Obstetric outcome of a primagravida with a uterine didelphys, a 20 cm fibroid, and a vaginal septum

Background: Mullerian anomalies, like a uterine didelphys (UD) and vaginal septae, are at increased risk for adverse pregnancy outcomes. Some obstetrical complications include spontaneous abortion, bleeding, fetal malpresentation, and cesarean delivery. Surgical treatment is rarely performed in UD.
Uterine fibroids in pregnancy are frequent and pain is the most common symptom. Fibroids in pregnancy are associated with an increased risk of spontaneous abortions, preterm labor and delivery, malpresentation, and placental abruption. Myomectomy is avoided during pregnancy and at delivery, due to the risk of hemorrhage. Acetaminophen is the treatment of choice.
Case: A 31-year-old female, gravida 1 para 0 with an intrauterine pregnancy (IUP), a 20 cm fibroid, a uterine didelphys (UD), and a longitudinal vaginal septum, was followed for pain caused by degeneration of the 20 cm fibroid. At term, she underwent labor induction due to oligohydramnios and delivered a healthy infant via vaginal delivery. A vaginal septoplasty was performed due to a partial tear of the septum. Estimated blood loss was 800 ml, and she received 2 units of PRBCs. She was discharged home on postpartum day 2. Her postpartum recovery was complicated with endometritis which was treated with methergine and antibiotics.
Conclusion: Few pregnancies with both UD and fibroids have been described. Many result in a cesarean delivery due to the inability for fetal head descent. The literature search did not find another successful vaginal delivery of an IUP with a uterine didelphys, a large fibroid, and a vaginal septum.