Uterus didelphys without vaginal septum identified intraoperatively at cesarean delivery: a case report

Introduction and Importance: Uterus didelphys is a rare Müllerian duct anomaly (MDA), accounting for approximately 10% of congenital uterine malformations. Although often asymptomatic, it may be associated with adverse reproductive outcomes including miscarriage, preterm birth, and malpresentation. Case Presentation: We describe a 20-year-old primigravida who presented at 39 weeks of gestation for elective cesarean section due to breech presentation. She had no history of infertility, miscarriage, or gynecologic complaints. Pregnancy progressed uneventfully, and a healthy male infant was delivered. Intraoperative inspection revealed a second uterus, and postoperative speculum examination confirmed two cervical canals without a vaginal septum, consistent with uterus didelphys subtype II. The postoperative course was uncomplicated, and the patient declined further renal evaluation. Clinical Discussion: This case illustrates that uterus didelphys may permit normal reproductive performance and successful term pregnancy. Diagnosis is frequently incidental, as routine imaging may fail to detect the anomaly. Careful intraoperative examination during cesarean section provides an opportunity to identify unsuspected uterine malformations, enabling appropriate counseling and management of future obstetric and gynecologic care. Conclusion: Uterus didelphys does not preclude successful pregnancy outcomes. Routine vigilance during cesarean section is essential to detect undiagnosed anomalies, which may influence future reproductive counseling and management.