How a bicornuate uterus affects pregnancy, intimate life and the general condition of a woman

Often the diagnosis of a "bicornuate" uterus confuses a woman, and you can't ask for explanations from your district gynecologist. Are these pathologies dangerous for the development of the fetus in the womb, is it possible to get pregnant with this diagnosis and how will the birth go, we asked our constant author, obstetrician-gynecologist, candidate of medical sciences, Alexandra Nikolaevna Taran.

Alexandra Nikolaevna, I would like to start from the very basics. Please tell our readers what the term "bicornuate uterus" means, what are the features of this pathology?

Let's imagine what a normal female uterus looks like - it is shaped like an inverted pear, the upper part of which is called the "bottom", and the bottom is its neck (more clearly can be seen in Figure 1). But there are also anomalies in the development of this organ - in 1 case out of 1000 in a female fetus during fetal development, the fusion of the Mullerian ducts does not occur completely, which leads to a form split into 2 parts (see Fig. 2). A woman most often learns about a bicornuate uterus during pregnancy, when the first ultrasound diagnosis is performed at 11-14 weeks. That is why I insist that you need to prepare for conception in advance so that these nuances are not a surprise.

Are there varieties in this structure of the uterus?

Yes, depending on the intensity of changes, we can distinguish:

complete bicornuity - in this case, the organ is divided into two cavities, between which there is a partition;
incomplete bicornuity - an average degree between complete bicornuity and a saddle uterus;
saddle uterus - in this case, there is only a depression in the upper part of the uterus.

How can a potential mother find out about her peculiarity? Are there any symptoms or signs?

When a woman cannot conceive for a long time, most couples turn to specialists. And already during research it turns out that this feature of the body exists. But most often this news brings the first planned ultrasound during pregnancy. There are no obvious symptoms of a bicornuate uterus, only indirect signs. For example, there may be irregularities in the cycle of menstruation.

What methods of diagnosing this anomaly exist?

As I said above, this is an ultrasound examination of the pelvic organs, as well as hysterosalpingography, laparoscopy and hysteroscopy.

Do I need to do surgery for a bicornuate uterus? Is there any alternative treatment?

If a woman cannot become pregnant or bear a child for a long time, then after a laparotomy or laparoscopy, the chances of a favorable outcome increase many times over. The surgical method of treatment is the only one to date. But this is a personal decision of everyone, the doctor will not force an operation, since this pathology is not life-threatening for a woman.

How to get pregnant with this feature of the body?

Despite the fact that a bicornuate uterus is a likely cause of infertility, in most cases, pregnancy occurs without problems. Complications may arise already at the next stages. The probability of a favorable outcome also depends on the severity of "bicorn" - the greater the intensity of splitting, the more problems may arise. With this pathology, the implantation egg can attach too low to the wall of the uterus, as a result - an increased risk of placenta previa. If the future fetus is attached locally in one of the horns, then the load on the ligaments that hold it will be excessively high.

Are there always problems when carrying a child?

Not always, but the probability is quite high. May occur:

isthmic-cervical insufficiency;
disorders of uteroplacental circulation;
incorrect presentation of the fetus (as a result, the uterus can squeeze the fetus);
outflow of amniotic fluid ahead of time;
birth disorders.

Could you elaborate on labor activity? How does a bicornuate uterus affect childbirth?

Not in the best way. Overstretching of the muscles of the uterus can lead to weakness of labor activity. With this pathology, the likelihood of traumatizing the uterus and the child increases, so most doctors and women in labor choose a caesarean section. But it all depends on the situation and the characteristics of the woman's body, so it is impossible to generalize here. I have taken birth in many women with a bicornuate uterus: there were both natural births and caesarean sections.

What should a pregnant woman do if she is suddenly diagnosed with a "bicornuate uterus"?

You don't have to be negative right away. In my practice, there were enough cases to confirm the possibility of a favorable outcome with this complication. Modern medical technologies in most situations allow you to save the pregnancy, but you need to monitor the condition of the pregnant woman and the fetus throughout the entire period.

The bicornuate uterus is a malformation of this organ, which is formed during the period of intrauterine development, when the reproductive system of the girl is formed. This malformation usually does not manifest itself for many years. However, when pregnancy occurs, pathology can make itself felt. The question often arises, is it possible to safely bear a child with a bicornuate uterus?

Let's find out what this pathology is, whether pregnancy is possible with a bicornuate uterus and how it affects the course of pregnancy.

Bicorn types

In a normal state, the uterus has the shape of a triangle. With two-horned, it has an irregular shape, dividing into two parts. Depending on the degree of this separation, the pathology differs by type:

- Complete. In this embodiment, it is divided into two planes connected by a thin partition.

- incomplete. With this variant of bicornuity, it is divided to a lesser extent and is distinguished by a small opening between its horns.

- saddle. In this form, it is not divided, but only has a small depression in the upper part, resembling a saddle.

Is it possible to get pregnant with a bicornuate uterus?

This malformation has low statistics, however, it is still often found in obstetric practice. And it manifests itself in different ways. Many women get pregnant without any problems, safely bear and give birth to a baby. They only learn about their features during pregnancy. But in some cases, women cannot bear a child or cannot conceive at all.

Although the inability to become pregnant, fortunately, is much less common and most often is a combination of this pathology with others. Most often, a bicornuate uterus is characterized by the inability to bear a child.

Symptoms of pathology

As such, there are no signs indicating this feature. In complicated cases, menstrual irregularities may occur. In most cases, a woman finds out about her anomaly during a visit to the doctor. It is detected during ultrasound, laparoscopy, hysteroscopy and hysterosalpingography.

This pathology is not treated by conservative methods. In the event that bicornuity causes infertility and miscarriage, a surgical operation is performed and the normal anatomical shape of the organ is restored.

What risks and complications can occur during pregnancy?

As we have already said, this pathology can cause miscarriage. This is due to the structural and functional inferiority of the bicornuate uterus.

First of all, due to the irregular shape, the presence of horns, the organ, as it were, stretches out and looks more like a canal. This shape is less suitable for egg implantation than the usual, triangular shape. In addition, the thickness of the endometrium is much thinner in the uterine horn than in the normal uterus.

Secondly, the limits of extensibility in a bicornuate uterus are much lower than in the normal structure of the organ. Therefore, a bicornuate (halved) uterus can hardly endure pregnancy, or it may not endure at all. In this regard, most often there is a threat of miscarriage in the 2nd-3rd trimester. There are frequent cases of premature birth.

Another reason for the threat of miscarriage in this pathology is isthmic-cervical insufficiency, when the cervix begins to open long before the onset of labor. In this case, a correction can be made and sutures are placed on the neck, which are removed just before the birth itself.

Thirdly, this anomaly can cause a violation of labor activity. This is due to the functional failure of the uterus, due to the pathology of the structure of the muscle layer, leading to impaired contractility. Therefore, in the case of a normal pregnancy, those who gave birth with a bicornuate uterus know that doctors recommend giving birth by caesarean section.

Other complications during pregnancy

Quite often there are violations in the attachment of the placenta. There are also violations of its structure, which can lead to placental insufficiency. Such complications often cause placental abruption and bleeding.

Often there is an incorrect position of the fetus. The fact is that with two-hornedness, the ability of the baby to move is significantly limited, and he is simply fixed, constantly in the breech presentation, and cannot turn around. In addition, in the case of an oblique or transverse position, the risk of miscarriage increases, and the impossibility of having a baby naturally increases.

But the risks with a bicornuate uterus are not limited to this. The fact is that even after successful gestation and delivery, the problems do not end there. The structural features of this organ cause a violation of the ability to contract after childbirth. In turn, this causes complications of the postpartum period, in particular hematometer (when a lot of blood accumulates in the uterine cavity) and postpartum endometritis.

As a result of our conversation, it should be emphasized that the characteristics of the passage of pregnancy in women with a similar anomaly and the possible consequences are very individual. In any case, if this pathology is detected, pregnancy is classified as a high-risk group. Such women should be under the constant supervision of a qualified specialist for the entire period of gestation.

Bicornuate uterus and pregnancy concepts are quite compatible. In some cases, pregnancy can proceed without features and complications. In severe cases with severe pathology, surgery can significantly increase a woman's chances of carrying and giving birth to a healthy child.

What is a bicornuate uterus

Congenital defects of the uterus are, fortunately, quite rare. A bicornuate uterus is the most common variant of the pathology. The uterine cavity is usually one in the lower sections and splits upward into two independent cavities, two horns. Both horns may be symmetrical and fully developed. In this case, pregnancy is possible in each of them. One of the horns may be underdeveloped, rudimentary. If a fertilized egg is fixed in it, the pregnancy passes as an ectopic one and may threaten to rupture the uterine horn. In rare cases, a full pregnancy occurs in both horns at the same time.

Symptoms

Often, a bicornuate uterus manifests itself as menstrual irregularities, amenorrhea, pain during menstruation and early miscarriages, as well as infertility. Sometimes not a single symptom appears, and the peculiarities of the structure of the uterus are found out only with a planned ultrasound during pregnancy.

The reasons

Anomaly of the development of the uterus is laid in the first trimester of intrauterine development. The causes can be both alcohol and nicotine abuse, toxic poisoning, and infectious diseases, including influenza, rubella, toxoplasmosis.

Diagnostics

Pathology can be suspected with the help of ultrasound. To clarify the diagnosis, hysteroscopy, MRI and even laparoscopy are used. If a bicornuate uterus during pregnancy interferes with its normal course, or if conception does not occur at all, the main method of treatment is surgical intervention. The main objectives of the examination and treatment are the identification and excision of the rudimentary horn, the removal of the intrauterine septum and the restoration of a normal single uterine cavity. After the operation, pregnancy should occur no earlier than a year later. To do this, an intrauterine device is installed in the uterine cavity. Earlier onset of pregnancy is fraught with uterine rupture.

The prognosis after surgical restoration of the cavity is very favorable. The percentage of miscarriage is reduced several times.

Childbearing and childbirth

The course of pregnancy with a bicornuate uterus should always be under close medical supervision. In the event that the pregnancy is fixed in a full-fledged horn, and the intrauterine septum is missing or surgically excised, problems may begin only by the end of the first trimester. This is due to the fact that the fetus may not have enough space, and the blood supply to the fetus may also be impaired. At a later date, such pathologies of pregnancy development as placenta previa and early aging, isthmic-cervical insufficiency, and the threat of interruption may occur.

If necessary, starting from the 28th week of pregnancy, a caesarean section can be performed to save the life of the fetus.

The decision on how the birth will go will depend on several factors. First of all, this is the location of the fetus and the anatomical features of the woman. Very often, with a bicornuate uterus, there is a breech presentation. Natural childbirth is possible, but both the woman and doctors must be prepared for the fact that an emergency caesarean section may be needed.

A bicornuate uterus is not a sentence. With proper medical supervision, quite natural bearing and the birth of a healthy child is possible.

Only in this case, a woman's chances of enduring and giving birth to a completely healthy and strong baby increase.

Most often, the fact that a woman has some kind of deviation or disease can be found out when a pregnancy registration is made. In this case, many are worried about the diagnosis of a bicornuate uterus.

Bicornuate uterus and pregnancy

Congenital anomalies in the structure of the main reproductive organ in a woman - the uterus, occur quite rarely. The most common pathology in the structure is bicornuity. With such a diagnosis, almost half of the total female population of the planet walks, while many are not even aware of it. Women become pregnant and give birth to children, while the pregnancy most often passes without complications. Miscarriage is also possible, since the bicornuate uterus can be of different shapes.

The classic definition of the diagnosis is when a woman has only one cervix, and the uterine cavities themselves are divided into two separate parts. Outwardly, such a uterus is presented in the shape of a heart. The upper cavity of the organ (about the third part) is divided into two parts or two branches. It is customary for the people to call each cavity a horn, hence the name of the two-horned deviation follows.

If we follow this, we can conclude that the organ was divided into several parts and in each of them a separate life can develop. A fertilized egg can be attached both in the center and in the right or left side of the uterus.

There are such forms of a bicornuate uterus:

Complete. This organ has a septum, and the horns themselves are located far from each other. In appearance, it may seem that a woman has two whole uterus. Such a diagnosis does not affect the conception and bearing of the baby. The fruit will form in one of the branches. It can be either a single neck or a bifurcated one.
Incomplete uterus. The organ is divided only in the upper part, the horns are located close to each other.
The saddle-shaped uterus has a small indentation on top. Conception with such a diagnosis can occur, delivery options can be advised by the gynecologist himself. A woman can give birth to a baby on her own during a caesarean section.

As noted earlier, the uterus in the form of a saddle develops incorrectly. This happens when the lower part (its bottom) splits into two parts. Such a deviation may not manifest itself at all and may not even bother a woman. Most often, she does not even imagine that she has problems in the structure of the organ, and she only finds out the whole truth at the first ultrasound (most often it is performed during pregnancy).

The genital organs develop in a female child at 11-13 weeks of pregnancy. The reasons for the abnormal formation of the reproductive organ can be completely different: poor health of the pregnant woman, frequent stress and anxiety, alcohol abuse, smoking, drug use, chemical poisoning.

According to statistics, about 23 percent of women are considered the owners of a saddle uterus. Such a deviation in no way worsens the course of pregnancy, only in special cases will it be necessary to carry out surgical treatment. For example, in the case when a woman cannot become pregnant for any reason, and also if the shape of the other saddle uterus is incorrect and can adversely affect the process of the formation of the baby.

Sometimes it happens that anomalies in the development of the reproductive organ are directly related to the rest of the vital parts of the body. For example, very often women are prone to disorders in the bladder and kidneys, and they also experience malfunctions in the endocrine system. They are at risk, since an irregularly shaped uterus can adversely affect the normal course of pregnancy. Ultimately, after the process of conception, various pathologies can occur, birth trauma, and intrauterine death of the fetus is also possible.

Expectant mothers are afraid of how the wrong shape of the organ can affect the normal course of pregnancy. In this case, there is no need to worry, since in such a uterus the baby develops, as a rule, normally and is born without any difficulties.

If the pregnancy is carried to term, then already at 7-8 months the woman is obliged to determine the method of delivery. The gynecologist may advise in this case to take a natural birth, if the pregnancy itself was stable, without any difficulties. And also, if a woman does not have any indications for surgical intervention, then you need to try to give birth to a baby on your own. During labor, the attending specialist can radically change his mind - if there is a direct threat to the life of the child and mother.

Reasons for development

Until this time, doctors cannot give a definite answer, which can adversely affect the development of the uterus. There are suggestions that during the laying of the genital organs of the fetus, the mother's body does not receive the right amount of nutrients.

Main reasons:

stress.
Drug use. In the 70s of the last century, doctors regularly prescribed women, including those in position, the use of drugs of the tetracycline group. According to scientists, this is the reason for the improper formation of organs in the fetus. But this is only one of many assumptions, accurate evidence has not been presented to this day.
developing in the body infection, as well as the recently transferred influenza, rubella or toxoplasmosis.

If there are no reasons for concern and complications, then a woman can find out about the pathology only during an ultrasound scan. Most often, at the first examination, when the pregnancy has already begun, the woman finds out her diagnosis.

And also the suspicion of a bicornuate uterus arises when a woman cannot become pregnant or she constantly has miscarriages: a child with this anomaly can be difficult to endure. If strong uterine bleeding is also added to this, then the likelihood that a woman has this pathology increases. Dysmenorrhea can also be a sign of a bicornuate uterus.

If the pregnancy has already begun, then you don’t need to worry in advance, maybe in your case everything will go well and without any problems. It will be very important to go to the doctor on time for examination and be observed by him throughout the pregnancy. The doctor will advise you on how to behave properly in order to keep the pregnancy and give birth to a healthy and strong child. Even if labor activity takes place ahead of schedule, there are still certain chances for a positive outcome.

If complications do not allow to conceive and endure a baby, then this problem can be solved with the help of an operation. Positive feedback from women with such a uterus who performed the laparoscopy procedure indicates an imminent pregnancy that proceeds without complications.

The course of pregnancy

In another form, it is very rare to find any abnormalities in the development of the fetus, but the course of pregnancy can vary markedly and directly depend on the degree of bifurcation of such an important organ.

As many gynecologists note, the shape of the uterus and pregnancy may simply not be combined with each other. It arises in different ways: the first is an irregular shape, which can cause an inferior development of the child, in addition, as soon as the fetus becomes larger, the organ simply cannot stretch.

Ultimately, early termination of pregnancy may occur. To prevent this from happening, you need to plan conception as early as possible. Modern gynecology helps to solve the problem of the uterus surgically: the septum is removed, as a result of which the overall integrity of the organ returns to its original state.

Complications during pregnancy

The main complications of pregnancy with a bicornuate uterus include:

termination of pregnancy at different times;
placenta previa;
leakage of amniotic fluid;
incorrect location of the fetus;
poor blood supply to the fetus and placenta;
weak cervix;
attachment of the embryo in a poorly developed "horn";
placental abruption during pregnancy;
premature withdrawal of water.

The discharge that occurs during pregnancy with a bicornuate uterus bothers a woman for all nine months of bearing a child. In the 1st and 2nd trimester, spotting of a bright red or brown hue may occur. The moment a woman realizes that something is wrong, she should immediately go for an examination to a treating specialist. In this case, most often the doctor prescribes hospitalization and complete rest.

A common cause of bleeding during pregnancy is the attachment of a fertile egg to the bottom of the uterus or to the side wall. After three weeks after implantation (if the embryo attaches too low), the placenta itself will close the internal uterine os, ultimately the woman will experience pain in the lower abdomen and bleeding. This may indicate an abortion.

At 6-8 weeks of pregnancy, bleeding occurs in 35 percent of women with this diagnosis, and 45 percent of expectant mothers have a partial placenta previa.

If bleeding occurs late in the gestation of the child, in the 3rd trimester, approximately after the thirtieth week, then this indicates that the placenta in the place of presentation cannot be stretched together with the growing uterus and it exfoliates over time. This is very dangerous, as childbirth can begin earlier than the measured time.

Bicornuate uterus and pregnancy in the right horn

There is no special significance to the place to which the fetal egg is attached, the main thing is that such a site is qualitatively supplied with food and contains the required number of capillaries and vessels. Gynecologists say that the stronger the underdevelopment of the organ, the more difficulties can arise during pregnancy.

If the fetal egg is attached to the right or left horn, then the load on such ligaments of the genital organ increases several times.

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