Definition
Bicornuate Uterus (also called heart-shaped uterus), is a congenital (present at birth) condition where the uterus has two cavities (spaces) instead of one large cavity. Most women with this condition don’t need surgery to repair it.
A bicornuate uterus consists of two symmetric uterine horns unified by caudal fusion. Both endometrial cavities communicate with the vagina either through a single uterine cervix (unicollis, most frequent) or through two uterine cervices (bicollis, less frequent). The occurrence of cervical atresia with the bicornuate uterus is rare. Patients may present with pelvic pain due to hematometra and retrograde menstruation from a non-communicating uterine horn. Treatment options are controversial and include hysterectomy or uterovaginal canalization with the principal goal of relieving the symptoms and preserving fertility.
Epidemiology of Bicornuate Uterus
The bicornuate uterus has a prevalence of 0.4% in the general population. A 2011 review shows that bicornuate uteri are more prevalent and certainly not uncommon, in women with infertility (1.1%). It is often asymptomatic before puberty and thereafter has a significant association with infertility and miscarriage.
Causes of Bicornate Uterus
- The bicornuate uterus is mainly caused by the abnormal fusion of mesonephric ducts (Mullerian ducts) that happens during embryogenesis in the first few months of pregnancy which leads to this congenital malformation.
- Normal development of Mullerian ducts depends on organogenesis, fusion, and septal resorption. Organogenesis is characterized by a fusion of both the ducts, failure in this process leads to uterine agenesis/hypoplasia or unicornuate uterus.
- Fusion is characterized by fusion of the ducts to form uterus, failure in this process leads to the bicornuate or didelphys uterus. Septal resorption is of the central septum once the fusion of ducts is complete, failure in this process leads to the septate or arcuate uterus.
- The Wolffian body and Muller’s duct plays an important role in the development of a reproductive system of the female. The time at which the arrest in the development takes place determines the degree of abnormality in the reproductive system. The arrest in the 12th week of development and the non-fusion of Mullerian ducts leads to duplication of the uterus. If the fusion happens shortly after this period of gestation, it results in a bicornuate uterus.
Symptoms of Bicornuate Uterus
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 symptoms:
- Abdominal pain
- Irregular, heavy or painful menstrual periods
- Abnormal bleeding
- Painful ovulation
- Infertility
- Miscarriage
If you experience any of these symptoms, it is advisable to consult a gynecologist and go through an ultrasound to check for the presence of this condition.
Complications of Bicornuate Uterus
Women do not even realize that they have a bicornuate uterus until they get pregnant. The misshapen uterus does not signify infertility but there could be complications in a pregnancy. It could become difficult getting pregnant in the first place. If you become pregnant, there could be complications. The severity of the complications will depend on the severity of the malformation of the uterus.
Risk conceiving: Usually women with a bicornuate uterus have difficulty in conceiving.
Miscarriage: In cases where women are successful in conceiving, there is a big risk of miscarriage. This is because there is not enough room for the baby to grow. A normal uterus expands to accommodate a growing baby, but in this case, the uterus cannot expand enough.
Preterm delivery: There are chances that the baby could be delivered prematurely.
Breech baby: The baby could be breech because it will not have enough room to fit comfortably in a head down position.
The placenta could be trapped or retained inside.
The baby could have birth defects as the misshapen uterus might not allow the baby to grow normally. There is also a risk that the baby might not be able to survive after birth.
Spontaneous abortion: There could be a spontaneous abortion.
C-section: In most cases where there is a bicornuate uterus the doctors will suggest a C section delivery so as to minimize the difficulties of vaginal delivery.
Diagnosis and test
Hysterosalpingogram (HSG) – This uses x-ray method to examine the uterus and patency of fallopian tubes. Fluoroscopy is used to carry out the examination along with contrast material.
Hysteroscopy: It is done by inserting a hysteroscope to view the insides of the uterus.
Ultrasound: The pelvic ultrasound provides a better picture of the uterus and pelvic organs.
Laparoscopy: This is a type of surgical procedure in which the doctor will insert a fiber optic instrument through the wall of the abdomen and this surgery helps in diagnosis of the bicornuate uterus and perform if any minor surgery is required.
The correct diagnosis is very important, to differentiate between the septate uterus and bicornuate uterus as the treatment options for these two conditions are different.
Treatment and medications
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.
- The closure of the incision will be similar to the one that is done in a cesarean operation.
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 labor and birth with an abnormally shaped uterus.