What is a bicornuate uterus? A uterus is supposed to have only one chamber. When it has two chambers or horns, it is known as bicornuate uterus. It is the result of fusion anomaly of the Müllerian ducts during embryogenesis. Such heart-shaped or Y-shaped uterus may or may not affect the ability of the woman to become pregnant and give birth.
Normally, when the embryo is 10-18 weeks of a gestational age, the paired Müllerian ducts fuse in the midline to form the uterine cavity, cervix, fallopian tubes, and two-third of the vagina. If the fusion occurs incompletely, and creates two separate chambers right above the internal os level (part of the cervix, which forms the neck of the uterus), a heart-shaped uterus is formed. The paramesonephric ducts (or Müllerian ducts) fuse near their juncture with the posterior wall of the primitive urogenital sinus to form the uterus and the superior end of the vagina. Bicornuate uterus is estimated to have an incidence of 0.6% all over the world.
Bicornuate Uterus Complications
A Y-shaped uterus occurs when the improper fusion of the Müllerian ducts is restricted to the superior portion of the uterine body.
As a result, a constricted environment is produced, which can further lead to anomalousness of the limbs. It may be due to both the compression of the fetus by the uterine wall, and the indirect consequence of the disrupted circulation of fluid due to vascular constriction.
The woman with bicornuate uterus may require one intrauterine device (IUD) with copper or IUD with progestogen in each horn.
Malpresentation (breech birth - feet first or transverse presentation) is noticed in most women with Y-shaped uteri.
The condition may lead to miscarriage in the first trimester.
Depending on the exact nature of the abnormality (degree of fusion), it may be difficult for the woman to carry her baby for the full nine months of pregnancy. The condition may lead to preterm labor. The rate of preterm delivery is 15 to 25%.
It may cause urinary system disorders such as exstrophy (inversion of a hollow organ like urinary bladder at birth), and renal and cloacal abnormalities.
Bicornuate uterus may or may not cause infertility, but it may make pregnancy difficult.
Symptoms of Bicornuate Uterus
It is possible to have a Y-shaped or heart-shaped uterus without knowing it. In fact, most women come to know about the abnormality, when they try for a baby. Bicornuate uterus symptoms may include:
- Heavy or irregular menstruation
- Abdominal pain, cramps
- Painful ovulation
Bicornuate Uterus Diagnosis
The woman is usually asymptomatic for this particular medical condition. The uterine abnormality is mostly detected during pregnancy or childbirth. This is the reason why it remains undetected and untreated till the woman gets pregnant. The diagnosis of the bicornuate uterus involves a number of tests. Some of the commonly used techniques are mentioned below.
Pelvic Exam: The diagnosis of the uterine abnormality starts with the examination of the pelvis. The physical examination may reveal a palpable mass at the location of the uterus, which may demand further investigation.
Laparoscopy: Laparoscopy is a minimally invasive surgery, wherein a small cut is made in the abdominal cavity to insert an instrument called laparoscope so as to see the internal structures on a screen. In case of bicornuate uterus, it is used to gather information about the exterior shape of the uterus.
Gynecologic Sonogram: Gynecologic sonogram is an imaging technique which uses ultrasound to assess the structure of a developing fetus.
Hysteroscopy: Hysteroscopy is a diagnostic procedure in which a viewing tube in inserted into the vagina, through the cervix, and into the uterus to examine internal anomalies.
Hysterosalpingography (HSG): Hystero means uterus while salpingo means tubes. Thus, the literal meaning of the term hysterosalpingography is taking photographs of the uterus and fallopian tubes. It is also referred to as hysterography. An X-ray test helps examine the inside of uterus and fallopian tubes, and the surrounding area.This diagnostic technique provides almost confirmatory information about the abnormal uterus.
Bicornuate Uterus Treatment
A corrective surgery called metroplasty (also known as uteroplasty or hysteroplasty) may be advised in certain cases. It is a type of plastic surgery or reconstructive surgery on the uterus. It is generally recommended only in women experiencing recurrent pregnancy loss. Although the pregnancy outcome improves after corrective surgeries, there is an increased risk of uterine punctures.
It can be concluded that a bicornuate uterus does not affect fertility, but may affect the pregnancy outcome. There are many examples of women with heart-shaped uterus giving birth to healthy babies. In fact, there was a report of a woman with bicornuate uterus giving birth to fraternal twins. It should be noted that women with a heart- or Y-shaped uterus can have children. However, these pregnancies are considered high-risk, and special care and medical attention is provided in order to avoid miscarriages and complications. A woman with uterine abnormalities needs extra monitoring during pregnancy.
Disclaimer: This HerHaleness article is for informative purposes only, and should not be used as a substitute for professional medical advice.