How a Double Uterus Can Complicate Abortion and Pregnancy

A double uterus is when someone is born with two distinct uteruses. Though rare, having this condition may be challenging during a pregnancy or abortion. Identification of a double uterus and proper management are essential to ensure a safe pregnancy or abortion.

What Is a Double Uterus and How Does it Form?

A double uterus, also known as uterus didelphys, is a rare condition present at birth where someone has two separate uterine cavities. Typically, this means they also have two cervices and sometimes a vaginal septum. It occurs during fetal development when the two ducts, which usually fuse to form a single uterus, fail to merge completely (1).

A double uterus is estimated to occur in around 0.3 – 5% of individuals with uteruses. However, it is difficult to know the exact figures as there is no universally accepted classification system (2). Many individuals with this condition are asymptomatic and may only discover it during imaging studies for unrelated issues, pregnancy, or infertility evaluation.

The severity of the condition varies widely, influencing how it affects reproductive health. Some common symptoms of a double uterus include:

• painful sex,
• heavy menstrual bleeding,
• painful cramping before and throughout your period,
• leaking blood despite using a tampon (because there is no tampon in the second vaginal canal),
• preterm labor, and
• frequent miscarriages (1).

Can You Have a Safe Pregnancy with a Double Uterus?

Several complications can occur with a double uterus:

1. Recurrent miscarriages
   • Having a double uterus does not necessarily mean you will experience a miscarriage; however, you may be at higher risk of having one. This is because a double uterus is smaller, which limits fetal growth. The abnormal shape can also alter the blood flow and placenta in the uterus (1).
   • Approximately 5 – 30% of women with uterine malformations have a history of miscarriage (3).
2. Preterm labor
   • Preterm labor can happen because of the placenta and uterine abnormalities.
   • Preterm births happen in roughly 17 – 33% of individuals with a double uterus (3).
3. Breech presentation
   • With a normal pregnancy, babies are born headfirst. Breech presentation is when the baby is born bottom first, which is considered a higher risk birth. This is not super common in individuals with a single uterus, accounting for 3 – 4% of births.
   • With a double uterus, breech presentation accounts for as many as 43% of births. A cesarean section (C-section) is much more common than vaginal delivery in these cases (3).
4. Intrauterine growth restriction (IUGR)
   • IUGR is a serious condition in which the fetus doesn’t grow at the expected rate during pregnancy.
   • Due to the smaller uterine size and impaired blood supply associated with a double uterus, IUGR is a possible complication (4).

Is Abortion Safe with a Double Uterus? How a Double Uterus Can Affect Abortion Procedures

Abortions in individuals with a double uterus can be more complex because of the differences in anatomy. Things that may affect an abortion include the number of uterine cavities, the location of the pregnancy, and whether there is a septum dividing the uterus. Key challenges include:

1. Where the pregnancy is located
   • With a double uterus, there are two uterine cavities. Determining which uterine cavity has the fetus is essential, as not knowing could lead to incomplete abortion or trauma to the wrong cavity.
2. Increased risk of leftover pregnancy tissue
   • A key part of every abortion procedure is the removal or expulsion of the pregnancy tissue. If the pregnancy tissue is in a smaller or less accessible uterine cavity, there is a higher risk that not everything will empty from the uterus.
   • Incomplete emptying of the uterus can cause complications like infection or prolonged bleeding.
3. Difficulty using instruments in a surgical abortion
   • When there are two cervices or a vaginal septum, a health-care provider may find it more difficult to use instruments, particularly during surgical abortion methods.
4. Higher risk of uterine perforation
   • Uterine perforation is a rare complication of procedures in the uterus. Thin uterine walls in those with a double uterus can increase the chances of perforation.

Medical and Surgical Options for Abortion with a Double Uterus

Health-care providers should determine the best abortion method to accommodate the unique anatomical differences of a double uterus. Options for abortion in these cases include:

1. Medical abortion
   • A medical abortion with mifepristone and misoprostol is generally considered safe for individuals with a double uterus.
   • Careful follow-up with an ultrasound is essential to confirm complete expulsion of pregnancy tissue.
2. Surgical abortion
   • Surgical methods may be used when a medical abortion is not feasible. These procedures require specialized skills from an experienced health-care provider to navigate the complex anatomy and avoid complications.
   • Surgeons may need to use imaging guidance, such as an ultrasound, to ensure the procedure is performed safely and accurately.
3. Hysteroscopic septum resection
   • A uterine septum is a membrane that presents at birth separating the uterus (5).
   • In cases of a double uterus where a uterine septum complicates abortion, the septum may be removed prior to or during the abortion procedure.
4. Advanced imaging techniques
   • A health-care provider may use an MRI or 3D ultrasound to see the uterine anatomy before proceeding with an abortion, reducing the risk of errors and complications.

Precautions and Care for People with a Double Uterus

Individuals with a double uterus require specialized care, both during pregnancy and when seeking abortion services. If you have a double uterus, consider:

1. Pre-pregnancy counseling
   • For those hoping to get pregnant, it is recommended you consult a health-care provider that is experienced in managing uterine anomalies.
   • Imaging procedures, such as an ultrasound or MRI, can help identify potential risks and prepare for a safe pregnancy.
2. High-risk pregnancy monitoring
   • Pregnancies in individuals with a double uterus are considered high risk. You will likely need more frequent monitoring to address complications early. Frequent ultrasounds are usually required to track fetal growth and position.
3. Careful selection of contraception
   • Long-acting reversible contraceptives (LARCs), such as intrauterine devices (IUDs), may be challenging to insert or less effective in individuals with a double uterus.
   • Alternative birth control methods, such as the birth control pill, may be more suitable if pregnancy is not desired.
4. Postabortion follow-up
   • After an abortion, patients with a double uterus should undergo a follow-up with their provider. Your provider can do imaging to confirm that the abortion is fully complete and rule out any potential complications.
5. Specialized training for providers
   • Providers offering abortion or pregnancy care to individuals with a double uterus should receive training in managing uterine anomalies, including the use of imaging and specialized surgical techniques.
   • Always seek abortion care from a licensed and experienced provider to ensure safety and proper management.

Conclusion

Though having a double uterus can bring about certain complications and risks, it doesn’t mean you can’t have a healthy pregnancy or safe abortion. However, proper care and treatment from a skilled health-care provider are needed to ensure the condition is managed appropriately.

Counselors

If you are interested in learning more, contact our counselors here at safe2chooose.