Uterine malformations and spontaneous triplet pregnancy are rare situations separately, and both are related to worse perinatal outcomes. In the 3 cases of combined triplet pregnancy and uterus didelphys previously published, at least 2 of the 3 fetuses died. Morbidity rates are also high. We report the case of a 24-year-old Caucasian woman with a uterus didelphys and two previous caesarean sections who carried a spontaneous triplet pregnancy. To our knowledge, this is the first case of a spontaneous triplet pregnancy in a uterus didelphys ever reported and the only one with uneventful perinatal outcome for all fetuses. Expectant management may be an alternative to embryo reduction to manage triplet pregnancies in a didelphys uterus, especially when this option is not considered. Nevertheless, there is not enough evidence to confirm which is the optimal management strategy, and more studies are needed.

Copyright 2010 S. Karger AG, Basel.