Objective This study was undertaken to evaluate the diagnostic manage ment and the reproductive outcome after surgical repair of a rare reproductive malformati on. Study design Sixteen women with a complete septate uterus, double cervix, an d a longitudinal vaginal septum were referred for evaluation. Presenting complai nts were chiefly pregnancy loss in parous women (n=9) and dyspareunia in nulligr avid women (n=7). The combination of hysterosalpingography, ultrasonography, and /or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n=11) and transabdominal (n=5) surgical tec hniqueswere used to repair the uterine septum. Results In no case was the correc t diagnosis made before referral; the uterus didelphys was the most common misdi agnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women con ceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous ab ortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metropla sty was performed in 5 women with subsequent term live births or ongoing third t rimester pregnancies in 5 of 5 (100%) patients. Conclusion The identification o f a duplicated cervix and a vaginal septum is consistent with several uterine ma lformations, which leads to frequent misdiagnosis and errors in management. Sign ificant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is there-fore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires famil iarity with both techniques. Objective This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformati on.. Study design Sixteen women with a complete septate uterus, double cervix, an extensive longitudinal vaginal septum were referred for evaluation. nts were chiefly pregnancy loss in parous women (n = 9) and dyspareunia in nulligr avid women (n = 7). The combination of hysterosalpingography, ultrasonography, and / or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 Both In hysteroscopic (n = 11) and transabdominal (n = 5) surgical tec hniqueswere used to repair the uterine septum. Results In no case was the correc t diagnosis made before referral; the uterus didelphys was the most common misdi agnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women con ceived for a total of 17 pregnancies; there were 14 term live births or just pregnancies in the third trimeste r (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third t rimester pregnancies in 5 of 5 (100%) patients. Conclusion The identification ofa duplicated cervix and a vaginal septum is consistent with several uterine ma lformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is there-fore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires famil iarity with both techniques.