Pregnancy has its share of unique things, with unheard of and incredible conditions to face. One condition that you’ve probably never heard of, but which can occur, is the bicornuate uterus pregnancy.
What is condition? What causes it? Read the post below. MomJunction has put together some relevant information to help you understand all about bicornuate uterus pregnancy.
What is Bicornuate Uterus?
A bicornuate uterus pregnancy, or a bircornuate uterus, is a scientific term derived from Latin. It means ‘horn.’ The bicornuate uterus is also called a heart shaped uterus, in which case the uterus is made up of two shapes that look like horns and are separated by a septum. The bicornuate uterus has a protrusion on the top, and on both sides of the womb. The protrusion makes the uterus appear more like a heart-shaped organ. However, if you have a bicornuate uterus, it does not mean that you have a split uterus but a complete uterus, which did not form properly.
Causes Of Bicornuate Uterus:
A bicornuate uterus is a congenital uterine malformation (mullerian duct abnormality). It is not unnatural for women to have abnormalities in the uterus. But in most cases, these abnormalities are undetected until a woman becomes pregnant. A woman with a bicornuate uterus, who is trying to conceive, need not feel that the anomaly is because of her lifestyle and health choices. It rarely is that simple. Here is a look at what leads to a bicornuate uterus:
- A bicornuate uterus forms even before a baby is born, while the fetus is forming and developing. The process is known as embryogenesis, and whatever changes or malformations happen during this time will result in the formation of the bicornuate uterus.
- During embryogenesis, an alteration in the fusion process can change the formation of the paramesonephric duct. These ducts later develop into the uterine tubes, the cervix, the uterus, and the upper one third part of the vagina.
- The alteration that occurs during the paramesonephric duct, the lower part of the uterus remains unitary (meaning it forms as a single unit) while the upper part gets bifurcated (meaning it develops into two different units).
Bicornuate Uterus Pregnancy:
A bicornuate uterus pregnancy is a situation in which the fetus begins to develop in any one of the two uterine horns, the protrusions situated on the top, or by the sides of the womb.
In around six out of ten cases where a woman gets pregnant even when she has a bicornuate uterus, the pregnancy does not last and results in a spontaneous abortion. Out of four out of ten women who don’t experience a spontaneous abortion, one woman ends up having a preterm pregnancy.
Bicornuate Uterus Pregnancy Outcomes:
A bicornuate uterus will make it difficult for you to conceive. However, if you do manage to conceive, there are several problems and complications it can cause on your pregnancy. Here are a few things you should keep in mind if you want to understand the way your pregnancy may shape up if you have a bicornuate uterus:
1. Difficulty In Holding On To The Pregnancy:
If you do have a bicornuate uterus, it can be quite difficult for you to hold on to your pregnancy or to go through your pregnancy in a healthy and regular way.
2. Less Chance That The Pregnancy Will Reach Its Full Term:
When you have a bicornuate uterus, it means that the uterus is shaped like a heart. It is not the ideal way for your unborn baby to develop in, and hence, can cause a lot of risks to your pregnancy, as well as reduce the chances of the pregnancy reaching full term. In the case of a bicornuate uterus pregnancy, your unborn baby will grow in one of the two protrusions on the top of the womb. As a result, your unborn baby will not have enough space to grow in, which will result in the miscarriage. In a normal shaped uterus, the uterus will grow as the unborn baby grows. But when you have a bicornuate uterus pregnancy, the uterus will not grow along with the baby’s growth, which means the unborn baby will not be able to grow and form as it should.
3. The Unborn Baby May Have An Abnormal Presentation:
If your unborn baby manages to implant itself in the larger part of your uterus, you may still be able to carry your pregnancy to full term. However, your unborn baby may be in an abnormal position, such as a breech position or a transverse position as it will be difficult for your baby to fit into a head downward position. As the months of pregnancy keep progressing and as your unborn baby keeps growing, the position will keep causing more and more discomfort. As a result, almost 15 to 20 percent of such pregnancies will result in a pre-term birth.
4. The Pregnancy Will Be Considered As High-Risk :
In the case of a bicornuate uterus, your doctor will place you on a high-risk pregnancy alert and will also keep you under close supervision to make sure that things are handled with the right care and medical attention.
5. There Is A Very High Risk Of Miscarriage:
At any given time, at least, 50 percent of women who get pregnant with a bicornuate uterus go through a miscarriage.
[ Read: Miscarriage Causes And Symptoms ]
6. Very Common To Have A Preterm Baby:
If you have a bicornuate uterus pregnancy and do not miscarry, the chances are high that you will have a preterm baby. Almost one out four pregnant women who have a bicornuate uterus and who do not miscarry, give birth to preterm babies. In case the baby is born too premature, your doctor will place your newborn in the incubator and supervise for any care or treatment.
[ Read: Risk Factors For Preterm Labor ]
7. The Different Shape Of The Uterus Requires Further Levels Of Progesterone:
When you have a uterus which is shaped differently from the way a uterus is naturally shaped, it creates some problems to the lining of the uterus. It is one of the biggest reasons which make the pregnancy result in a preterm birth. When you have a differently shaped uterus, you need a higher amount of the hormone progesterone to help thicken the walls of your uterus, or the lining of the uterus. In many cases, your doctor will try and give you shots that will help to add more progesterone and help you experience a full term pregnancy.
8. It Is Possible You May Not Be Aware Of The Condition Yet Give Birth Successfully:
While it seems that if you have a bicornuate uterus, you will not be able to give birth, there have been many instances where women have successfully given birth to healthy babies. In fact, you may not always even be aware of the fact that you do have a bicornuate uterus and give birth too.
9. All Progesterone Shots Should Be Given Early:
If your doctor finds out that you do have a bicornuate uterus and that you will need shots of progesterone, it is important to start the treatment as early as possible. In most cases, your doctor should start giving you the progesterone shots from the earliest weeks of your pregnancy, until about you are 36 weeks into the pregnancy. By the time you will reach your 34th week of pregnancy, your body will start to produce lesser amounts of progesterone. If you have a bicornuate uterus, you will find it difficult to hold on to your pregnancy till the end of the full term. In such a situation, the additional shots of progesterone that your body will receive for the past months will come in help.
[ Read: Progesterone During Pregnancy ]
10. Going For A Cesarean Instead Of A Vaginal Birth:
In case you have a bicornuate uterus, your doctor will also suggest that you go for a cesarean delivery instead of going for a natural vaginal birth. Going for a cesarean birth will help to reduce any complications related to the birthing process. Also, having a bicornuate uterus will make your baby breech, which can cause a lot of difficulty at the time of birth in case of a vaginal birth.
11. The Baby May Be Affected With Fetal Growth Retardation:
In case you do go on with the bicornuate uterus pregnancy, there is a high chance that your unborn baby can get affected with a condition known as the fetal growth retardation. It is a condition in which your unborn baby will have less than ten percent of the total weight a fetus should have based on the gestational age. However, it is not a common occurrence. In most cases, the baby will either not be able to survive, or will be born very early.
Symptoms Of Bicornuate Uterus:
Just as each pregnancy is unique and different, every woman’s physical formation is also different, including the way your uterus is formed. In a similar way, the signs and symptoms will also differ from woman to woman if they are having bicornuate uterus.
Here are some of the most common bicornuate uterus symptoms:
- Excessive pain when you have your monthly cycle – you may experience severe pain during your menstrual cycle which can often cause a lot of discomforts too.
- Pain in the abdomen
- Pain and discomfort during your days of ovulation
- Problems in conceiving – as a result of the difficulty that you face through your menstrual cycle, your ability to conceive also gets affected. In case you can conceive even after you have a bicornuate uterus, you may find it medically difficult to hold on to the pregnancy. In such a case, your doctor will consider your pregnancy as a high-risk pregnancy.
[ Read: High Risk Pregnancy ]
Diagnosing A Bicornuate Uterus:
In many cases, you may not even be aware that you have a bicornuate uterus and may already have given birth to a healthy child earlier. However, your doctor can come to know whether or not you have a bicornuate uterus by carrying out the following tests:
1. Hysterosalpingogram (HSG):
Your doctor can conduct a hysterosalpingogram (HSG) examination. It is an examination that uses the X-ray method to examine your uterus as well as your fallopian tubes. A special type of X-ray also referred to as the fluoroscopy, is used to carry out the examination, along with a contrast material. It is a non-invasive procedure which will help your doctor to assess the situation and discuss the best way of treatment.
A hysteroscopy is a type of examination in which your doctor will look inside your uterus to understand the condition and find out what will be the best method of treatment. It will allow your doctor to reach a proper diagnosis and will also allow him or her to look for, as well as treat any issues of abnormal bleeding. To perform a hysteroscopy, your doctor will use a thin and lighted tube which is known as the hysteroscope. Your doctor will insert it into your vagina and examine your cervix, as well as the inner part of your uterus.
3. Confirming The Diagnosis:
It is possible that your doctor may want to use one of the above or both the procedures mentioned above to look whether you have a bicornuate uterus condition. However, in addition to the procedure that your doctor will choose, your doctor will also use another three-dimensional procedure using either an ultrasound or a laparoscopy. A Laparoscopy is a type of surgical procedure in which your doctor will insert a fiber optic instrument through the wall of your abdomen. It will allow your doctor to view the organs inside your abdomen and will also help your doctor to carry out any minor surgery if it is required.
Why Should You Confirm The Diagnosis In Case Of Multiple Miscarriages?
If you have been pregnant a few times and have gone through multiple miscarriages, it is important that your doctor first confirms the diagnosis procedures that are mentioned above.
- In many cases, it is possible that you are suffering from a condition known as septate uteri, which can also be misdiagnosed as a bicornuate uteri condition. Both the conditions tend to look the same in the case of imaging diagnosis treatments, such as X-ray, ultrasound or HSG.
- However, both the conditions are very different from each other. In the case of a septate uterus, it will be round on the top and there will be a single cavity in your uterus. In the case of a bicornuate uterus, your uterus will dip on the top part and will form into a heart shape which will have two cavities.
- The treatment for both the uterine malformation conditions is different, so it is important that your doctor first knows for sure what the exact condition is that you are suffering from.
- If you have a bicornuate uterus, your doctor may suggest you go for a reconstructive surgery (as discussed below). In case you have a septate uterus condition, your doctor may suggest hysteroscopic surgery.
- Also, if you have a bicornuate uterus, it may not lead to as many miscarriages as are caused in the case of a septate uterus.
It is possible that you have had multiple miscarriages in the past, but your doctor has diagnosed it as a bicornuate uterus condition after using some method that involves an imaging study. However, you can always go for a second opinion by speaking to a specialist and confirm the diagnosis, as it will help you choose the best possible treatment option.
Surgery And Treatment Options For Bicornuate Uterus:
If you are diagnosed with a bicornuate uterus, your doctor will suggest you go for reconstructive surgery, especially if you are planning to get pregnant. Here is how reconstructive surgery will be performed if you have a bicornuate uterus:
- The procedure of reconstructive surgery is also known as metroplasty.
- To carry out the procedure, your doctor will first make an incision that will help to separate the cavity in the uterus.
- Once that is done, your doctor will make another incision in a vertical position by using a layered closure.
- The closure will be almost same to the one that is done as part of a cesarean operation.
[ Read: Uterine Fibroids During Pregnancy ]
Things To Keep In Mind About A Reconstructive Surgery:
Before you are taken in for reconstructive surgery, your doctor will take care of the following steps:
- Your doctor will perform a complete examination to make sure that you do in fact have a bicornuate uterus.
- Once you are through with the surgery, your doctor will ask you to wait for at least three months before you try and conceive. Your body will need that much amount of time to heal from the surgery and get back to its previous state. It is important that you do keep the three-month rule in mind, as in case you do get pregnant before that, it could lead to internal bleeding as well as other complications.
- In case you do end up getting pregnant before the three months post your surgery are up, you will be at a high risk of suffering from a uterine rupture at the time of labor. It is a fatal condition and can lead to the loss of the baby, as well as cause serious complications and issues to the mother.
Remember that a bicornuate uterus pregnancy is a condition that happened even before you were born and is not something you have control over. If you are diagnosed with the same, do not stress and worry about why it happened. Instead, speak to your doctor about it and see the best possible method to diagnose and treat the same. Follow your doctor’s advice about the various pregnancy dos and don’ts in such a condition to make sure both you and your unborn baby remain healthy and safe.
Moms, did you experience bicornuate uterus pregnancy, or know of someone who did? If yes, do share the experience and care advice here to help out other women who may be going through the same.
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