Background: Müllerian duct anomalies occur in 0.1% to 3% of women, and they are often associated with reproductive problems such as miscarriage, premature labour, premature rupture of the membranes, or malpresentation. Having a twin pregnancy in a patient with a bicornuate uterus (uterus bicornis unicollis) is rare, especially if it is a spontaneous conception.
Case: A 40-year-old primigravid woman conceived a twin dichorionic diamniotic pregnancy after three years of primary infertility. She was found on 3-D ultrasound examination to have a bicornuate uterus with one fetus in each horn The prenatal course was uncomplicated. At 38 weeks' gestation, twin babies were successfully delivered by elective bilateral low transverse Caesarean section.
Conclusion: Because the incidence of such pregnancies is very low, it remains unclear whether a twin pregnancy in a bicornuate uterus is better delivered vaginally or by elective Caesarean section.