# Peripartal management of dichorial twin pregnancy in a bicornuate bicollis uterus: a case report and review of the literature

## TL;DR

This case report describes a rare twin pregnancy in a bicornuate bicollis uterus and highlights the challenges and outcomes of its management.

## Contribution

The paper presents a rare case of twin pregnancy in a bicornuate bicollis uterus and emphasizes the need for better management guidelines for such cases.

## Key findings

- Twin pregnancy in a bicornuate bicollis uterus is extremely rare, with only six previously reported cases worldwide.
- The case resulted in spontaneous deliveries at 27 weeks, highlighting risks like preterm labor and growth restriction.
- Interdisciplinary care and monitoring are essential for managing such high-risk pregnancies.

## Abstract

The management of a pregnancy in a bicornuate uterus is particularly challenging. A bicornuate uterus is a rare occurrence and a twin pregnancy in a bicornuate uterus even more rare. These pregnancies call for intensive diagnostic investigation and interdisciplinary care.

We report on a 27-year-old European woman patient (gravida I, para 0) with a simultaneous pregnancy in each cavity of a bicornuate bicollis uterus after embryo transfer. The condition was confirmed by hysteroscopy and laparoscopy. Several unsuccessful in vitro fertilization (IVF) attempts had been performed earlier before embryo transfer in each cornus. After a physiological course of pregnancy with differential screening at 12 + 6 weeks and 22 + 0 weeks of gestation, the patient presented with therapy-resistant contractions at 27 + 2 weeks. This culminated in the uncomplicated spontaneous delivery of the leading fetus and delayed spontaneous delivery of the second fetus.

Only 16 cases of twin pregnancy in a bicornuate unicollis uterus have been reported worldwide and only 6 in a bicornuate bicollis uterus. The principal risks in such pregnancies are preterm labor, intrauterine growth restriction, malpresentation and preeclampsia. These typical risk factors of a twin pregnancy are greatly potentiated in the above mentioned setting.

A twin pregnancy in the presence of a uterine malformation is rare and difficult to manage. These rare cases must be collected and reported in order to work out algorithms of monitoring and therapy as well as issue appropriate recommendations for their management.