Interval Vaginal Delivery of Term Twins From Bilateral Horns of a Uterus Didelphys: Insight Into Labor Initiation and Progression

Uterus didelphys, characterized by two separate uterine cavities and cervices, is associated with increased obstetric complications. Twin pregnancy with one fetus in each horn is exceptionally rare, often managed by cesarean or resulting in preterm birth. We report the first known case of term vaginal deliveries from both horns, occurring 6 days apart. A 28-year-old woman with uterus didelphys spontaneously conceived twins, with one fetus in each horn. At 37 + 4 weeks of gestation, labor began spontaneously in the left uterus. The cardiotocogram initially showed asynchronous contractions between the horns during the latent phase, becoming synchronous in the active phase. The first twin was delivered via forceps due to non-reassuring fetal status. The right uterus showed weak contractions but did not progress to labor. Six days later, labor was induced, and the second twin was also delivered via forceps. This case offers rare clinical insight into labor initiation and inter-horn coordination.