Bicornuate uterus: causes, types and consequences. Pathology treatment. Pregnancy and the bicornuate uterus

bicornuate uterus and pregnancy - actual problem obstetrics and gynecology, because this pathology causes a third of miscarriages in women with uterine malformations.

The bicornuate uterus is a congenital anomaly. The uterus begins to form from the Mullerian ducts of the embryo from about the 6th week of pregnancy. Due to genetic or teratogenic causes, these ducts do not merge, which leads to a bifurcation of the upper part of the uterus, and then the girl is born with a uterus bicornuate - a bicornuate uterus. And for adult women, a bicornuate uterus, pregnancy and childbirth represent a chain of problems with the birth of children.

ICD-10 code

Q51.3 Bicornuate uterus

Bleeding with a bicornuate uterus during pregnancy

The main cause of bleeding in a bicornuate uterus during pregnancy is placenta previa, which is a consequence of implantation. gestational sac not in the region of the back and side walls of the body or the bottom of the uterus, but in the endometrium of its lower part.

After implantation - from the 3rd week of pregnancy - the formation of the placenta begins, and inside the wall tissues the uterus is coming the process of vascularization, that is, the formation of additional blood vessels. If the embryo has settled too low in the uterus, then the placenta (which is completed by the 13th week of pregnancy) can close its internal os. As a result, the pregnant woman has bloody issues or bleeding (with pain in the lower abdomen). And this is the main harbinger of abortion.

Bleeding with a bicornuate uterus during pregnancy most often occurs after 6-8 weeks of gestation and is observed in almost 35% of pregnant women. And partial placenta previa is noted on average in 40-45% of pregnancies with a bicornuate uterus.

If bleeding with a bicornuate uterus during pregnancy occurs in the later stages (after 30-32 weeks), then its etiology is due to the fact that the placenta previa cannot stretch as the size of the uterus increases and begins to exfoliate.

Bicornuate uterus and missed pregnancy

A missed pregnancy - that is, the cessation of fetal development and its death - if a pregnant woman has a complete or incomplete bicornuate uterus is a natural unfavorable outcome if the egg is attached not to the walls of the uterus, but to the septum.

The fact is that the tissues of these partitions do not have blood vessels, which means that the embryo cannot develop normally and dies

In addition, the septum in a bicornuate uterus - when the embryo is located near it - can simply interfere natural process fetal growth due to insufficient free space in the uterine cavity.

Bicornuate saddle uterus and pregnancy

A bicornuate saddle uterus and pregnancy is the most favorable of the considered variants of this pathology. However, it can also lead to complications.

Obstetricians note that this type of bicornuate uterus can also lead to miscarriage (although much less often than with a complete or incomplete bicornuate uterus), and fetal fading, and premature birth. So, in 15-25% of pregnant women with a bicornuate saddle uterus, childbirth begins much earlier than the due date. And this increases not only the overall perinatal morbidity of newborns, but also the risk of death in premature infants.

Also this congenital pathology uterus affects the position of the fetus, and most often doctors state a transverse or oblique presentation, in which you have to do C-section. And after a natural delivery, such a uterus contracts very poorly and bleeds for a long time.

Bicornuate uterus and twin pregnancy

Pregnancy with twins with the anatomical structure of the uterus, in this case - in the presence of a bicornuate uterus, does not have a direct causal relationship. After all, the conception of twins is the result of the fertilization of two follicles that have matured at the same time.

However, according to some reports, pregnancy with twins (single or fraternal) more often develops in women with anatomical pathologies of the structure of the uterus. At the same time, such a pathology as a complete bifurcation of the uterus is in the lead - that is, when the septum of the bicornuate uterus reaches the internal pharynx or cervical canal with the formation of two separate cavities.

A bicornuate uterus and twin pregnancy are obstetricians at a very high risk of miscarriage. There are even uterine ruptures. And childbirth after the 32-34th week of pregnancy with twins is 90%.

As a result of many years clinical observations it has been established that the probability of fertilization of two eggs with a bicornuate uterus or its complete bifurcation is only one in a million.

In the case when a bicornuate uterus and pregnancy - in terms of the ability to bear and give birth to a child - are mutually exclusive concepts, a woman can undergo an operation to restore the uterine cavity. It is open (with dissection abdominal cavity) or hysteroscopic metroplasty. During this surgical intervention, the septum is dissected, and the uterus is “reconstructed” into a single cavity. Almost 63% clinical cases the reproductive capacity of the uterus was fully restored.

Bicornuate uterus and pregnancy: features and complications

Among the pathologies that arise in the process prenatal development, bicornuate uterus is quite common: it is detected in about 0.5% of women childbearing age. Does this pathology affect the ability to conceive? Most experts argue that a bicornuate uterus and pregnancy - in the sense of the possibility of becoming pregnant - are not mutually exclusive concepts. Many women, having such an anatomical defect reproductive organ and get pregnant and give birth. It's all about how deformed the uterine cavity is.

With a complete bicornuate uterus, there is a septum in its cavity (sometimes two-thirds of the cavity depth), which divides the uterus into two parts, and the fetus can develop in one of them. With an incomplete bicornuate uterus, a slight division of the cavity is observed in its upper third. And the so-called saddle-shaped (or arcuate) bicornuate uterus has only a slight depression at the bottom of the cavity.

It should be noted that pregnancy with any of the three types of bicornuate uterus is associated with complications and requires additional medical monitoring. The risks lie in such adverse outcomes as habitual miscarriages (miscarriage reaches 45-50% of cases) and miscarriage (about 5%).

Bicornuate uterus and pregnancy have other complications. This is the wrong presentation of the fetus and premature birth. Breech presentation of the fetus is fixed in 50% of pregnancies with a partial bicornuate uterus. And in 40% there is a foot presentation, which complicates the course of childbirth and threatens the newborn with asphyxia.

Number premature birth in the presence of a bicornuate uterus, it ranges from 25% to 35%. Doctors explain this by increased overstretching of the uterus, which has an irregular shape. Because of this, childbirth begins ahead of time. Another factor that provokes preterm labor is the inability of the isthmus and cervix to withstand internal pressure and keep the growing fetus until the due date (this is called isthmic-cervical insufficiency of the uterus). So in 65-70% of cases, a caesarean section becomes the only way out.

Gynecologists are increasingly drawing the attention of women to the fact that they plan pregnancy in advance. As a result of carefully planned actions, examinations and preparation of the body for this important event, a woman has every chance to endure and give birth healthy baby without obstacles. Most often, they find out that a woman has some kind of deviation or disease when they come to register for pregnancy. Many are puzzled by the diagnosis of "bicornuate uterus".

Gynecologists are usually not verbose, so such patients are often at a loss and stressful condition. How can the course of pregnancy be affected with a bicornuate uterus, and in general, is it possible to get pregnant with such a pathology, we will talk.

What does the diagnosis of "bicornuate uterus" mean?

Congenital serious anomalies in the structure of the main reproductive organ in a woman - the uterus, are extremely rare. A common type of uterine pathology is bicornuity. Almost half of the female population walks with this diagnosis, and many do not even know about it. Women become pregnant and give birth to children, and most often the pregnancy proceeds without complications. Miscarriage is no exception, since the bicornuate uterus can be of different types.

The classic concept of diagnosis is when there is one cervix, and the uterine cavity itself is divided into two parts. Externally, the bicornuate uterus takes on the shape of a heart. Upper cavity uterus (approximately one third) is divided into 2 parts or 2 branches. In the people it is customary to call each cavity a “horn”, hence the name of the diagnosis “bicorn”. Based on this, we can draw the following conclusion: since the uterus is divided into 2 parts, each of them can develop new life. A fertilized egg is able to attach both in the middle and on the right or left side of the uterus. As a result, the gynecologist makes the following diagnosis: "Bicornuate uterus and pregnancy in the left horn", or vice versa.

The normal structure of the uterus is as follows: if you look carefully at the picture, and then turn it upside down, you can see the shape of a pear in the picture. The lower part of the organ is the neck, and the upper one resembles a drop or a pear.

Consider the types of bicornuate uterus:

Full. In such an organ there is a partition, and the so-called "horns" or branches are located far from each other. Outwardly, it may seem that a woman has 2 uterus. Such a diagnosis will allow you to calmly conceive, endure and give birth to a child. The fetus will develop in one of the ramifications of the uterus. There is one neck or forked.
Incomplete uterus. The organ is divided only at the top, the "horns" are located at a small distance from each other.
The saddle-shaped uterus has a slight indentation on top. Conception with such a deviation of the organ is possible, pregnancy can proceed without complications, the gynecologist will recommend delivery options. A woman can give birth to a child on her own or by caesarean section.

You can see the types of bicornuate uterus in the photo:

Bicornuate saddle uterus

As mentioned earlier, the saddle-type uterus is formed incorrectly, this is when Bottom part uterus (bottom) splits into 2 parts. Such an anomaly may not manifest itself in any way and not disturb the woman. Often she does not even suspect that she has an abnormal structure of the uterus, and she learns the whole truth at the first ultrasound in her life (most often this happens during pregnancy).

The genital organs are formed in the female fetus at 11-13 weeks of gestation. The causes of abnormal development of the uterus can be different: bad feeling mothers, smoking, stress, reception medicines, chemical poisoning.

According to statistics, 23% of women are owners of a saddle uterus. This deviation does not affect the course of pregnancy, only in special occasions may be required surgical intervention. For example, if a woman cannot become pregnant for this reason, and also if the irregular shape of the bicornuate saddle uterus can adversely affect the development of the fetus.

There are cases when anomalies in the development of the reproductive organ are directly related to other vital organs. For example, often women suffer from work disruption Bladder and kidneys, fights at work endocrine system. They are at risk because an irregularly shaped uterus can affect normal course pregnancy. As a result, after conception, pathologies are possible, birth injury, intrauterine death of the fetus is not excluded.

Expectant mothers are concerned about how their uterus shape can affect the normal course of pregnancy. IN this case you should not worry, because the child in such a uterus will develop normally.

If the pregnancy is completed, then already at 7-8 months a woman needs to decide on the tactics of delivery. The gynecologist may recommend natural childbirth if the pregnancy was stable, without complications. In addition, if a woman has no other indications for surgical intervention, then it is worth trying to give birth on her own. During labor activity the doctor can radically change his decision - when there is a threat to the life of the child and mother.

Causes and symptoms

Until now, doctors cannot say unequivocally what can affect the development of a bicornuate uterus. There are suggestions that when laying the female genital organs of the fetus maternal organism not getting enough nutrients.

The reasons may be:

stress;
taking medications. In the 70s of the last century, doctors often prescribed to women, including pregnant women, taking tetracycline group drugs. According to scientists, this could be the reason improper development reproductive organs in the fetus. But this is only one of the assumptions, there is no exact evidence yet;
use alcoholic beverages smoking during pregnancy;
the presence of infection in the body, as well as the transferred influenza, toxoplasmosis and rubella.

The bicornuate uterus, as we found out, may not manifest itself in any way. If there is no cause for concern, then a woman will know about it only on an ultrasound scan. Most often, at the first examination, when pregnancy has already begun.

It also happens vice versa, when an irregularly shaped uterus “declares” itself much earlier - as soon as the first menstruation begins. A bicornuate uterus often causes painful and heavy periods, cycle disorders, the appearance of amenorrhea, as well as miscarriages and infertility.

If abnormalities in the development of the uterus prevent a woman from conceiving a child, then this problem can be solved operational way. Positive reviews women with a bicornuate uterus who have undergone a laparoscopy procedure show evidence of early offensive pregnancy without complications.

If pregnancy has already begun, then you should not panic in advance, perhaps in your case everything will be fine. It is only important to undergo an examination on time and be observed throughout the pregnancy by a specialist. Your doctor will advise you on how to behave in order to keep the pregnancy and have a baby. Even if labor activity begins ahead of schedule, there are chances for a successful outcome.

Pregnancy and the bicornuate uterus

With a bicornuate form of the uterus, abnormalities in the development of the fetus are extremely rare, but the course of pregnancy can be very different and depend on the degree of bifurcation of this organ.

As many gynecologists say, a bicornuate uterus and pregnancy may not be compatible. This manifests itself in different ways: first, the irregular shape of the uterus can cause the full development of the fetus, plus everything, as soon as the fetus begins to grow, the organ can no longer stretch. As a result, early termination of pregnancy is possible. To prevent this from happening, it is necessary to plan conception in advance. Modern gynecology allows you to solve the problem of a bicornuate uterus in an operative way: the septum is removed, as a result, the integrity of the organ is restored.

About complications

What complications can occur during pregnancy in a woman with a bicornuate uterus? Such questions are often asked by women at the gynecologist, but they do not always receive clear answers. Let's look at this issue in more detail.

Frequent complications:

termination of pregnancy for different terms. It could be an early miscarriage or a premature birth. The risk of miscarriage increases many times over, as the irregularly shaped (elongated) uterus does not allow the fetal egg to attach properly. The thickness of the endometrium (inner uterine layer) in a bicornuate uterus is always thinner, which can also affect the attachment of the embryo. And what is very important - such a uterus stretches worse, and this already leads to the risk of developing premature birth;
if the embryo is attached too low, then there is a high risk of developing placenta previa;
full or partial leakage of amniotic fluid;
the fetus is not positioned correctly, since the bicornuate uterus is always smaller than the normal one. As a result, the child is limited in the ability to change position, he cannot move actively and because of this he chooses a position that is convenient for him. As a result, most often in women with a bicornuate uterus, the fetus occupies a transverse, pelvic or oblique presentation;
placental nutrition, that is, the normal blood circulation of the fetus is disturbed;
cervical insufficiency - this means that the cervix dilates ahead of time and unable to hold the fetus. This is also the reason for abortion at different times;
when the embryo attaches in the rudimentary horn (poorly developed part of the uterus). Such a pregnancy is equated to an ectopic, which means that an urgent interruption is required;
premature detachment placenta due to insufficient blood circulation.

Discharge during pregnancy with a bicornuate uterus can disturb a woman for 9 months. In the 1st and 2nd trimester, spotting of bright red or Brown. As soon as a woman suspects something is wrong, an urgent need to see a doctor. In such cases, hospitalization and complete rest are recommended. Common cause bleeding during pregnancy - attachment of the fetal egg to the bottom of the uterus or side wall. 3 weeks after implantation (if the embryo is attached very low), the placenta will close the internal uterine os, and as a result, the woman may experience pain in the lower abdomen and bleeding. This may indicate an abortion.

At 6-8 weeks of pregnancy, bleeding was noted in 35% of pregnant women with a diagnosis of "Bicornuate uterus", and in 45% of expectant mothers there is a partial placenta previa.

When bleeding occurs late in pregnancy, in the 3rd trimester, after about 30 weeks, this means that the placenta at the site of presentation is not able to stretch with the enlarging uterus and it gradually exfoliates. This is very dangerous, because childbirth can begin ahead of schedule.

Pregnancy in the right horn of a bicornuate uterus

It does not matter in which horn the fetal egg is attached, the main thing is that this area is well supplied with food, there are enough vessels and capillaries in it. Gynecologists say that the more the organ is underdeveloped (that is, the branches are located far from each other), the more problems maybe during pregnancy.

If the fetal egg is fixed in the left or right horn, then the load on the ligaments of the reproductive organ increases greatly.

If the pregnancy began to develop in that part of the uterus where the nutrition for the embryo is insufficient, then as a result, the pregnancy is terminated spontaneously.

What if it's a twin?

A multiple pregnancy in a woman with a bicornuate uterus is no exception. Moreover, fraternal or monozygotic multiple pregnancy develops more frequently than healthy women. But the organ itself does not affect the nature of the fertilization of the egg. IN gynecological practice there have been cases when a woman with a bicornuate uterus has a septum located closer to cervical canal or pharynx and forms 2 separate cavities (1 in 1,000,000).

Gynecologists regard any case of multiple pregnancy in a woman with a bicornuate uterus as a high risk, since abortion can occur at any time. In 90% of cases after the 30th week of pregnancy, childbirth occurs. Uterine ruptures are no exception, which is very dangerous for the health of a woman and future babies.

If you have a bicornuate uterus and a multiple pregnancy has occurred, you need to consider that the load on the body will be increased. Therefore, as soon as you find out about your pregnancy (even if this is the second pregnancy with a bicornuate uterus), you must immediately register. Then you will have a better chance of a successful outcome.

If you have a bicornuate uterus but are unable to conceive or carry a child, then you need to consider conservative method treatment. You may need surgery to restore the integrity of the uterine cavity. Only qualified specialist will be able to conduct competent treatment tactics (open surgical intervention, hysteroscopy). During the operation, the septum is dissected, and the uterus is “formed” into a whole cavity. As a result of such an intervention, in 63 cases out of 100 reproductive function women fully recovered.

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 constantly author, obstetrician-gynecologist, candidate 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- it is shaped like an inverted pear, top part which has the name "bottom", and its neck is located below (more clearly can be seen in Figure 1). But there are also developmental anomalies. this body- in 1 case out of 1000 in a female fetus during intrauterine 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 - average degree between complete bicornuity and 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 there is this feature organism. But most often this news brings the first planned ultrasound during pregnancy. Overt symptoms bicornuate uterus does not exist, 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 ultrasonography 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. Surgical method 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 the bicornuate uterus - probable cause 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 - increased risk placenta previa. If 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 the most 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 technology in most situations, they allow you to save the pregnancy, but you need to monitor the condition of the pregnant woman and the fetus throughout the entire period.

Doctors do not just focus on the fact that every woman plans her pregnancy in advance. Preparing for this step, you can find out everything about your state of health, exclude pathologies and cure existing diseases, thereby increasing the chances of successful conception and bearing a fetus. But, in most cases, women go to the doctor already in position and for the first time encounter diagnoses that they did not know about before. The combination of a bicornuate uterus and pregnancy is not uncommon.

The bicornuity of the genital organ is a congenital disorder of the development of the uterus, which is formed in a woman even during intrauterine development in the 1st trimester. Normally, this organ develops in a certain sequence: initially it consists of two separate cavities, then the existing septum disappears, leaving a single cavity. Due to impact adverse factors separation may not occur in full, against which the diagnosis of a bicornuate uterus arises.

Depending on the degree of division of the reproductive organ, the bicornuate uterus is classified into the following types:

Saddle uterus. The smallest degree of anomaly, which practically does not lead to doubling of the organ. The saddle uterus is shaped like a heart or saddle-like depression.
incomplete doubling. The reproductive organ is divided into two parts, but this opening is small, it is localized exclusively in top point organ.
Full doubling. The most severe form of a bicornuate uterus. The organ is divided into two parts by the remaining congenital septum. Separation is rarely even, in most cases one uterine horn is smaller or larger than the other. This species is considered to be a rudimentary anomaly.

Is pregnancy possible?

Problems with conception with a bicornuate uterus are quite rare. Most often, a woman can become pregnant, but the course of this pregnancy depends on many factors, in particular, the degree of uterine bifurcation.

For example, with a saddle-shaped genital organ, pregnancy usually proceeds easily, without complications. In other cases, the probability pathological course pregnancy is increasing, so women with a bicornuate uterus require careful medical monitoring.

Unfortunately, if problems with conception arise, then in the future, for many women, pregnancy and a bicornuate uterus become mutually exclusive concepts. This is due to the fact that as the fetus grows, the irregular shape of the organ cannot adapt to its changes. The situation ends. In this case, it is necessary to consult a doctor to normalize the structure of the organ, and only after that do it.

Features of the course of pregnancy with a bicornuate uterus

With the onset of pregnancy, women with a bicornuate uterus should see a doctor for further monitoring. The gynecologist must diagnose the severity of the violation of the structure of the uterus and make a prediction of how it will affect the development of the fetus. There are many nuances in this case, and each of them makes its own adjustments to pregnancy and childbirth. Fortunately, in most cases, the diagnosis of the future mother does not interfere with the pregnancy.

If both horns of the uterus are well developed and have similar dimensions, the embryo can attach itself in one of them and begin its development without deviations. If the sizes of the horns are very different, that is, one uterine horn is underdeveloped, and is considered a rudiment, then the development of an embryo in it will be impossible - sooner or later such pregnancy will terminate by type - there will be a rupture of the uterine horn and hemorrhage into the abdominal cavity.

The most dangerous is the 1st trimester, when the embryo implants and begins its development with possible subsequent outcomes.

Multiple pregnancy

Childbirth with a bicornuate uterus is usually complicated by discoordination and weakness of the birth process, since the abnormal structure of the organ interferes with the development of normal labor activity. It also increases the risk of injury to both the woman in labor and her child. All this leads to the fact that most doctors choose as a method of delivery.

The risk of complications remains elevated and postpartum period. Due to the pathological structure, the uterus is incapable after the birth of the child. The involution of the uterus slows down, and this can cause the development of infectious and inflammatory complications, most often in the form.

Also, the outflow of blood from the cavity of the bicornuate uterus is often disturbed, which leads to the accumulation of secretions and the formation of a hematometer, which requires urgent surgical intervention.

bicornuate uterus - serious pathology. Many women with this disorder, who have given birth to healthy children, insist on mandatory medical supervision and the implementation of all recommendations prescribed by a specialist. In this case, the chances of successfully bearing a baby increase significantly.