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Pregnancies have their share of unique occurrences that can be rare and unheard of. Sometimes, a woman’s uterus experiences various natural abnormalities which affect its shape and structure. These aberrations often remain unknown to the patient until pregnancy. Among women who are trying to find medical assistance for infertility, one out of thirteen ends up being diagnosed with some kind of uterine malfunction or abnormality. Among these conditions is the bicornuate uterus, something that very few people heard about.
What Is a Bicornuate Uterus?
A bicornuate uterus is a condition which is also known as the heart-shaped uterus. It is a condition wherein the uterus consists of two-horn shaped projections. A septum, which is a kind of partition, separates these two horns.
Bicornuate Uterus Vs. Normal Uterus
A bicornuate uterus is characterised by a cleft on the upper fundus, which gives it a hear shape. This does not necessarily mean that the uterus is split; it is a complete one which is malformed during embryonic development of the woman in her mother’s womb.
A normal uterus is formed in a female foetus during the 5th week of the pregnancy. The formation begins when two unrelated structures called horns move down into the pelvis and fuse together, forming the uterus. The septum indicates the zone of fusion and isolates the two structures. This is later reabsorbed to make an intrauterine cavity. A bicornuate uterus is formed when the horns move into the pelvis, but do not fuse completely. The upper portion dips inward while the lower portion remains normal.
A bicornuate uterus pregnancy is difficult because the foetus begins to develop and grow in either of the two horns or the protrusions situated on the womb (top portion or on either side). Such pregnancies do not last and usually result in a natural abortion.
The seriousness of this condition varies from one woman to another. It can range from mild to severe complications. An incomplete bicornuate uterus is a mild problem, while a severely deformed uterus is riskier. In an incomplete bicornuate uterus, the top portion dips inwards and could hinder the growth of the foetus. In the case of a severely deformed uterus, the top portion dips downwards and divides the uterine cavity into two chambers, making it much harder for the foetus to form properly.
What Are the Causes of a Bicornuate Uterus?
Several complex factors are involved in the development of this condition. Let us have a look at some of the heart-shaped uterus causes:
The bicornuate uterus forms during the development of the foetus. This is the embryogenesis process and any malformations that occur during this process will result in the formation of a bicornuate uterus.
The fallopian tubes, the uterus, cervix, and the upper part of the vagina develop from the paramesonephric ducts. These consist of paired ducts present in the embryo that run laterally to the urogenital ridge. Any modifications during the fusion process affect the formation of these ducts.
The alterations during the formation of the paramesonephric duct result in the upper part of the uterus getting bifurcated, while the lower part does not go through any alterations.
There are multiple symptoms that could indicate bicornuate uterus. Though women experience these symptoms, identifying them before pregnancy can be very hard. Below is a list of the heart-shaped uterus symptoms:
- Abdominal pain
- Irregular, heavy or painful menstrual periods
- Abnormal bleeding
- Painful ovulation
If you experience any of these symptoms, it is advisable to consult a gynaecologist and go through an ultrasound to check for the presence of this condition.
Outcomes of Pregnancy With a Bicornuate Uterus
It is difficult to conceive if one has a bicornuate uterus. If one manages to conceive against the odds, multiple issues and complications can arise during the pregnancy. Here are some of the outcomes when a woman is diagnosed with a bicornuate uterus:
- Struggles in carrying on with the pregnancy
It is quite difficult to have a normal and healthy pregnancy if one suffers from a bicornuate uterus. The condition makes it hard to continue with the pregnancy to a full term as the chances of the foetus developing inside are very less.
- Fewer chances for a complete pregnancy term
A bicornuate uterus is not an ideal condition for a foetus to grow in. A foetus formed in this abnormal environment causes danger to the pregnancy. It also reduces the chances of continuing the pregnancy to its full term. In the case of a bicornuate uterus, the foetus may grow in either of the two horns. Consequently, there is not enough space for the foetus to grow in, and this, in turn, results in miscarriage. A uterus that is shaped normally grows and expands as the foetus develops, unlike the bicornuate uterus which does not grow as the baby grows.
- The foetus may be positioned irregularly
If the foetus gets implanted in the greater section of the bicornuate uterus, the pregnancy could carry on to its full term. Despite this, the position of the unborn child could be abnormal (breech or transverse position).
This is due to the foetus’ inability to position itself into a downward position. With progress in pregnancy, the foetus keeps growing and this unusual position will cause great discomfort to the baby. Consequently, nearly 15 to 20 per cent of such instances result in premature birth.
- Bicornuate pregnancy is a risky one
The doctors will put you on a high-risk alert if you have a bicornuate uterus. They will also monitor you closely to ensure appropriate medical attention for you.
- High probability of bicornuate uterus miscarriage
Nearly half the number of women who are pregnant with this abnormal uterus undergoes a miscarriage.
- High probability of preterm delivery
The chances of delivering a healthy full-term baby are very slim (one out of four women). In the case of premature birth, the baby will be placed in an incubator and will be kept under constant observation for care and treatment if required.
- The abnormally shaped uterus requires an additional amount of progesterone
An abnormally shaped uterus causes problems in the uterine lining. This is one of the main reasons behind a preterm delivery. An abnormally shaped uterus requires higher amounts of progesterone, which will help in increasing the thickness of uterine walls or the lining of the uterus. In most cases, shots are administered to help ease the pain.
- Fewer chances of a successful birth
Being unaware that you have a bicornuate uterus before pregnancy is very common. While the chances of giving birth with a bicornuate uterus are very low, there have been instances where women have delivered healthy babies successfully. In fact, there are possibilities that you might be unaware of your condition and still have a healthy birthing process.
- The progesterone shots need to be administered early in the pregnancy
It is vital to start administering progesterone shots early into the pregnancy, provided the doctor has identified that you have a bicornuate uterus. In most instances, the shots are given from the initial weeks, until about 36 weeks. As you reach the 34th week, your body will reduce the amount of progesterone produced. It is difficult to see your pregnancy till its full term if you have the bicornuate uterus. In such conditions, the additional hormone shots administered to you will help with the pregnancy.
- Prefer a Caesarean rather than the natural (vaginal) birth
Doctors recommend a C-section instead of natural birth in case you have a bicornuate uterus. Opting for the former will help in reducing complications while giving birth. Having this abnormally shaped bicornuate uterus can lead to difficult situations if you go through a normal birthing process as this will make your baby breech.
- Chances of retardation of foetal growth
The unborn child can be affected by a condition in which the foetal growth can be hampered or slowed down in cases of bicornuate uterine pregnancy. In this condition, based on gestational age, your foetus will have extremely low weight as compared to the normal weight it should have. However, this condition does not occur often. In most of the cases, either abortion takes place or the baby is born much earlier.
The initial ultrasound during pregnancy can help detect this condition. Intubation of the uterus cavity is performed when the patient is diagnosed. The shape of the uterus can be recognised during this process and hence a conclusion can be drawn as to whether one does have the bicornuate anatomical structure. A pelvic exam by the gynaecologist or an MRI can also detect the bicornuate uterus.
Doctors also employ hysterosalpingography (HSG) or hysteroscopy to identify a bicornuate uterus. The HSG is an X-ray method that examines the uterus as well as the fallopian tubes. This procedure is a non-invasive one that enables doctors to assess the condition. Hysteroscopy, on the other hand, is an invasive procedure which allows the doctor to examine the cervix, as well as the inner part of the uterus.
A bicornuate uterus ultrasound with the help of a vaginal, abdominal sensor or a laparoscopy is employed to confirm the presence of this abnormality. It is imperative to confirm your diagnosis as could be instances of the condition being misdiagnosed. You could also have a condition known as the septate uteri, which is commonly mistaken for a bicornuate uterus. Although both these conditions look the same, the treatment for each varies greatly. It is always better to take a second opinion then receive the appropriate treatment.
Bicornuate Uterus Treatment
Doctors recommend reconstructive surgery if you have a bicornuate uterus but wish to plan a pregnancy. The bicornuate uterus surgery is also known as metroplasty, and it corrects the structure of the uterus:
- The doctor first makes an incision in order to separate the cavity in the uterus.
- Once the cavity is separated, the doctor uses a layered closure and makes another incision in a vertical position.
After a successful surgery, the mother-to-be should wait for the wound to heal completely before trying to get pregnant. It usually takes between three to five months for a complete recovery from the surgery.
The most important thing one can do to keep the uterus healthy is to maintain its strength, circulation, and position. One will need to keep the uterus in the best condition if one is already planning a pregnancy or facing labour and birth with an abnormally shaped uterus.
It is very important to consider your options and plan well in advance if you are trying to conceive with an abnormally shaped uterus. This will give you better chances to experience a healthy pregnancy, labour, delivery, and a healthy baby!