Bicornuate uterus

Among uterine abnormalities, bicornuate is the most common, but overall it is diagnosed in only 0.1-0.5% of women.

The formation of a bicornuate uterus is associated with disorders in intrauterine development.

The pathology develops due to the incomplete fusion of the Müller ducts in 10-14 weeks of embryogenesis, which leads to the separation of the division of the uterine cavity into two niches.

Often in a bicornuate uterus there is one cervix and one vagina, but doubling of the cervix and the presence of an incomplete vaginal septum are possible. One horn of the uterus with bicorn form can be embryonic /rudimentary/.

In case of implantation of the ovum in the rudimentary horn, the pregnancy proceeds as ectopic with rupture of the horn and intraperitoneal bleeding.

In other cases, both horns are properly developed and in each of them full uterine cycles can occur and a pregnancy can occur, ending in birth.

Bicornuate uterus – What are the symptoms

The presence of bicornuate uterus is possible and not accompanied by significant clinical manifestations. Sometimes there is algodismenorrhoea and uterine bleeding.

Often, women with this anomaly experience miscarriages or suffer from infertility. However, it is not excluded that the pregnancy and birth will pass without complications.

In bicornuate uterus, pregnancy usually develops in one of the available horns, and in rare cases simultaneously in both horns.

Pregnancy with such an abnormality of the uterus is often accompanied by an increased risk of its loss, which is why it requires careful medical monitoring.

Spontaneous abortions in a bicornuate uterus usually occur in the first trimester, because the growth of the embryo interferes with the normal blood supply, which leads to a decrease in the volume of the internal cavity of the uterine horn.

Furthermore, with bicornuate uterus abnormalities of the location of the placenta often occur – placenta previa or an abnormally low position, which causes premature detachment and abnormal bleeding during pregnancy.

The presence of a bicornuate uterus increases the likelihood of isthmicocervical insufficiency, breech presentation of the fetus, premature birth and disorders of the contractile activity of the uterine muscles and of postpartum hemorrhage.

In the case of an oblique or transverse presentation of the fetus, a cesarean section is indicated.

Treatment of bicornuate uterus

Surgery is only applied in case of repeated miscarriages /2-3 times in a row pregnancy loss / or infertility.

The aim of the operation is to restore a single full-fledged uterine cavity.

Most often in operative gynecology, one resorts to extirpation of the rudimentary horn or removal of the septum separating the cavity.

The standard surgical intervention for uterine bicornuate is a Strassmann operation, which consists of a laparotomy, dissection of the uterine fundus with a transverse incision, followed by excision of the median septum, with subsequent placement of a mesh of the lining of the uterus.

In addition, surgical correction of a bicornuate uterus can be performed using hysteroscopy methods.

After the surgical restoration of the single uterine cavity, an intrauterine device is placed for a period of 6-8 months.

Prognosis

When the capacity of the deformed uterus is sufficient, the delivery of the fetus and delivery pass without complications.

With a more pronounced separation of the uterine cavity the risk of miscarriage or premature birth increases.

The purpose of particularly detailed pregnancy monitoring in women with bicornuate uterus is to prevent miscarriage, isthmicocervical insufficiency and bleeding.

When there is a risk of termination of pregnancy in the later stages – after 26-28 weeks of gestation, a cesarean section is performed to preserve the fetus.

When the fetus is delivered, the issue of delivery is decided taking into account various factors such as position and presentation of the fetus, concomitant pathologies of the pregnant woman.

After surgical correction of uterine bicornuate, the risk of spontaneous abortion drops from 90 to 30%.