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

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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.

In your scan, the cervical length is greater than 0.9 inch, that is normal. But, the os has to be closed. There are pregnancies where the os remains open throughout 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 itfurther 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 proven method is to have a 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.