Uterus Didelphys Bicollis Diagnosed Intraoperatively in a Primigravida After Long-Standing Primary Infertility: A Case Report.

Uterus didelphys is a rare Müllerian duct anomaly, characterized by complete duplication of the uterine cavity and cervix. It is often associated with a longitudinal vaginal septum. Patients may present with dysmenorrhea, dyspareunia, and abnormal uterine bleeding, although it may remain asymptomatic until pregnancy. We report a case of a 41-year-old primigravida with 22 years of primary infertility, diagnosed with uterus didelphys intraoperatively. She presented with intermittent per-vaginal spotting and lower abdominal enlargement. Transabdominal ultrasonography (USG) revealed an unexpected 20-week pregnancy. Despite multiple subsequent antenatal ultrasonographic examinations, the uterine anomaly was not identified. At 32 weeks and 6 days, she presented with lower abdominal pain, and USG revealed severe oligohydramnios, breech presentation, and asymmetric intrauterine growth restriction. Per-vaginal examination revealed a longitudinal vaginal septum with two vaginal canals, each leading into a separate cervix. An emergency lower-segment caesarean section (LSCS) was performed. Intraoperatively, the uterus was found to consist of two separate uterine cavities that were not communicating, each leading into a distinct cervix, consistent with uterus didelphys bicollis​​​​​​. Uterus didelphys bicollis was confirmed. A live male infant weighing 1.810 kg was delivered. Both the mother and neonate recovered uneventfully. This case highlights that uterus didelphys may remain undiagnosed despite prolonged infertility and multiple antenatal USG. A thorough pelvic examination may provide an important clinical clue and prompt targeted imaging. Early diagnosis of Müllerian anomalies may support individualized counselling, appropriate imaging, and risk-based obstetric surveillance.