Overview
A bicornuate uterus is a uterine malformation that develops when the Mullerian duct’s ability to fuse is compromised. Although the bicornuate uterus is a rare defect, it is linked to poorer reproductive outcomes. The most frequent symptoms are recurrent pregnancy loss and preterm labour.
A bicornuate woman’s uterus has a pear-like shape. It is approximately 3 inches long, 2 inches wide and 1 inch deep while they are not pregnant.
The baby develops in the fundus, the top part of the uterus, throughout pregnancy. A small opening known as the cervix is made when the lower portion of the uterus enters the vagina. For the infant to pass through during delivery, this opening enlarges.
Congenital uterine abnormalities can develop in some women at birth. A uterine anomaly that resembles a heart is called a bicornuate uterus. Two horns that link to the fallopian tubes protrude from the top of the fundus, which is indented sharply.
The bicornuate uterus may have a significant impact on the ability to conceive and have a healthy pregnancy. Congenital uterine anomalies occur in some women from birth, whereas post-operative complications or prior infections can cause uterine issues.
Types of bicornuate uterus
Partial bicornuate uterus
A uterus that is only partially bicornuate has less separation between its two compartments. Although the indentation that divides the uterus is still heart-shaped, it is not as sharp.
Complete bicornuate uterus
A complete bicornuate uterus is one that has a strong indentation at the top, which clearly separates the uterine chamber.
Symptoms of bicornuate uterus
Frequent miscarriages
A bicornuate uterus can cause difficulties in getting pregnant or maintaining pregnancy.
Although just 0.4% of persons have a bicornuate uterus in the general population, those who have experienced several miscarriages are more likely to have one.
A bicornuate uterus is present in 2.1% of people who have experienced repeated miscarriages.
Vaginal bleeding
A longitudinal vaginal septum, commonly known as a double vagina, is something that about one-fourth of women with bicornuate uterus have. This indicates that a tissue wall separates their two vaginal chambers. If so, a person could still bleed from the other cavity while using tampons.
Painful menstruation
Blood flow through the cervix can be difficult for a woman with a bicornuate uterus, which could lead to increased and worsened pain.
Painful intercourse
The irregular and tilted uterus in some women might occasionally make sex penetration difficult.
Pelvic pain
Some women with bicornuate uterus experience pain in the pelvic region, especially during menstruation or while having sex.
Complications of bicornuate uterus
Bleeding
The majority of patients with a bicornuate uterus are asymptomatic during adolescence. Due to the presence of two uterine cavities, some adolescent girls may experience menorrhagia or dysmenorrhea.
Also, early in pregnancy, women with bicornuate uteruses can experience mild vaginal bleeding due to hormone-induced thickening and bleeding of the endometrium in the opposite horn of the womb.
Uterine adhesions
Injury or infection to the endometrium causes damage to the lining and the development of adhesions (scar tissue) between the inner uterine walls, where the walls abnormally attach to one another.
Miscarriage, premature labour, third-trimester haemorrhage or aberrant placental attachment are more likely to complicate pregnancies that occur following treatment. The nature and severity of the adhesions have an impact on the likelihood of a successful post-treatment pregnancy.
Birth defects
Congenital abnormalities are four times more likely to occur in children of women with bicornuate uterus than in children of mothers with a normal uterus.
Diagnosis of bicornuate uterus
Ultrasound
Ultrasound is primary imaging carried out when a patient initially comes for diagnosis. It is non-invasive and radiation-free.
Coronal views are the most important as they reveal information about the endometrial pit and serosal surface of the uterus.
Due to the endometrium’s thickness and echogenicity, which can aid in precisely separating the bicornuate uterus, the ultrasound should be performed during the secretory phase of the menstrual cycle.
The uterus is categorised as bicornuate if the indent is greater than 10 mm.
MRI scan
MRI is the best quality level for determining the bicornuate uterus as it is non-invasive and provides pictures in multiple planes.
It can provide information about the anatomy of the uterine structure and fundal surface, the vagina, the cervix and the entire pelvis.
By examining the tissue between the two horns, the distinction between the bicornuate and didelphys uterus is completed. The uterus is bicornuate if tissue is present.
Hysterosalpingography
Hysterosalpingography is the most established and widely used technique for determining infertility.
During hysterosalpingography, an oil or water-based contrast is infused through an endocervical catheter into the uterine cavity. This contrast opacifies the uterus and will portray the endometrial orifice of the uterus.
Under fluoroscopic direction, different pictures of the uterus and uterine tubes are taken. If two horns of the uterus are evident with an intercornual point of more than 105 degrees, it is termed the bicornuate uterus.
Treatment for Bicornuate uterus
Although most women do not require surgery to fix a bicornuate uterus, it can be corrected surgically. Those who have experienced a miscarriage in the past may undergo surgery.
A Strassman metroplasty is a procedure used to treat the bicornuate uterus and is often carried out laparoscopically. The uterus’s horns are separated by any aberrant tissue, and the form is corrected using stitches.
When to see a doctor?
Women having irregular vaginal bleeding or pelvic pain during menstruation or sex are advised to speak with their healthcare provider. These uterine bicornuate symptoms signify the necessity to visit a doctor.
Conclusion
A bicornuate uterine patient may experience several undesirable problems.
Preterm labour is the bicornuate uterus’s most frequent consequence. A woman with a bicornuate uterus may visit the clinic complaining of repeated miscarriages. As an uncommon anomaly, a gynaecologist’s job is to educate the patient about her diagnosis and inform her of any associated consequences.
Women who repeatedly lose their pregnancies may endure anxiety or depression. In this situation, the psychiatrist has a crucial role to perform.
FAQs
Can you carry full term with a bicornuate uterus?
Is it difficult to get pregnant with a bicornuate uterus?
What do I need to know about the bicornuate uterus?
If a woman is pregnant and has a bicornate uterus, the pregnancy will be treated as high risk as it increases the risk of miscarriage later in the pregnancy.
