Bicornuate uterus : How does it affect your pregnancy

The bicornuate uterus is a congenital abnormality of the uterus. This heart-shaped, irregular form of the uterus is an uncommon condition. Most women with a bicornuate uterus can have a healthy pregnancy but may have slight risks of miscarriage.

Overview:

A bicornuate uterus means that the uterus is either completely or partially duplicated, but there's only one cervix. The health experts don’t know how this condition affects a woman's ability to have children¹.

Having a bicornuate uterus can lead to miscarriage, preterm labor, and premature birth. Ultrasound can confirm the diagnosis, but it’s crucial to note that having a bicornuate uterus doesn’t essentially mean you can’t get pregnant, but it can be more challenging.

Healthcare providers treat a pregnancy in one part of a bicornuate uterus using Stressman and cerclage metroplasty^,
4.

What is a bicornuate uterus?

The health experts define a bicornuate uterus as

“The bicornuate uterus is a type of congenital uterine irregularity that happens due to a lateral fusion defect of the Mullerian ducts during embryologic development.

This condition leads to numerous anatomic variations such as complete or partial division between the endometrial cavities, single or duplicated cervices, and associated vaginal anomalies.

A woman with a bicornuate uterus may be identified at the time of pregnancy, during the evaluation of poor obstetrical outcomes, or evaluation of an obstructing, or evaluation of an obstructing, or nono obstructing vaginal anomaly, still several females are asymptomatic and remain undiagnosed. Evaluating females with a possible uterine anomaly needs a physical examination and detailed history⁴.

How common are uterine abnormalities?

Uterine abnormalities are quite common, impacting approximately, 3-4% of females. But it’s not often that pregnancies occur in a uterus with bicornuate uterus problems.

The occurrence of uterine differences varies, depending on the population and the diagnostic method. The occurrence of 1-10% was found in an unselected population 2-8% in subfertile females, and 5-30% of females with a history of miscarriage^.

How can I know if I have a bicornuate uterus?

You don’t even know you have a bicornuate uterus until your healthcare provider tells you after a check-up for the problem of something else, such as, during a routine pregnancy check-up or even during childbirth, your healthcare provider may discover that your uterus is shaped differently³.

What should my healthcare provider consider if I have bicornuate uterus?

Your healthcare provider should consider certain possibilities, such as having painful periods or having multiple miscarriages. It’s also crucial for you if you are trying to conceive and are having trouble.

A study found that about 3% of women with uterine problems have a bicornuate uterus, where the uterus is heart-shaped.

Another study came across children born to mothers with this condition and revealed that they were more likely to have birth defects.

Is it possible to become pregnant if I have a bicornuate uterus?

Your pregnancy can be difficult if you have bicornuate uterus. Although it’s possible to get pregnant there will be a higher risk of complications such as miscarriage, or preterm labor. Your ultrasound report will confirm the diagnosis, but it’s important to know that having this condition doesn’t necessarily mean women can’t get pregnant—it just might be more challenging.

Why does a bicornuate uterus cause difficulty in getting pregnant?

The problem is not usually getting pregnant—it’s carrying the baby to full term. Women with uterine issues might have smaller uteruses, weaker muscles, or problems with blood flow, all of which can make it harder for the baby to grow properly. This can lead to miscarriage, the need for a C-section, or premature birth.

Symptoms:

What are the symptoms of bicornuate uterus?

You might experience certain symptoms if you have a bicornuate uterus such as:

Vaginal bleeding
Pelvic pain
Frequent miscarriages
Painful intercourse (dyspareunia)
Painful menstruation

In most cases, you may even don’t know you have a heart-shaped uterus and you may feel normal with these symptoms. Your ultrasound report can reveal your uterus anomaly.

Causes:

What causes a bicornuate uterus?

A bicornuate uterus is a congenital condition, meaning that it develops in the womb between 10 and 20 weeks of pregnancy. A heart-shaped uterus characterizes this uterus anomaly

During fetal development, the Mullerian ducts, which are two ducts that typically merge to form one uterine cavity, may not fuse completely in some individuals. This results in forming a bicornuate uterus, which has two uterine cavities. This condition can manifest as a deep heart shape or a minor malformation that never causes any issues. It is important to note that a heart-shaped uterus is not hereditary, which means that it cannot be passed down from parent to child.

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Diagnosis:

How is a bicornuate uterus diagnosed?

Most females don’t know that they have a heart-shaped uterus until they experience repetitive miscarriages. Your healthcare provider can reveal the shape of your uterus after repeated pregnancy loss, during pregnancy, or because of painful periods by following tests such as:

1. Ultrasound:

Overall, ultrasound is a non-invasive and valuable tool in the diagnosis of bicornuate uterus, providing crucial information for healthcare providers to effectively manage and counsel patients with this condition.

In the case of bicornuate uterus, ultrasound can accurately identify the characteristic heart-shaped or "bicornuate" appearance of the uterus. This imaging technique can differentiate between a bicornuate uterus and other uterine abnormalities, such as a septate uterus or a unicornuate uterus.

2. MRI (magnetic resonance imaging):

MRI is another imaging modality that can be used in the diagnosis of bicornuate uterus. While ultrasound is typically the first-line imaging technique for evaluating uterine abnormalities, MRI can offer additional information and detail, especially in complex cases or when ultrasound results are inconclusive.

MRI provides highly detailed images of the internal structures of the body, including the uterus. It can accurately delineate the shape, size, and configuration of the uterus, allowing for a comprehensive assessment of uterine anomalies such as bicornuate uterus.

Why is appropriate imaging important when diagnosing a bicornuate uterus?

Doctors use special tests like imaging to tell if a woman has a bicornuate uterus or another kind of problem with her womb. They also might check her urinary tract with these tests. Even though having a bicornuate uterus usually doesn't make it harder to get pregnant, it can make some problems more likely during pregnancy⁴.

Treatment:

What are the treatment options for bicornuate uterus?

The management of a bicornuate uterus varies depending on factors such as the severity of the condition, symptoms, and the patient's reproductive intentions. Treatment options typically include:

1. Symptomatic Treatment:

Women experiencing symptoms such as heavy menstrual bleeding or pelvic pain may benefit from symptomatic treatment options, including medications or surgical procedures to alleviate discomfort.

2. Pregnancy Management:

Close monitoring and management of any pregnancy-related complications are crucial for women with a bicornuate uterus. This involves regular prenatal care and interventions such as cerclage to prevent preterm labor.

3. Fertility Assistance:

For women experiencing difficulty conceiving, assisted reproductive technologies like intrauterine insemination (IUI) or in vitro fertilization (IVF) may be utilized to improve the chances of pregnancy.

4. Surgical Correction:

In cases where the bicornuate uterus significantly impacts fertility or increases the risk of complications during pregnancy, surgical intervention may be considered. Metroplasty, a procedure to remove the uterine septum, can often improve fertility outcomes and reduce the risk of miscarriage or preterm birth.

5. Observation:

If the bicornuate uterus is asymptomatic and does not interfere with fertility or pregnancy, a watch-and-wait approach may be recommended. Regular monitoring by your healthcare provider ensures any potential complications are detected early.

When might healthcare providers recommend surgical intervention?

For some women who've had a lot of pregnancy problems before, doctors might think about doing surgery to help them. They might do a surgery called Strassman metroplasty or put in something called a cervical cerclage⁴.

What complications may arise from surgical treatment for a bicornuate uterus?

When treating a bicornuate uterus through surgery, there will be some associated risks, including:

Infection
Bleeding
Uterine scarring/adhesions

Prevention:

How can I prevent a bicornuate uterus?

A bicornuate uterus is a condition that arises during fetal development and is not caused by anything your parents did or didn’t do. Therefore, there is nothing you can do to prevent a heart-shaped uterus.

How will a bicornuate uterus affect my pregnancy?

The heart shape of your uterus does lead you to some extended higher risk for certain pregnancy complications including;

Low birth weight (because your fetus doesn’t have enough space to grow)
Preterm birth and early labor
Miscarriage
Postpartum hemorrhage
Vaginal bleeding
The fetus is transverse, breech, or in another position in the uterus other than head-down.
Incompetent cervix
Placenta previa, or other condition of the placenta
Elevated chance for cesarean delivery
Pregnancy-induced high blood pressure

Pregnancy with a bicornuate uterus requires more monitoring compared to a pregnancy with a normal uterus shape. Your healthcare provider will likely have a more prenatal ultrasound so they can observe the shape and size of your uterus and the position of the fetus, placenta, and shape.

The chances of having a c-section can elevate with the heart-shaped uterus as your baby is more on the verge of the breech.

Can I have a normal childbirth with a bicornuate uterus?

You can have a healthy pregnancy and normal childbirth. You need to practice extra precautionary measures and regular check-ups to ensure you and your baby stay safe through pregnancy and delivery.

Can a bicornuate uterus affect my labor and delivery?

Your heart-shaped uterus could affect your childbirth. Since your uterus is abnormal in shape, it might not enlarge enough to accommodate a full-term baby. This means your baby could be jam-packed very tightly and in an uncomfortable position inside your womb. As a result, there will be higher risks of your baby being breech. Therefore, healthcare providers often recommend a C-section.

Will my baby have a birth defect?

It's important to note that having a bicornuate uterus does not necessarily mean that your baby will have a birth defect. However, it does increase the likelihood of preterm labor, which means that you may give birth before your baby's organs or systems have fully developed, typically before the 37th week of pregnancy.

Conclusion:

The bicornuate uterus is a heart-shaped anomaly of the uterus and presents as a rare congenital uterine anomaly. Although most women with this condition can have healthy pregnancies, there is a slight risk of miscarriage. While imaging aids in diagnosis, there's limited knowledge about its impact on fertility. Pregnancy complications, such as preterm labor, are heightened, warranting careful management, including surgical interventions for select cases.

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