal. Yet, they may share a cervix and vagina as well. While pregnancy is possible with a didelphys uterus, individuals might face increased risks of: […] Despite these challenges, many people with a double uterus go on to have successful pregnancies. […] Treatment options vary depending on the type of uterine anomaly and its impact on your fertility. Your fertility specialist will work with you to develop a personalized treatment plan. This may include: […] Surgical correction […] Specialized prenatal care […] Specialized monitoring during pregnancy.

• #20 Uterine Septum Treatment | Double Uterus Treatment | Dr Hayden Homer

  https://www.drhaydenhomer.com.au/fertility/uterine-septum/

  A uterine septum is a partition (or septum) that runs through the middle of the uterine cavity and is one form of double uterus. […] Septae have been strongly linked with an increased risk of adverse pregnancy outcome. One of the most common problems associated with septae is miscarriage. It is thought that this occurs when the embryo attempts to implant on the septum; because the septum does not have a good blood supply, this then compromises the supply of blood to the embryo causing it to miscarry. Other problems associated with the septum are fetal malpresentations during late pregnancy (e.g. breech presentation) and fetal growth restriction. […] The uterine septum can be resected by highly trained specialists using hysteroscopy. During this operation, either electricity delivered by a fine probe or a fine pair of operating scissors, is used to divide the septum. The resected septal edges then retract into the muscle of the womb thereby allowing the cavity to regain an almost normal volume and shape.

• #21 Uterus Didelphys: Causes, Signs, Pregnancy, Treatments | RoRoRo

  https://ro.co/fertility/uterus-didelphys/

  Having a didelphys uterus typically does not affect your ability to become pregnant, but it can cause some complications. […] Your healthcare provider will monitor you and give you all the support you need to try to avoid these complications. […] If you become pregnant, your healthcare provider will closely monitor your pregnancy with additional scans and tests to give you the best chance at a healthy pregnancy. […] Most people with a didelphys uterus will not require surgery to correct the uterine shape. However, if you’ve experienced recurrent pregnancy loss, a procedure called Strassman metroplasty may be recommended. […] Contact your healthcare provider if you experience any of the following symptoms: Chronic abdominal pain, Pain during sex, Painful periods, Repeated miscarriages. […] Discuss any symptoms and concerns with your healthcare provider. Together, you will develop a treatment plan that involves close monitoring if you become pregnant, offering you the best chance for a healthy pregnancy and baby.

• #22 Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development – the 2Close study: a multicentre randomised controlled trial | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2221-y

  Double-layer compared to single-layer closure of the uterus after a caesarean section (CS) leads to a thicker myometrial layer at the site of the CS scar, also called residual myometrium thickness (RMT). It possibly decreases the development of a niche, which is an interruption of the myometrium at the site of the uterine scar. Thin RMT and a niche are associated with gynaecological symptoms, obstetric complications in a subsequent pregnancy and delivery and possibly with subfertility. […] Given the higher risk on myometrium loss and thus development of a thinner residual myometrium after single-layer closure, we hypothesise that this method introduces a higher risk on postmenstrual spotting and possibly subfertility after a CS and that it can be prevented by applying double-layer unlocked closure.

• #23 Single- versus double-layer closure of the caesarean (uterine) scar in the prevention of gynaecological symptoms in relation to niche development – the 2Close study: a multicentre randomised controlled trial | BMC Pregnancy and Childbirth | Full Text

  https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-019-2221-y

  Double-layer unlocked closure is considered safe, without a clinically relevant higher risk on short-term outcomes. Moreover, it results in a thicker residual myometrium, especially when unlocked sutures are applied. […] We hypothesise that niche related postmenstrual spotting and fertility problems will reduce together with decrease in niche prevalence, in which identification of the best uterine closure technique regarding RMT and niche development will be of great significance. […] This study will gain insight in the most optimal uterine closure technique after CS which is relevant for women and gynaecologists, since we will focus on long-term gynaecological symptoms and reproductive outcomes in relation to changes of the lower uterine segment after CS and in particular niche development.

• #24 A Case Report on an 18-Year-Old Primigravida Patient With Uterine Didelphys | Narula | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/818/506

  We present a case of an 18-year-old primigravida who presented to labor and delivery at 41 weeks and 3 days, admitted for induction of labor at late term. […] Based on literature review, and in consideration of this case, we suggest if suspicion of a Mullerian anomaly in the antepartum period, a full evaluation of the anomaly be performed along with a plan for delivery. […] In analysis of the case, pathology reports, and further literature review, there are a few points we can consider for future pregnancy planning for women with uterine anatomical anomalies. We recommend discussing the routes of delivery as well as gestational age of delivery early in the antepartum period in patients with a Mullerian anomaly. Early planning would facilitate the proper resources to be available at the time of delivery to minimize possible maternal and fetal adverse outcomes.

• #25 A Case Report on an 18-Year-Old Primigravida Patient With Uterine Didelphys | Narula | Journal of Clinical Gynecology and Obstetrics

  https://jcgo.org/index.php/jcgo/article/view/818/506

  Based on literature review, the best long-term outcome in such uterine anomalies is achieved with an early diagnosis, complete evaluation, clear understanding of the anomaly, mobilization of appropriate surgical resources, sufficient preoperative counseling, and planned surgical intervention if necessary. […] In order to avoid emergency surgeries with less than ideal preparations, women with possible uterine anomalies detected at first trimester ultrasounds should be fully worked up, including: imaging such as an magnetic resonance imaging especially in indeterminate cases. Additionally, planning for delivery would allow for the appropriate resources to be available to facilitate a safe outcome for both mother and neonate. […] Full diagnosis and evaluation of the anomaly is necessary and important in order to plan for delivery appropriately.

• #26 Uterus Didelphys Care and Double Uterus Treatment in Madurai

  https://infertility-center-madurai.com/double-uterus/

  This minimally invasive procedure not only aids in addressing fertility challenges associated with double uterus but also holds the potential to enhance overall reproductive outcomes by optimizing the uterine structure. […] For women with uterus didelphys seeking to conceive, Guru Hospital offers comprehensive preconception counseling, fertility assessments, and individualized care plans.

• #27 Uterus Didelphys: Symptoms, Risks and Treatment | MyloFamily

  https://mylofamily.com/article/uterus-didelphys-understanding-symptoms-risks-and-treatment-options-231181?type=cold-cough-540&%3F-655125=&stage=pregnancy&srsltid=AfmBOoqbUX8S2sC2gYCjBzfVDWc7wK9CwUzIaSdAf2ApPUTnNaOSUNLm

  Uterus didelphys usually does not need any treatment as most patients are asymptomatic. Even in pregnancy, just monitoring is enough and most patients rarely ever required surgery. The choice of treatment depends on various factors, including the individual’s reproductive goals and any existing complications. […] Assisted reproductive technologies, such as in vitro fertilization (IVF), can be used to increase the chances of pregnancy in women with uterus didelphys. IVF involves the fertilization of eggs in a laboratory setting and the subsequent transfer of embryos into the uterus. […] Women with uterus didelphys require close monitoring throughout pregnancy to identify and manage any potential complications. This includes regular prenatal check-ups, ultrasounds, and other diagnostic tests to ensure the well-being of both the mother and the baby.

• #28 Double Uterus with Single Cervix: A Case Report

  https://brieflands.com/articles/amhsr-64494

  Congenital abnormalities of the uterus occur due to inappropriate formation, fusion, or absorption (resorption) of mullerian duct in uterus. […] Pregnancy in patients with congenital malformations of the genital tract is high risk and requires special attention. […] Twin pregnancy management in a bicornis unicollis uterus must be individualized with respect to the management of the delivery and pregnancy. These actions should be done until further reported experience clarifies the ideal management.

• #29 Three cases of didelphys uterus, including uterus didelphys with Obstructed Hemivagina and Ipsilateral Renal Agenesis (OHVIRA Syndrome) AKA herlyn-werner-wunderlich syndrome, with a systematic review – MedCrave online

  https://medcraveonline.com/OGIJ/three-cases-of-didelphys-uterus-including-uterus-didelphys-with-obstructed-hemivagina-and-ipsilateral-renal-agenesis-ohvira-syndrome-aka-herlyn-werner-wunderlich-syndrome-with-a-systematic-review.html

  Symptomatic treatment of these malformations can be hormonal or surgical. Menstrual suppression with OCPs or Lupron can alleviate dysmenorrhea, decrease blood loss and improve quality of life. Surgical intervention can be used to remove obstruction or correct anatomy to prevent future complications such as miscarriages. […] Prompt diagnosis and treatment is needed to ensure relief of symptoms, prevention of infection and preservation of fertility.

• #30 Uterine (Endometrial) Cancer Risk Factors & Prevention | Memorial Sloan Kettering Cancer Center

  https://www.mskcc.org/cancer-care/types/uterine-endometrial/risk-factors

  Before menopause, a womans ovaries normally produce two main types of hormones: estrogen and progesterone. Estrogen encourages the growth of endometrial cells in the uterus, whereas progesterone inhibits it. When a woman has high circulating levels of estrogen and low levels of progesterone over long periods of time, the risk for uterine (endometrial) cancer rises. […] In addition to getting regular annual checkups with your gynecologist and reporting any unexpected or abnormal vaginal bleeding, lifestyle measures, such as keeping your weight under control with physical activity and following a low-fat diet, may help to prevent uterine cancer. Using oral contraceptives has also been associated with a reduced risk.

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