Uterus didelphys with double vagina diagnosed during third cesarean section: A case report

Dorji, Namkha; Tshering, Sangay; Wangden, Tshering

doi:10.1177/2050313x211072967

Cited by 4 publications

(7 citation statements)

References 25 publications

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“…The shorter vagina may be also involved in the closed vaginal phenotype. It is reported that a patient has the similar pathology of longitudinal vaginal septum, resulting in dyspareunia and obstruction [ 40 ]. Whether RA signaling is involved in the above process needs further study.…”

Section: Discussionmentioning

confidence: 99%

RA-RAR signaling promotes mouse vaginal opening through increasing β-catenin expression and vaginal epithelial cell apoptosis

Zheng

Zhang

et al. 2023

Reprod Biol Endocrinol

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Background Retinoic acid (RA) plays important role in the maintenance and differentiation of the Müllerian ducts during the embryonic stage via RA receptors (RARs). However, the function and mechanism of RA-RAR signaling in the vaginal opening are unknown. Method We used the Rarα knockout mouse model and the wild-type ovariectomized mouse models with subcutaneous injection of RA (2.5 mg/kg) or E2 (0.1 µg/kg) to study the role and mechanism of RA-RAR signaling on the vaginal opening. The effects of Rarα deletion on Ctnnb1 mRNA levels and cell apoptosis in the vaginas were analyzed by real-time PCR and immunofluorescence, respectively. The effects of RA on the expression of β-catenin and apoptosis in the vaginas were analyzed by real-time PCR and western blotting. The effects of E2 on RA signaling molecules were analyzed by real-time PCR and western blotting. Results RA signaling molecules were expressed in vaginal epithelial cells, and the mRNA and/or protein levels of RALDH2, RALDH3, RARα and RARγ reached a peak at the time of vaginal opening. The deletion of Rarα resulted in 25.0% of females infertility due to vaginal closure, in which the mRNA (Ctnnb1, Bak and Bax) and protein (Cleaved Caspase-3) levels were significantly decreased, and Bcl2 mRNA levels were significantly increased in the vaginas. The percentage of vaginal epithelium with TUNEL- and Cleaved Caspase-3-positive signals were also significantly decreased in Rarα−/− females with vaginal closure. Furthermore, RA supplementation of ovariectomized wild-type (WT) females significantly increased the expression of β-catenin, active β-catenin, BAK and BAX, and significantly decreased BCL2 expression in the vaginas. Thus, the deletion of Rarα prevents vaginal opening by reducing the vaginal β-catenin expression and epithelial cell apoptosis. The deletion of Rarα also resulted in significant decreases in serum estradiol (E2) and vagina Raldh2/3 mRNA levels. E2 supplementation of ovariectomized WT females significantly increased the expression of RA signaling molecules in the vaginas, suggesting that the up-regulation of RA signaling molecules in the vaginas is dependent on E2 stimulation. Conclusion Taken together, we propose that RA-RAR signaling in the vaginas promotes vaginal opening through increasing β-catenin expression and vaginal epithelial cell apoptosis.

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Section: Discussionmentioning

confidence: 99%

RA-RAR signaling promotes mouse vaginal opening through increasing β-catenin expression and vaginal epithelial cell apoptosis

Zheng

Zhang

et al. 2023

Reprod Biol Endocrinol

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“…Mullerian defects are among a group of abnormalities that affect the genital and urinary system given the fact that they both share a common embryological origin (5,6). Uterine didelphys belongs to Mullerian duct anomaly class III as de ned by American society of reproductive medicine which includes adnexal adhesions and distal tubal occlusions among others (8).…”

Section: Discussionmentioning

confidence: 99%

“…It is one of the least common Mullerian abnormalities (4). The mean incidence has been reported to be 8.4% globally (5). Following failed fusion of the paramesonephric ducts early in the pregnancy, there is formation of a longitudinal vaginal septum, two vagina, and two hemi-uteri each with its separate ovary and fallopian tube.…”

Section: Introductionmentioning

confidence: 99%

Uterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section

Ali,

Mohamud,

Kune

et al. 2023

Preprint

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Introduction: Uterine didelphys is an extremely very rare Müllerian duct defect globally that if found coincidentally can be so disturbing to the attending clinician, the patient and her family members. Wepresent a case report of an undiagnosed uterus didelphys in a pregnant woman who was admitted at 39 weeks and 4 days of amenorrhea with a double uterus that was found coincidentally at her third delivery by elective caesarean section and had a good fetal outcome. Case presentation: We are presenting a 32 year old Gravida 4 Para 3+0 patient who was admitted at 39 weeks and 4 days of amenorrhea and reported a history of three previous caesarean scars. She was accordingly delivered by elective caesarean section. Intraoperatively, a second non gravid uterus with ipsilateral fallopian tube and ovary was coincidentally noted and a contralateral fallopian tube without ovary was also appreciated in the same uterus. Exploration revealed that each uterus had one fallopian tube and ovary, and that both uteri joined at one cervix. Conclusion: Careful assessment of all women scheduled for surgery is crucial to avoid such unnecessary disturbing phenomena

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“…Preventive measures for uterus bicornis unicollis cases cannot correct the congenital abnormality but can optimize health quality of life through education, physical examinations, routine ANC, and regular monitoring to prevent early and advanced complications in both mother and baby [ 1 , 3 , 4 ]. A study found that uterine didelphys does not necessitate a cesarean section, instead fetal presentation does [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

“…In uterine didelphys, management of childbirth can be done either by vaginally or through cesarean section [ 6 , 25 ]. However, this condition is associated with fetal breech presentation and is the most common indication for cesarean delivery in women with uterine didelphys [ 1 , 4 , 13 , 21 , 26 ] Furthermore, if no coexistent symptom present, additional treatment to uterine disorder is deemed unnecessary [ 6 ]. In this present case, the patient showed no particular symptom prior and was decided to be given an emergency cesarean section based on her history with two previous cesarean deliveries and the fetus’ breech presentation as seen in the ultrasonography examination imagery.…”

Section: Discussionmentioning

confidence: 99%

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births

Hasanuddin,

Maharani,

Nora

et al. 2023

Narra J

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Bicornis unicollis uterus is a rare congenital uterine abnormality that occurs due to the failure of Mullerian duct fusion early in the development of the female internal genitalia system. In this case report, we present a woman with bicornis unicollis uterus who had preterm birth. A 30-year-old female patient with two caesarean sections history with premature babies was presented to the hospital with a complaint of regular contractions for twelve hours in her third preterm pregnancy. The patient has no particular symptoms besides acute abdominal pain. The ultrasonography examination indicated a uterus didelphys with breech presentation fetus. Due to the patient’s caesarean history and the fetal presentation, an emergency caesarean section was decided and performed. It was found that the gravid uterus was on the left and the baby was subsequently delivered with a complete placenta. Postoperative condition of the patient was shown to be stable while the baby underwent an intensive care at the neonatal intensive care unit. This case report highlights that early diagnosis in this rare case is critical since bicornis unicollis uterus are mostly asymptomatic. Caesarean section was chosen in the present case based on consideration of the fetal and maternal clinical conditions.

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Uterus didelphys with double vagina diagnosed during third cesarean section: A case report

Cited by 4 publications

References 25 publications

RA-RAR signaling promotes mouse vaginal opening through increasing β-catenin expression and vaginal epithelial cell apoptosis

RA-RAR signaling promotes mouse vaginal opening through increasing β-catenin expression and vaginal epithelial cell apoptosis

Uterine Didelphys in a G4P3+0: a Disturbing Phenomenon at Caesarean Section

Bicornis unicollis uterus as a risk factor of preterm birth: A case of young woman with multiple premature births

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