Uterine Rupture in a Didelphic Uterus: A Rare Case Report of Intrauterine Foetal Demise in a Primigravida

Uterus didelphys is an uncommon developmental Müllerian malformation caused by a lack of complete fusion between the paramesonephric ducts, making the foetus have two uterine cavities, making pregnancy outcomes difficult. Though a large proportion of women with this anomaly successfully deliver, spontaneous rupture of an unscarred uterus is extremely rare. We describe a case of a 27-year-old primigravida who presented with vaginal bleeding, labour-like pain, and no foetal movement after 48 hours. Intrauterine foetal demise (IUFD) was identified by ultrasound. The exam revealed severe abdominal tenderness and palpable foetal parts, which raised the suspicion of uterine rupture. An exploratory laparotomy showed there is hemoperitoneum, and the foetus is floating freely in the peritoneal cavity. The uterus had two cavities (uterus didelphys), and one of the hemi-uteri had been ruptured at the base of the uterus. The surgery was successfully completed, and the patient healed without problems. The case suggests the critical role of antenatal diagnosis of uterine anomaly early in pregnancy and monitoring of rupture in an unscarred uterus. The awareness of such unusual manifestations can positively influence the maternal outcomes by providing timely surgical intervention and multidisciplinary care.