What Is Unicornuate Uterus?
A unicornuate uterus is a rare congenital abnormality in which the uterus is smaller than a normal-sized uterus, with only one functioning fallopian tube (instead of two). In a typical female, the uterus resembles an upside-down pear. The uterus has a hollow cavity where a baby grows and is connected to two fallopian tubes. The fallopian tubes are at the top and on either side of the uterus. These tubes are responsible for commuting eggs from the ovaries to the uterus during ovulation. A typical uterus has the appearance of an upside-down pear.
During fetal development, the Mullerian ducts fuse together to form the uterus, while the upper part forms the fallopian tubes. If there are any issues during the duct development, it may result in a unicornuate uterus that looks like a single-horned uterus. This disorder is not detected until later in life. About one in 4,020, women have a unicornuate uterus. Women with a unicornuate uterus rarely have noted a second smaller remnant of a uterus, called a hemi-uterus, which may or may not be connected to the rest of the uterus. If a hemi-uterus is present, then surgical removal of the hemi-uterus is needed as it can block the flow of the menstrual blood and cause pain.
What Can Be the Cause of the Unicornuate Uterus?
Research estimates that in all women with reproductive tract abnormalities, about 0.1 percent of women have a unicornuate uterus. Sadly, the exact cause of this abnormality is not found. Hence, the potential risk factors to prevent this from occurring are also unknown. Some researchers believe that it is a congenital condition and happens due to an abnormal formation of the Mullerian duct or paired duct of the embryo.
What Are the Symptoms of the Unicornuate Uterus?
Usually, people with a unicornuate uterus do not experience any symptoms before puberty, especially if it is a hemi-uterus with a functional endometrium and a small cavity that connects with the uterus and the vagina and carries out the menstrual fluid. About 65 percent of women with unicornuate uterus experience conditions that may remain undetected until the woman finds it difficult to get pregnant. In some women, there will be no connection between the horn and the uterine cavity, which can lead to the following health issues:
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Chronic Pelvic or Abdominal Pain - When the functioning horn is solid and isolated from the rest of the uterus, the menstrual fluid builds up and cannot drain out through the vagina leading to the chronic abdomen or pelvic pain.
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Hematometra - This can occur when the menstrual blood gets accumulated or is retained in the uterus because it is unable to drain through the vagina, causing symptoms like abdominal cramps, urinary retention, and frequent urination.
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Pregnancy-Related Issues - Miscarriage, premature birth, and breech position.
How Are Uterine Abnormalities Diagnosed?
If a patient presents with symptoms, a healthcare provider will take a health history and perform a physical exam. Additionally, a pelvic examination will also be performed to rule out other potential causes. Following this, a few imaging and other tests will be advised for better understanding and confirmation, which includes:
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Laparoscopy - In this procedure, small keyhole incisions are made to insert small instruments with cameras and light to visualize the abdominal cavity, including the uterus and associated structures.
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Hysterosalpingogram - A dye is inserted into the uterus through the cervix, and then X-rays are taken to look at the uterus and associated structures.
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Hysteroscopy - In this procedure, a tiny telescope is inserted into the uterus through the cervix to visualize the uterus and detect any abnormalities.
Does the Unicornuate Uterus Affect the Pregnancy?
Women with unicornuate uteruses can have successful pregnancies. If they have a functional ovary, uterus, and fallopian tube, then pregnancy without any assistance is possible. However, in many cases, it poses a difficult time conceiving, and many bring challenges during pregnancy, like miscarriage, growth retardation, placental abruption, placental pervia, premature labor, breech positioning, and may require emergency C-section (cesarean section). If conceiving is difficult, assisted reproductive technology (ART) may be helpful. Treatments like in vitro fertilization (IVF) or intrauterine insemination are commonly followed treatments that help conceive a child. Once pregnant, regular prenatal care is a must as it is considered a complicated or high-risk pregnancy. And the health care professionals will carefully monitor the progress of the pregnancy.
What Is the Treatment for the Unicornuate Uterus?
There are surgical and non-surgical procedures to manage the condition, and healthcare professionals choose the required treatment depending on the health and situation of the patient. Usually, the following treatments are followed:
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Cerclage or Cervical Stitch - In this procedure, the cervix is sewn and closed during pregnancy, or a cervical ring or pessary is placed in case of cervical shortening. This treatment is recommended for women with a repeated history of miscarriages, incompetent cervix, and premature delivery due to a unicornuate uterus.
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Laparoscopic Surgery - This treatment helps remove an isolated hemi-uterus in patients who experience abdominal pain due to the accumulation of menstrual blood in the hemi-uterus that cannot flow out.
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Emergency Delivery - Pregnancy is possible in women with unicornuate uterus. However, this involves a greater risk to pregnant women. So, the healthcare provider may recommend more frequent pre-visits and ultrasounds to monitor the baby’s growth because a critical situation can occur in any situation due to the smaller uterus that has a high chance for rupture due to space constriction for the growth of the baby by the end of the second trimester. Utmost care should be taken to avoid risks for both the mother and the baby.
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Non-surgical Intervention - Non-surgical intervention is recommended unless the patient experiences any pain or a pelvic mass. If the hemi-uterus is solid and non-functioning, it does not require surgical removal.
Conclusion:
Uterine abnormalities like the unicornuate uterus are rare congenital anomalies. Usually, these abnormalities get unnoticed till their teenage, but after puberty, some women experience abdominal pain due to the accumulation of menstrual blood in the uterus. Conceiving a baby with a unicornuate uterus is also a hard task; many complications may accompany it. But advancement in medicine has made it easy; with proper treatment and care, pregnancy and childbirth are possible with a unicornuate uterus.
