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Bicornuate uterus with triamniotic dichorionic triplet pregnancy (3D ultrasound)

Case contributed by Gamal Elsayed Abdelmoamen Fares
Diagnosis certain

Presentation

Gravida 2 Parity 1. Previous cesarian section. Gestationally aged 16 weeks. History of uterine anomaly not specified discovered by her physician last pregnancy during C-section.

Patient Data

Age: 30 years
Gender: Female

Images 1 to 4 shows axial transverse views of two uterine horns with external myometrial indentation differentiating them from septate uterus , one horn with larger fetus which is viable with its own placenta and the other horn with non viable monochorionic diamniotic pregnancy "one empty sac and the other with dead fetus aged 14 weeks"

Images 5 and 6 show longitudinal planes , the last one shows cervical os divided by a large septum.

This case is considered to be bicornuate bicollis uterus (complete division).

Case Discussion

In this case, the uterus is bicornuate bicollis (complete division), with one horn containing a viable normal pregnancy with its own placenta, and other horn containing a non-viable monochorionic diamniotic twin pregnancy.

The woman had previous delivery by CS where she was notified by her obstetrician that she had a uterine anomaly. She came to our department this current pregnancy, with the early ultrasound scan showing triplet pregnancy in a divided uterine cavity by 2D ultrasound.

According to the Müllerian duct anomaly classification which is a seven-class system, this case is class IV (bicornuate uterus), sub-classified to (a) which is  complete division, all the way down to the external os (bicornuate bicollis), as shown in the last image.

The cervical length was about 4 cm, and she was counseled that there was no indication for cervical cerclage.

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