-Rare case of Didelphys Uterus
Doctors at the Georgetown Public Hospital have delivered twins in a rare case of Didelphys Uterus, a condition in which the patient has two uteri.
In what is likely to be the first ever case documented in Guyana, the 20-year-old mother delivered twins, by Caesarean section, after going into labour on August 25, last.
The babies, a boy and a girl, were delivered at 37 weeks (considered full term) with the boy weighing 2.64 kg; while the girl weighed 2.54 kg at birth.
GPHC officials informed journalists of the unusual case yesterday. The meeting was facilitated by Head of the Department of Gynaecology, Doctor Lucio Pedro and Senior Registrar, Doctor Rafi Rozan, who delivered the babies.
Didelphys Uterus, sometimes referred to as Uterus Didelphys, is one which represents a uterine malfunction where the uterus is presented as a paired organ when the embryogenetic fusion of the Mullerian ducts fail to occur.
This results in a double uterus with two different cervices and rarely, a double vagina as well.
The 20-year-old mother happens to fall into a very extraordinary population, since this case is one in a million, according to experts. With Guyana’s population in mind (which is less than a million) “It is like winning the lottery,” said Dr. Rozan.
“This is not the first case of uterine abnormalities that we have seen, but it is the first case where we had uterine malformations, abnormalities with two babies, we call it two uteri,” Dr. Pedro said.
The doctor explained that the woman came and was told she is going to have twins, but they were unaware of the fact that she has two uteri.
Dr. Rozan said that the occurrence is one which presents itself rarely in approximately 0.05 to five percent of the general population.
“The exact statistics in Guyana is unknown. This is based on international statistics from the United States of America”.
“The entire human system has derived embryonically from three different layers. One such layer is the mesoderm from which the genital apparatus develops. So in the embryonic stage, usually up to two to eight weeks, there are two ducts.
“They usually are the ones that differentiate and develop into the sexual genitalia for a boy or for a girl, so in the embryonic state it is usually together, it is common and the human tendency is normally or always feminization…so after eight weeks, going on to ten, if there are any risk factors, such as the ‘Y’ chromosome that determines the male sex or testicular testosterone… that would inhibit the differentiation or development of the womb duct.”
“It is like a tube coming from both sides which would fuse around eight to ten weeks eventually forming cavities.” It is these fusions that can possibly stay together and result in a person not developing a vagina or a cervix or a uterus.”
This is referred to as Kuster-Rokitansky-Syndrome, which according to him is also very rare.
The doctor related that in his career, he had only seen two such cases. Other abnormalities are likely to develop such as apoptosis, which is the death of cells.
He said, “In this case, the apoptosis happens, but the septum that usually is supposed to go away, stays. So it divided the uterus into two cavities, independent cavities with two cervices.”
It can further develop into two vaginas, which makes it possible for such a person to get pregnant in two different instances.
Patients can develop problems and are likely to suffer from pain during sex and menstruation, since the menstrual cycle will be happening from both cavities. It also becomes difficult for the patient to get pregnant and even after fertilization, miscarriages and preterm deliveries, among others can be expected.
It is even possible for the person to get pregnant from two different partners.
The doctors sought to give reference to a case where “one baby was black and one baby was white”.
“In this case, the patient basically had two different cavities with two different cervices, meaning that she could have independently got pregnant in the right side or in the left side. In this case the patient got pregnant on both different cavities.” The most beautiful part of the case is that the patient was able to deliver babies of different sexes. A boy was growing in the right side and a girl in the left side.
An actual image was displayed by the doctor of the uterus. He said initially he thought it was a bicornuate uterus, because of the heart shape.
The mother, who underwent an approximate 40-minute delivery, sought for intra-uterine contraceptive and had one placed on each uterus.
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