TWO LIVES, TWO HORNS": A STUNNING CASE OF TWIN GESTATION IN A BICORNUATE UTERUS

Introduction: A bicornuate uterus is a congenital Mullerian duct anomaly that result from incomplete canalisation, fusion or resorption of the paramesonephric ducts during the period of embryogenesis. It is a fusion anomaly or defect characterised by a uterus with two horns (cornua) connected by a single cervix. It is associated with adverse pregnancy outcomes including recurrent pregnancy loss, preterm delivery, malpresentation, fetal growth restriction and increased Caesarean delivery. Twin gestation within a bicornuate uterus is extremely rare making its documentation clinically important. In such cases each fetus may occupy a separate uterine horn, creating unique physiological constraints and poses significant clinical challenge due to the risk of obstetrics complications. Case presentation: We present the case of a 29-year-old G2P1+0 1A, at an EGA of 38 weeks and LCB 12 years ago who presented to our labour ward with complaints of spontaneous labour pain and liquor drainage with no history of headache, blurring of vision or epigastric pain. No preceding history of trauma to the abdomen. She was not a known hypertensive and her first delivery was via spontaneous vertex delivery. She had a working diagnosis of SPE with twin gestation and an unfavourable cervix at term. Management and outcome: The patient had stabilization and delivered via caesarean section of live set of dichorionic diamniotic females both with good Apgar scores and both in cephalic presentation. The biconuate uterus was incidentally identified during the procedure. Each of the twin was occupying a separate horn linked at the lower uterine segment and a single cervical os. Conclusion: The case demonstrate that although twin gestation in a bicornuate uterus carries significant risk /complication, favourable maternal and perinatal outcome could be positively achieved. There is need for a high index of suspicion among healthcare workers in low- to middle-income countries where early diagnosis might be a dilemma, high index of suspicion is paramount to reduce morbidity and mortality.