Introduction:
A bicornuate uterus is a rare birth defect of the uterus or an anomaly of the Mullerian duct that can cause complications during pregnancy. The uterus appears to be heart-shaped in the bicornuate uterus, and it has two conjoined cavities as compared to a single cavity in a normal uterus. The shape of the uterus is important for becoming pregnant because it affects the position of the baby in the uterus. Uterus abnormalities are rare; about three percent of women are born with congenital defects in the shape, size, or structure of the uterus. This anomaly can only be treated through surgery.
What Are the Types of Bicornuate Uterus?
The bicornuate uterus is of two types, namely incomplete (partial) or complete. Depending on the dipping down from the top of the uterus towards the cervix, they are differentiated as follows:
-
Incomplete Bicornuate Uterus - When there is a lesser degree of separation between the two cavities of the uterus, it is referred to as an incomplete or partial bicornuate uterus. This uterus is still heart-shaped; however, the indentation that divides the uterus is not severe.
-
Complete Bicornuate Uterus - When the indentation at the top of the uterus is severe, it is referred to as a complete bicornuate uterus. This makes the separation of the uterus more distinct.
What Are the Causes of Bicornuate Uterus?
A bicornuate uterus is a birth defect. It happens when the uterus of the fetus does not develop normally in the mother's womb, which usually occurs between 10 to 20 weeks of pregnancy. During development, two ducts known as the Mullerian ducts usually fuse to form one uterine cavity. But in the case of a bicornuate uterus, the ducts do not merge completely, causing two uterine cavities or horns in the uterus. When the horns pop out a little, the uterus appears to be heart-shaped. Unfortunately, this condition cannot be prevented or stopped from occurring.
What Are the Symptoms of Bicornuate Uterus?
The symptoms of a bicornuate uterus differ from person to person; some may not experience any symptoms. Most women might come to know only when they have trouble getting pregnant.
In some cases, the bicornuate uterus can sometimes cause symptoms, including:
-
Painful Periods - It can be challenging for blood to flow through the cervix in people with a bicornuate uterus, which may cause more pain.
-
Fertility Problems - Having trouble becoming pregnant or staying pregnant can occur due to anatomical issues like having a bicornuate uterus.
-
Bleeding Through Tampons - About 25 percent of women with a bicornuate uterus have a longitudinal vaginal septum (double vagina). One is said to have a longitudinal vaginal septum if there are two vaginal cavities separated by a wall of tissue. In such cases, bleeding from the other cavity can happen even if a tampon is in.
-
Pain during intercourse.
-
Abdominal discomfort.
What Are the Risks of a Bicornuate Uterus During Pregnancy?
If there is mild deformation of the uterus, the chance of experiencing complications during pregnancy is less, and one might have a full-term or nearly full-term pregnancy. But in the case of having a bicornuate uterus, becoming pregnant can be difficult, and even if pregnancy occurs, the condition will be considered a high-risk pregnancy. In this condition, the pregnancy would be monitored more often, with more prenatal checkups pertaining to the health and development of the baby for a better pregnancy outcome.
However, the complications of bicornuate pregnancy include:
-
Premature Rupture of Membrane - If the baby grows too large than the uterine cavity, the walls of the uterus overstretch, leading to an early water break. This can sometimes result in preterm labor.
-
Incompetent Cervix - When the cervix is too weak to carry the baby inside, it is more likely to open prematurely. The doctors may strengthen the cervix with cerclage.
-
Miscarriage - A bicornuate uterus increases the risk of having a miscarriage later in pregnancy and might result in early delivery of the baby. This may be due to reduced uterine capacity or irregular uterine contractions.
-
Malpresentation - There is an increased chance of malposition of the baby during birth due to the deformity of the uterus. The doctors do not attempt to correct the position of the baby in an abnormally shaped uterus. Therefore, mostly the baby is delivered through cesarean section.
-
Birth Defect - Babies born to a mother with a bicornuate uterus have a greater chance of developing birth defects when compared to those born to mothers without the condition.
Does a Bicornuate Uterus Cause Infertility?
A bicornuate uterus does not cause infertility, but it can make conceiving more difficult. About one percent of women with infertility have a bicornuate uterus. In addition, women with this condition have an increased risk of certain pregnancy complications. So, this is considered a high-risk pregnancy.
How Is a Bicornuate Uterus Diagnosed?
Most people with a bicornuate uterus will not know about their uterine abnormality until they experience repeated pregnancy loss. However, in some cases, a bicornuate uterus is found during a routine ultrasound because of painful periods or during pregnancy. Initially, a pelvic examination is carried out, and the healthcare provider will use different imaging techniques to confirm a bicornuate uterus. The test includes:
-
Ultrasound - An ultrasound is typically the first diagnostic test used to detect an anomaly in the uterus. It is done using high-frequency sound waves, which create images of the parts inside the body. After detecting the abnormality, the healthcare provider may use more advanced diagnostic techniques to view the uterus's shape in a better manner.
-
Magnetic Resonance Imaging (MRI) - This provides the most detailed pictures of the uterus from multiple angles and dimensions.
-
Hysterosalpingography (HSG) - A dye is inserted into the cervix to reach the uterus while performing this test. An X-ray is taken along with the movement of the dye, which shows the size and shape of the uterus.
What Is the Treatment for a Bicornuate Uterus?
In most cases, the bicornuate uterus does not require surgery to correct the condition, as most women do not experience any symptoms. A bicornuate uterus may require surgery in rare cases, like in women experiencing recurrent miscarriages. Metroplasty is a surgical procedure done to correct the bicornuate uterus, which corrects the shape of the uterus to the preferred upside-down pear shape. This surgery is a minimally invasive surgery, which is done laparoscopically. The surgery involves removing the tissue, which causes the indentation or heart-shaped appearance.
Conclusion:
A bicornuate uterus is a rare congenital anomaly that gives a heart-like shape to the uterus and makes pregnancy complicated. In most cases, this condition goes unnoticed until there is a recurrent miscarriage. But in some cases, women do not experience any complications. Only in rare situations, surgery for a bicornuate uterus is recommended. Close monitoring and frequent prenatal checkups can avoid any complications.
