Background: Spontaneous triplets in a uterus didelphys are an extremely rare finding. Only four other cases are reported in the literature. Case: A 24 year old gravida 3 para 2-0-0-2 conceived spontaneous triplets in a uterine didelphys. She developed cervical insufficiency and underwent cerclage placement at 17 weeks. After spontaneous rupture of membranes at 29 weeks gestation, she underwent repeat cesarean section, with delivery of three viable fetuses. Mother and all three babies are currently alive and well. Conclusion: Expectant management with cerclage placement is a possible alternative to selective reduction for desiring patients with triplets in a uterus didelphys.