Q. What are the precautions to take during pregnancy in case of a bicornuate uterus?

Answered by
Dr. R Balakrishnan Menon
and medically reviewed by iCliniq medical review team.
Published on May 15, 2018 and last reviewed on: Oct 23, 2019

Hello doctor,

My wife is 30 years old and pregnant. This is our first child. We got married four years ago. She got pregnant soon after. But, since we were not ready, we opted for a termination of the pregnancy using a medicine. Now, my wife had undergone a pelvic ultrasound. She has been given three observations: bicornuate uterus, internal os opening is 3.7 mm, and the cervical length is 3.5 cm. In addition, a single live intrauterine fetus with FHR 165 bpm and growth 15 weeks was noted.The doctor said that the internal os should be closed until the end of pregnancy. So, he advised her a complete bed rest and prescribed Proluton Depot 500 mg and Hucog injections. Apart from this, she has been asked to take some medicines. Can you please help with following queries? What is the risk and impact of a bicornuate uterus? The internal os is open by 3.7mm. What is the impact of the same? Is the child at a high risk? I am quite worried about the reports. If the internal os has opened, will it keep increasing or can it close again without manual intervention such as cerclage? Are there any additional precautions or measures that need to be taken. Any information will help.

Dr. R Balakrishnan Menon

Infertility Obstetrics And Gynaecology
#

Hello,

Welcome to icliniq.com.

How are you doing?

  • Uterus usually develops from two horns, which come together and fuse. Over few weeks, the wall in between the two horns gradually disappear, to form a uterus with a single cavity. In your wife's case, it can be bicornuate (when the two horns do not fuse fully) or a septate uterus (when the wall in between does not fully disappear). This cannot be differentiated in just a normal scan as they look alike. It can be diagnosed by 3D scans or MRI or hystero-laparoscopy. But, we do not need to worry about this as both have the same outcome. Had it been diagnosed earlier, the septa could have been corrected, but not bicornuate.
  • Usually, when there are such congenital problems in the uterine formations, there will be a loss of polarity in the uterus, that is, the muscle fibers of the uterus will not act in coordination.
  • Since in your scan, the cervical length is greater than 2.5 cms, that is normal. But, the os has to be closed. There are pregnancies where the os remains open through out pregnancy, and the baby is normally delivered. But, in a lady with uterine problems, there is a risk that it will give way after 18 to 20 weeks of pregnancy. This is because till then, the weight of the baby does not fall on the cervix. But, once the baby reaches 18 to 20 weeks, its weight will be on the cervix, irrespective of the position of the mother.
  • Once it starts opening, it is next to impossible to stop it further and will end in abortion. The membrane exposed to vaginal flora is at a risk of rupturing on its own. So, the pregnancy will have to be terminated. She is also at a risk of delivery at early gestation even if the pregnancy carries on. As the space inside the uterus is compromised by the wall, the baby will start pushing out. Also, towards the delivery date, the presentation of the baby will not be head down, as the baby takes the most spacious place. This will necessitate a cesarean.
  • So, the ideal and proved method is to have a Shirodkar's cervical cerclage. This is done at 14 to 16 weeks at the level of the internal os, the mouth of the uterus and in the inner limit of the cervix. She will need a short hospital stay of 1 or 2 weeks and proper rest for the rest of the pregnancy. It will remain for the entire pregnancy, and once removed, the baby will come out at 40 weeks.
  • Through out the pregnancy, taking a course of antibiotics for three to five days every month will avoid an infection in the vagina. She can continue the injections until 20 weeks and then stop it. She should avoid any infections, especially urinary infection, respiratory infection, and gastroenteritis.
  • Two to three months after the delivery have a 3D scan or MRI (magnetic resonance imaging) to find the exact problem of the uterus. If septate, have it cleared so that in the next pregnancy, you will not have these anxious moments. Hope I have been of help to you. Do write back if any more queries

All the best.

For more information consult an obstetrician and gynaecologist online --> https://icliniq.com./ask-a-doctor-online/obstetrician-and-gynaecologist

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