Bicornuate uterus

The bicornuate uterus literally means that the inner part of a woman’s body has two horn-like shapes. The name refers to a problem of congenital formation, that is, to a condition with which one is born. To find out what the bicornuate uterus is and if we are facing an affirmative diagnosis , we can go to a specialist, who will also inform us of the risks , especially during pregnancy.

In fact, this anomaly, which is characterized by presenting this organ in the shape of a heart, is usually detected when the woman becomes pregnant.

However, below we present some of the most important data to know this variation in the shape of the aforementioned female reproductive organ.

What is the bicornuate uterus

Embryologically, the uterus is formed after five weeks of gestation. It begins near the kidney, as two separate structures called horns. It then migrates down into the pelvis when the two horns merge into one.

The fusion area is a septum that divides the two and is reabsorbed to form a normal intrauterine cavity. Sometimes, however, this progression does not occur in the correct way.

The two horns migrate downward, but do not fully fuse to form a normal uterus. The most common abnormality is a septum or septate uterus. It occurs when the uterine horns are completely fused, but the middle septum is not fully absorbed. The uterus appears as two horns internally, but externally it appears to be unified.

A septum may be associated with miscarriages, while a bicornuate uterus is generally associated with an increased risk of preterm birth.

The non-invasive pelvic MRI procedure can differentiate these two conditions and other congenital uterine abnormalities.

Surgical procedures

Both abnormalities can be approached surgically. A septum uterus can be repaired with a one-day procedure called surgical hysteroscopy with septum resection.

On the other hand, a true two-horned uterus can only be approached by a more important surgery, called a Strassman metroplasty , which requires an abdominal incision.

Training

This type of abnormality forms even before a baby is born, while the fetus is forming and developing. The process is known as embryogenesis and any change or malformation that happens during this time will result in its formation.

During embryogenesis, an alteration in the fusion process can change the formation of the paramesonephric or Müllerian ducts . These ducts then develop into the uterine tubes, the cervix, the uterus, and the upper third of the vagina.

The lower part of the uterus remains as a single unit, while the upper part forks.

Diagnosis of this malformation

In many cases, we may not even know we have it and we may have already delivered a healthy child before. However, our doctor can know if we have it or not, by performing the following tests:

Hysterosalpingogram

It is a test that uses the x-ray method to examine the uterus and fallopian tubes. A special type of x-ray, also known as fluoroscopy, is used to perform the exam, along with a contrast material . It is a non-invasive procedure that helps the doctor assess the situation and analyze the best form of treatment.

Hysteroscopy

It is a type of test in which the doctor looks inside the uterus to understand the condition and discover the best treatment. It allows you to reach a proper diagnosis and also look at how to treat any abnormal bleeding problems. To perform a hysteroscopy, the doctor uses a thin, lighted tube. He inserts it into the vagina and examines the cervix as well as the inside of the uterus.

Confirm diagnosis

Your doctor may want to use one or both of the above procedures to determine the diagnosis. However, there is also another three-dimensional procedure using ultrasound or laparoscopy.

The latter is a type of surgical procedure in which a fiberoptic instrument is inserted through the wall of the abdomen. It allows you to see the organs within the abdomen and helps to perform any minor surgery, if necessary.

Need for diagnosis

In cases of multiple miscarriages, it is important to undergo tests to confirm a diagnosis. This condition can be confused with the septum uterus, because it looks the same when diagnosed by imaging, such as X-ray, ultrasound, or HSG.

As we have discussed previously, both conditions are very different from each other. In the case of a septum uterus, it will be round at the top and there will be a single cavity in the uterus. In the case of a bicornuate uterus, on the other hand, the uterus plunges into the upper part and forms a heart shape with two chambers.

The treatment for both is different, so it is important to know with certainty which is the exact condition that we suffer from.

Risks and possibilities

The main health risks occur during pregnancy. The fetus begins to develop in either of the two uterine horns, the bumps located on the top or sides of the uterus.

In about six out of ten cases where a woman becomes pregnant, the pregnancy does not last and results in a miscarriage . Out of four out of ten women who do not experience a miscarriage, a woman ends up having a premature pregnancy.

This makes conception difficult. Even so, if it is achieved, several problems and complications can occur during pregnancy, such as:

Probability of a failed pregnancy

The fetus grows in one of the two protrusions in the upper part of the uterus. As a result, it does not have enough room to grow, which ends in a miscarriage. In a normal uterus, it grows along with the fetus. This does not happen in cases of this type, which means that the fetus cannot grow and form as it should .

The fetus may occupy an abnormal position

If the fetus is able to position itself in the largest part of the uterus, the pregnancy may advance. However, it may be in an abnormal position, such as ass or transverse.

As the pregnancy months continue to progress and the fetus continues to grow, the position will continue to cause more discomfort. About 15-20% of such pregnancies end in premature birth .

Very high risk of miscarriage

At least 50 percent of pregnant women with this type of condition suffer miscarriage .

Premature baby

Almost one in four women with this type of pregnancy and who do not miscarry, give birth to premature babies .

Extra progesterone levels

When we have a uterus with this shape, we need a greater amount of the hormone progesterone to help thicken the walls of this organ or its lining.

Delivery without complications

Although in most cases there are problems such as those mentioned, there are also others in which affected women give birth in an uncomplicated delivery.

Cesarean section instead of vaginal delivery

Your doctor may suggest a cesarean delivery, rather than a natural vaginal one, to reduce the risk of any complications. The baby is likely to arrive on the butt, which can cause many difficulties at birth in case of a normal vaginal delivery.

Symptoms of the bicornuate uterus

Just as each pregnancy is unique and different, so is the physical formation of each woman, including the way the uterus is formed. Thus, the signs and symptoms of this organic abnormality may also differ from one woman to another.

These are some of the most common symptoms:

• Excessive pain with menstruation .
• Pain in the abdomen
• Pain and discomfort during your ovulation days .
• Problems conceiving: As a result of the difficulty you face throughout your menstrual cycle, the ability to conceive is affected as well.

Surgery and treatment options

One of the main solutions is reconstructive surgery , especially if we plan to get pregnant. This is how it is done:

The procedure, also known as a metroplasty , involves an incision to separate the cavity in the uterus. Once this is done, another incision is made in an upright position using a layered closure. The closure will be almost the same as that done as part of a cesarean section.

This condition occurs even before the affected people are born and is not something we have control over. Therefore, if they are diagnosed, we should not feel guilty. It is best to keep in touch with our doctor to clarify what the bicornuate uterus is and, in any case, what is the best possible method to obtain a second and more reliable diagnosis , to know what the risks are and how to treat the bicornuate uterus , about everything, if we want to get pregnant.