The bicornuate uterus and pregnancy

What is a bicornuate uterus?

A bicornuate uterus is a congenital anomaly of the female reproductive system where the uterine body is divided into two parts by a septum. The degree of separation can vary: it can be a complete or incomplete split, and this condition can also take the form of a saddle. This anomaly can lead to reproductive disorders, and the main complications during pregnancy include the risk of miscarriage, placental dysfunction, and fetal development delays.

Causes and symptoms of a bicornuate uterus

There are no clear specific symptoms of this anomaly. However, some women may present the following symptoms:

• painful menstruation;
• abnormal bleeding;
• difficulties in conceiving;
• complicated pregnancy and childbirth.

Diagnosis of a bicornuate uterus

A woman may learn about the presence of this anomaly after several unsuccessful attempts to conceive or carry a child. The following diagnostic methods are used to accurately detect the anomaly:

• Pelvic ultrasound - allows for the assessment of the structure of the uterus;
• Hysterosalpingography or echo-salpingography - a radiological or ultrasound method used to examine the patency of the fallopian tubes and the shape of the uterine cavity;
• Hysteroscopy - a method that allows for the examination of the inner surface of the uterus using a special endoscope.

Correction of the anomaly and pregnancy planning

If a bicornuate uterus has been discovered before planning a pregnancy, a woman may be offered surgical correction methods, such as:

• Septal excision - removal of the membrane separating the uterine cavity;
• Horn resection - used when one of the horns of the uterus is nonfunctional or causes complications;
• Cavity fusion - performed when the uterus is incompletely divided.

Assisted reproductive techniques may also be recommended to a woman:

• IVF (in vitro fertilization) - a procedure aimed at facilitating conception;
• IVF with egg donation - suitable for patients with low ovarian reserve;
• IVF with double donation - used in cases of severe reproductive disorders.

Management of pregnancy in the case of a bicornuate uterus

Pregnancy with a bicornuate uterus requires increased attention from obstetricians and gynecologists. The main risks and possible complications are as follows:

• Spontaneous miscarriages - especially in early pregnancy;
• Bleeding from the additional horn - may threaten the pregnancy;
• Abnormal placental implantation - increases the risk of premature detachment;
• Inadequate cervical function - may lead to preterm labor;
• Fetal malposition - may require a cesarean section.

Nevertheless, a pregnancy with a bicornuate uterus can proceed without significant complications. The management of these patients includes:

• regular monitoring of the uterus and fetus;
• hospitalization during critical periods of pregnancy;
• prophylactic treatment to prevent the threat of miscarriage;
• decision on the method of delivery (natural delivery or cesarean section).

If the pregnancy proceeds without significant anomaly, the woman may be allowed to deliver naturally. However, if a cesarean section is necessary, the doctors may simultaneously perform a surgical correction of the anomaly.

A bicornuate uterus is an anatomical feature that can affect conception, the course of pregnancy, and childbirth. However, with adequate monitoring and timely treatment, many women successfully give birth to healthy babies. The management of pregnancy in the case of a bicornuate uterus should be carried out by an experienced obstetrician-gynecologist who understands the specifics of this anomaly to ensure the best chances of successful delivery.