What is Bicornuate Uterus?
“Cornu” means horn, the uterus has two horns, hence the name bicornuate uterus. It is characterized by heart-shaped uterus, with a wall inside and a partial split outside. Bicornuate uterus is the most congenital uterine anomaly seen due to non-fusion of mullerian ducts. This condition mainly affects the reproductive capability of women. Bicornuate uterus is seen in around 1-5/1000 US women. The shape of the uterus plays an important role as this determines the position of the baby (Transverse lie /longitudinal lie / oblique lie) in the womb during pregnancy. Bicornuate uterus is undiagnosed until a woman gets pregnant or in process of conception.
Causes of Bicornuate Uterus:
Bicornuate uterus is mainly caused by 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 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 bicornuate or didelphys uterus. Septal resorption is of the central septum once the fusion of ducts are complete, failure in this process leads to septate or arcuate uterus.1
The wollfian body and Muller’s duct plays an important role in the development of 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 uterus. If the fusion happens shortly after this period of gestation, it results in bicornuate uterus.2
Symptoms of Bicornuate Uterus :
- Irregular vaginal bleeding
- Repeated spontaneous abortions
- Abdominal discomfort
Bicornuate Uterus Pregnancy:
Bicornuate uterus is high-risk pregnancy as the fetus begins to develop in any one horn of the pregnancy, and the pregnancy does not last as there is not enough space for growth and results in spontaneous abortion. Higher levels of progesterone have to be given to sustain the pregnancy. C–section is the only option in this kind of pregnancy.
Complications of Bicornuate Uterus
- Increased risk of miscarriages
- Congenital anomalies in fetus
- Intra uterine growth retardation
- Difficulty in completing the pregnancy term
- High-risk pregnancy
- Preterm delivery
- Abnormal presentations of fetus
- Adherent placenta
- Post-Partum Hemorrhage (PPH)
Diagnosis of Bicornuate Uterus
Hysterosalphingogram (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 uterus.
Ultrasound: The pelvic ultrasound provides a better picture of 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 abdomen and this surgery helps in diagnosis of bicornuate uterus and perform if any minor surgery is required.
The correct diagnosis is very important, to differentiate between septate uterus and bicornuate uterus as the treatment options for these two conditions are different.
Treatment of Bicornuate Uterus
The reconstructive surgery for Bicornuate Uterus is called as Laparoscopic metroplasty. This surgery for Bicornuate Uterus is associated with fewer complications including bleeding, adhesion formation and duration of hospitalization.3
Hysteroscopic metroplasty can also be performed to treat Bicornuate Uterus. This surgery avoids uterine scar and need for elective C-section. The septum is resected with resectoscope or scissors.4
Success Rate of Surgery for Bicornuate Uterus
This surgery has high success rates in improving the fertility and pregnancy outcomes. The pregnancy can be continued till full term with successful delivery of the child.
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- Tubal Disease: Diagnosis, Treatment, Types & its Treatment
- Br J Radiology 2009 Dec: 82 (984) 1034-1042.
- PMC 1822608
- Saeed Albrozi – Laparoscopic metroplasty in bicornuate and Didelphic uteri: Feasibility and Outcome.
- Shaw’s Textbook of Gynaecology.