A bicornuate uterus is a rare abnormality where the womb is not pear-shaped but instead heart-shaped, with a deep indentation at the top. Often described as a womb with two horns, it is caused by a defect in the fusion of the Mullerian ducts (primary structures that form reproductive and urinary systems) in the fetus during pregnancy.
While a bicornuate uterus does not necessarily cause infertility, it may increase the chance of complications during pregnancy for mother and baby, such as recurrent pregnancy loss, premature labor, malpresentation, breech presentation, and low birth weight.
These complications occur because the baby does not have enough space to grow in a bicornuate uterus. Irregular uterine contractions may also occur during labor because of the uterus’ improper shape.
Nearly 3% of women have uterine irregularities in size, shape, or structure. And although bicornuate uteruses are rare, it is one of the most common conditions among uterine irregularities.
What are different types of bicornuate uterus?
A bicornuate uterus is classified into two types depending on the division of the cervix:
- Bicornuate unicollis uterus: The indentation that starts at the top of the uterus reaches only half of the uterus. Though it appears to have two uterine cavities from the outside, there is only one cavity inside.
- Bicornuate bicollis uterus: The indentation that starts at the top of the uterus reaches the bottom of the uterus and divides the uterus into two cavities and presents as two uteruses, although it is a single uterus.
What are the symptoms of a bicornuate uterus?
Women with a bicornuate uterus may not experience any symptoms. Asymptomatic women are first diagnosed with the condition after having an ultrasound or other imaging tests of the abdomen.
However, a few women with bicornuate uterus may experience the following symptoms:
- Abdominal pain and discomfort
- Pain during the period (dysmenorrhea)
- Abnormal and irregular vaginal bleeding
- Pain and discomfort during intercourse
- Frequent miscarriages
Young women without any uterine abnormalities may experience these symptoms as well, so diagnosis should not be made solely based on symptoms.
How is a bicornuate uterus diagnosed?
Women may be diagnosed during a routine ultrasound scan when they are pregnant or if they are experiencing symptoms. Women with irregular bleeding, repeated miscarriages, and painful periods should see a doctor.
Investigations that help diagnose a bicornuate uterus include:
- Pelvic examination
- Hysterosalpingogram, during which special dye is injected into the uterus, and X-rays are used to take images of the uterus and fallopian tubes (this imaging technique shows any deformities in the womb)
- High-frequency ultrasound waves are used to create the outlines of the uterus and its contents.
- Strong magnetic fields and radio waves are used in magnetic resonance imaging (MRI) to provide detailed images of the uterus
What is the treatment for a bicornuate uterus?
The only treatment option for a bicornuate uterus is surgery, although most women will not require surgery to correct a bicornuate uterus.
Strassman’s metroplasty may be done to repair a bicornuate uterus in a woman who has a history of miscarriage. Laparoscopic Strassman's metroplasty is less invasive than abdominal Strassman's metroplasty. Though Strassman's metroplasty is an invasive procedure, abdominal Strassman's metroplasty has been found to be more beneficial because it increases the number of successful deliveries.
In one study, 88% of individuals who underwent a Strassman’s metroplasty had successful pregnancies and gave birth to healthy children through Cesarean delivery.
Another study found that abdominal metroplasty increased live birth rates from 3.7% to 80%.
Kaur P, Panneerselvam D. Bicornuate Uterus. [Updated 2021 Jul 28]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK560859/
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