Anomalies in the structure of the female reproductive organs occur rarely; the most common defect (0.1 - 0.5%) is a bicornuate uterus, characterized by doubling, in which the two cavities of the body of the organ are not completely separated. The body of the uterus is divided into two horns, which are connected at the bottom.

The defect is classified as an anomaly in the development of the paired Müllerian canal, which is formed in the fetus at the beginning of pregnancy (10–14 weeks). The duct is the basis for the further intrauterine development of the uterus, vagina, and fallopian tubes in a female fetus.

The paramesonephric (Müllerian) duct consists of two parts fused in the distal (far) section. If intrauterine development is disrupted (underdevelopment of one part of the duct, the impossibility of merging its lower parts), uterine defects develop. It is possible to develop a bicornuate saddle uterus, partial bifurcation, or a bicornuate uterus with a septum. In some cases, the pathology is combined with other abnormal forms of the vagina, cervix, urinary tract, and kidneys.

Reasons

The exact causes of a bicornuate uterus have not been established. An anomaly is formed in the embryo during intrauterine development under the influence of unfavorable factors:

A hereditary factor and chromosomal abnormalities in the mother cannot be excluded.

Classification

The bicornuate uterus is classified according to the type of cleavage:

1. Complete separation - the septum extends from the fundus of the uterus to the internal os, forming two isolated horns. Sometimes the cleavage is so pronounced that two separate niches are formed, like two closely spaced queens. Is it possible to get pregnant with this type of anomaly? Yes, in this case, pregnancy can develop and proceed without problems in one of the niches.
2. Incomplete separation - a shallow opening is formed between the horns in the upper third of the organ. The horns are the same in size and shape. The cavity is divided by a partition, which can be of different lengths.
3. With the saddle-shaped (arched) version, the shape of the uterus resembles a saddle - this is a depression at the bottom of the organ. Pregnancy is possible, but miscarriage occurs, since the saddle shape of the uterus leads to malpresentation of the fetus.

These are the three main types of bicornuate uterus. There is also a double body of an organ with a common neck or with a double neck, with atresia (fusion) of the internal cavity, atresia or atrophy of one horn.

Symptoms

Normally, the uterus resembles a triangle with a base and a cavity inside. With an anatomical anomaly, the organ looks like a cap with two halves diverging to the sides. These cavities can communicate with each other and open into the cervical canal separately or have a common exit into the cervical canal. The angle of divergence of the cavities is different in each case, which depends on the development of the external walls and the length of the septum. The layers of the horn walls are fully developed in most cases, but asymmetry also occurs when one horn is underdeveloped or overgrown.

A bicornuate uterus may not give any clinical manifestations, and even often gestation and childbirth with a bicornuate uterus proceed without complications. In some women, pregnancy ends in spontaneous abortion with a bicornuate uterus, which is due to the small amount of space for fetal development in one horn and insufficient blood supply.

A characteristic sign of a bicornuate uterus is menstrual disorder. Most often, bleeding, prolonged and painful periods are observed with a deterioration in general well-being, excitability of the nervous system, dyspeptic disorders, headaches, decreased performance, and the addition of infections.

The pain of menstruation with a bicornuate uterus is caused by an enlargement of the organ, in which the uterus presses on neighboring tissues and nerve plexuses. Bleeding and an increase in the duration of menstruation are due to the fact that the volume of a bicornuate uterus is larger than that of a normal one, so more endometrium is rejected, but its evacuation is difficult. In horizontally located niches, blood can stagnate, which causes severe discomfort.

If a woman does not have vaginal abnormalities, the bicornuate uterus does not affect her sex life and libido. A woman experiences during intimate intimacy all the same sensations as with a normally developed organ.

Diagnostics

The defect is discovered accidentally during examination of a pregnant woman or during a preventive gynecological examination. Bimanual examination can detect fundal deformation (if the defect is significant), the presence of a septum, and a double neck.

Clinical signs of the pathology are absent or similar to other diseases of the female reproductive system, therefore reliable methods are used to confirm the diagnosis:

1. Transabdominal or transvaginal ultrasound examination - evaluates the anatomical structure of the organs of the urinary and reproductive systems. 3D scanning is used more often, but with minor deformations the pathology may not be noticed, it all depends on the experience of the diagnostician.
2. X-ray - the outer boundaries of the uterus can be determined, but the type of anomaly cannot be determined.
3. Hysterosalpingography is an x-ray of the genital organs with contrast, which allows you to evaluate the uterine cavity and tubal patency. It is more often used to identify the causes of infertility, which is possible with a bicornuate uterus.
4. Hysteroscopy refers to therapeutic and diagnostic minimally invasive surgical techniques. With the help of endoscopic examination, abnormalities in the structure of the organ, the cause of uterine bleeding, polyps and submucosa are identified. The procedure allows you to assess the condition of the endometrium.
5. Laparoscopy is a therapeutic and diagnostic gentle surgical technique that can be used to detect and remove polyposis and cystic formations, and identify structural defects of the reproductive organs, kidneys, and urinary tract.
6. MRI or CT - determine the shape of the organ, the structure of the walls, and identify anatomical anomalies.

In diagnosis, it is important not only to make the correct diagnosis, but also to assess the functionality of the reproductive system, the likelihood of pregnancy, and the prospects for surgical treatment.

Treatment

In the treatment of malformations of the uterus and appendages, it is important to both eliminate the anomaly and preserve reproductive function. Indications for surgery for a bicornuate uterus:

• repeated early miscarriages;
• infertility;
• history of stillbirths;
• (accumulation of blood in the uterus).

Treatment tactics are selected individually. Today they use minimally invasive technologies. The most commonly used reconstructive method is metroplasty, which is performed:

• with removal of one horn;
• with removal of the complete septum;
• with excision of an incomplete septum;
• with partial excision of the uterine wall and subsequent formation of the fundus.

Correction of the septum is carried out using a gentle, simple operation - hysteroscopic metroplasty. The procedure is as follows: during hysteroscopy, the walls of the uterus are stretched using an isotonic solution, then the necessary manipulations are carried out with optical scissors.

To evacuate pathological fluid or blood clots, hysteroresectoscopy is used, which allows electrodes to cut tissue of different thicknesses. With this option, the operation time is significantly reduced and the risk of complications is minimized.

Metroplasty is performed laparoscopically (surgical access through small holes in the abdomen) or laparotomy (surgical access through an incision in the peritoneum). After a successful operation, an intrauterine contraceptive device is installed for a period of 6–8 months. You can plan a pregnancy after 8–9 months.

Successful metroplasty can reduce the risk of complications during gestation from 85% to 30%. In many cases, surgery eliminates the cause of infertility. IVF increases the chances of pregnancy with a bicornuate uterus, especially if the deformation is mild. If bicornus is combined with other anomalies of the genitourinary organs, IVF becomes the only chance to get pregnant.

Forecasts

The most favorable prognosis is the saddle-shaped form of the anomaly. The structural defect is usually weakly expressed, the uterine cavity is deformed insignificantly or not deformed at all. The likelihood of conception with this type of defect is higher than with others.

With atresia or atrophy of one horn, medical abortions are dangerous, which lead to scar tissue changes, which can cause infertility.

During gestation, with a bicornuate uterus, the following complications are possible:

• low placement of the placenta;
• incorrect;
• premature;
• breech or transverse presentation of the fetus;
• (violation of cervical opening);
• premature birth;
• postpartum bleeding.

If the fertilized egg is attached to the atrophic horn, the horn will most likely rupture with intra-abdominal bleeding. The clinic resembles a current. If the horns are full and the volume of the cavity is sufficient, usually the course of pregnancy is normal and ends with childbirth.

Defects of the Müllerian canal do not affect the development of the ovaries, therefore, in teenage girls, menarche (first menstruation) occurs on time, and there are no gross hormonal abnormalities.

Prevention

To minimize the risks of developing anatomical abnormalities in the fetus, the expectant mother should eliminate bad habits, eat rationally, be moderately active, not be overloaded physically and psychologically, take more frequent walks in the fresh air and go to nature.

Management of pregnancy with a bicornuate uterus in a patient requires prevention of potential complications. In the early stages, bed rest, therapy with antispasmodics, hemostatics, sedatives, and gestagens are indicated. If there is a threat of failure in the later stages, a cesarean section is performed at 26–28 weeks.

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During pregnancy, the presence of various pathologies in the fetus is quite common. This also applies to the formation of the genital organs. In this article we will talk about such an anomaly as a bicornuate uterus. It is interesting that this phenomenon does not occur as often as compared to other pathologies. For example, pathologies of the female organs are found in 62% of women. Whereas bicornuity of the organ is found in only 0.5-1% of all women. So, let's take a closer look at what this pathology is and what consequences it has on a woman's life.

What is a bicornuate uterus and what does it look like?

A bicornuate uterus is a congenital defect of the body of an organ that begins to develop during the prenatal period of a girl’s life. This defect affects the structure of the uterine body. It is interesting that when bicornuate organ body is present in women, they do not even suspect it. This pathology has several types, therefore its manifestations are different.

What does she look like? Normally, the uterus is shaped like a pear. When bicornuated, this organ visually resembles a jester's cap. That is, the body of the organ diverges in different directions, as if branching off. Hence these branches are called horns. These two branches are connected to each other by the cervical canal. Sometimes these two horns are not symmetrically developed. One of them may even stop functioning over time. Interestingly, with this shape of the uterus, the fetus can develop on the right, left, or in the middle. Therefore, during pregnancy, a woman with this pathology can see the following entry on the card: “bicornuate uterus with pregnancy on the right side.” Visually, a variety of bicornuate queens can be seen in the picture below.

Causes of the anomaly

At the moment, no one can say exactly what influenced the formation of a bicornuate uterus. We can only guess what could have caused the development of this anomaly. One of the assumptions remains that during pregnancy and fetal maturation the woman did not consume enough vitamins and macroelements. And this contributed to the formation of pathology. Below are several conditions that, according to experts, can cause the formation of this pathology.

• stress and psychological trauma during pregnancy;
• avitaminosis;
• taking certain medications (tetracycline group);
• the presence of bad habits during pregnancy;
• intoxication with narcotic drugs;
• illnesses suffered during pregnancy, such as influenza, measles, jaundice, rubella and even common ARVI;
• the mother has a heart defect;
• endocrine abnormalities: diabetes, abnormalities in the thyroid gland;
• negative environmental atmosphere;
• hereditary manifestations of pathology.

Toxicosis and fetal hypoxia can also be unfavorable phenomena for the normal development of the fetus.

Symptoms

Most patients with this defect do not feel any clinical manifestations until the first ultrasound. Some people find out about their pathology only during pregnancy. In some cases, pregnancy and childbirth are so successful that it cannot be assumed that the woman is suffering from pathology. But still, the symptoms make themselves felt in most cases. Below are the most common manifestations of a bicornuate uterus.

• hormonal disorders;
• painful menstruation;
• the duration of menstruation is maximum;
• painful sensations during PMS;
• miscarriages;
• difficulty in getting pregnant;
• the enlarged organ begins to put pressure on nearby organs, causing discomfort.

Those who have been diagnosed with this pathology should not consider themselves to be different from everyone else. After all, the bicornuity of the uterus does not at all affect the quality of sexual life. The woman still experiences arousal and has the ability to have an orgasm. And the anomaly does not always affect the possibility of conception. A girl can easily conceive and give birth to a child without any problems. Also, with a bicornuate uterus, girls and women should not experience pain during sexual intercourse, unless there are concomitant diseases with a similar symptom.

Species

Uterine pathology caused by bicornuity comes in different types. Below are the three main types of bicornus.

Consequences and complications

All consequences and complications from the pathology can only appear during pregnancy and childbirth. What are these manifestations?

• vaginal discharge during gestation with bicornus can be observed throughout pregnancy;
• partial placenta previa at 8 weeks of pregnancy;
• spontaneous abortions in the early stages;
• premature birth due to the fact that the egg is not fully attached correctly;
• low position of the ovum;
• leakage of amniotic fluid;
• due to the fact that such a uterus is much smaller in size than a normal one, the child is not able to move freely, so the fetus may lie incorrectly;
• poor fetal nutrition;
• risk of developing postpartum endometritis;
• early dilation of the cervix (cervical insufficiency);
• if the embryo is attached to a non-functional uterine horn, then actions similar to an ectopic pregnancy are carried out - an operation to remove the fetus;
• premature separation of the placenta.

Diagnostics

How is it possible to detect this pathology, even if all the symptoms are absent? There are basic effective methods for diagnosing a bicornuate uterus. First of all, this is a visual examination by a gynecologist. Already at this stage, the doctor will see the presence of partitions and will send for additional research methods. The main purpose of these examinations should be to determine the functionality of the uterus and the possibility of conception and childbirth.

• Ultrasound. Ultrasound should be performed using vaginal or abdominal sensors. If changes in the uterus are minor, then bicornuity may not be detected immediately. Therefore, it is very important to use 3D ultrasound instead of 2D.
• MRI. This is a fairly highly informative method for identifying pathologies of internal organs. Tomography allows you to accurately determine the presence of pathologies and the degree of their development. It shows the shape, structure and location of the pathology in the uterus.
• Laparoscopy. Examination through surgery. Using small incisions, a sensor with a camera is placed into the abdominal cavity. An image of all internal organs is displayed on the screen. This way the doctor will determine the exact location of the pathology.
• Hysteroscopy. The cavity is examined using an endoscope. The structure of the endometrium and the shape of the uterus are assessed. The doctor also determines whether the openings in the fallopian tubes are passable.
• Hysterosonography. This is a study of the internal female organ by injecting a contrast agent into it. Next, an x-ray is taken and the type of uterine pathology is determined from it. It allows you to determine the non-functioning sides of the bicornuate organ.

After determining the presence of pathology, the doctor decides whether it is worth treating. A positive decision is made if the pathology

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Approximate reading time: 12 minutes

The human body is a mystery and has intrigued the minds of scientists throughout human existence. Of particular interest is the woman's body as a source of new life. Despite the fact that the basic principles of structure are the same for all people, each organism is unique and has its own characteristics. Depending on their nature, experts talk about the presence of developmental anomalies. In one case, the tissue or organ may be modified, in another - absent or duplicated. The last variant of deviation from the norm of development is a bicornuate uterus.

This structural feature is considered the most common among uterine developmental anomalies, but in general it is quite rare, affecting 0.1% - 0.5% of women. But do women diagnosed with a bicornuate uterus understand that such development is not a death sentence for their reproductive function? Does it reduce their anxiety? Probably not. Each of them is concerned about the question of whether pregnancy is possible with a bicornuate uterus, how does it proceed and what features does it have? What is a bicornuate uterus in women?

Let's talk about all this in order.

What is a bicornuate uterus in women?

It is no secret that the formation and initial development of all human systems and organs occurs in the mother’s womb. Thus, the female genital organs are formed from approximately 7 to 14 weeks of fetal development, and the uterus is formed due to the fusion of the Müllerian ducts. If this process deviates somewhat from the normal pace, there are frequent cases of abnormal development, in which the uterus does not develop correctly.

In this regard, a two-horned uterus (lat. Uterus bicornis) is a type of violation of the intrauterine development of the girl’s reproductive system, expressed in the division of the uterine cavity into two parts, merging into one vagina.

Types of bicornuate uterus and their features

Today, gynecology distinguishes 3 types of bicornuate uterus, each of which has its own characteristics and a certain impact on the possibility of motherhood. So, a bicornuate uterus can be complete, incomplete and saddle-shaped (or arcuate). Each type is discussed in more detail in the table below. (To view from a mobile phone, rotate it to a horizontal position to fully display the table)

View	Image	Peculiarities	Bicornuate uterus and pregnancy
Complete bicornuate uterus		Complete splitting of the uterine cavity by the septum, starting from the uterosacral ligaments. As a result, two cavities (two horns) are formed, flowing into one cervix and vagina. The angle between the horns may vary.	Possible. It all depends on the development of the horns. Depending on the results of the examination, metroplasty may be indicated.
Incomplete bicornuate uterus		The septum is located in the upper 1/3 of the uterus, so the horns are separated shallowly. Therefore, they most often have approximately the same size and shape.	Possible.
Saddle bicornuate uterus		The uterine cavity is slightly changed, the horns practically merge, and there is a saddle-shaped depression in the fundus.	Possible.

Causes of abnormal development

There is no single specific reason that leads to the formation of this particular developmental pathology in the literature.

However, there are factors whose impact in the first trimester of pregnancy can lead to abnormalities of the fetal reproductive system:

• Intoxication: the mother’s use during pregnancy of such harmful and aggressive agents as tobacco, alcohol, drugs, potent and any other medications without a doctor’s prescription.
• Psychotraumatic circumstances and/or chronic stress.
• Acute lack of adequate nutrition and vitamin deficiency.
• Some diseases of the endocrine system (thyrotoxicosis, diabetes mellitus) and cardiovascular system (heart disease).
• Infectious diseases such as measles, rubella, toxoplasmosis, influenza, as well as sexually transmitted infections (syphilis and others).
• Problems with fetal nutrition and chronic oxygen starvation.
• Acute toxicosis during pregnancy.
• A genetic factor that is most often not taken into account due to lack of awareness.

Due to the influence of these factors in the first weeks of pregnancy, there are frequent cases of abnormal development of not only the reproductive system, but also the baby’s urinary system. Therefore, it is extremely important that the expectant mother pays due attention to her health, sees a doctor and takes care of the unborn child.

Dangers of a bicornuate uterus and its symptoms

Is a bicornuate uterus bad, what dangers does this anomaly pose and what consequences can it lead to?

First- this diagnosis can become cause of infertility and inability to bear a baby, that is, miscarriages. However, this is not always the case; it all depends on the degree of development of the uterine horn or horns. The more pronounced the septum of the uterine cavity, the higher the chance of losing the child.

Second - this feature often causes abnormal spontaneous uterine bleeding.

And although a bicornuate uterus causes infertility in about half of the cases, its detection is not as obvious as it seems. During a routine gynecological examination, it is detected extremely rarely. Most often, a woman learns about this structural feature in one of three cases:

• diagnosis in connection with the problem of infertility or miscarriage;
• thorough diagnosis at the stage of pregnancy planning;
• directly during pregnancy.

In connection with the above, a woman may not even be aware of her illness. However, there are still some signs that may suggest something is wrong:

From the side of gynecology:

• uterine bleeding;
• pain in the lower abdomen as during menstruation;
• algodismenorrhea;

From the side of reproductive function:

• miscarriages (especially in the 1st trimester of pregnancy);
• premature birth;
• infertility;
• frozen pregnancy;

From the placenta:

• location anomalies;
• premature detachment;
• placental bleeding;

On the fetal side:

• breech presentation;
• transverse or oblique position;
• oxygen starvation and lack of nutrition in general;

From the side of labor:

• isthmic-cervical insufficiency;
• premature birth;
• violation of contractile function of the uterine muscles;
• postpartum bleeding.

It must be remembered that these symptoms do not appear in everyone and not always, as well as the fact that a bicornuate uterus and pregnancy is possible and quite often it is successful. If any symptom or several are noticed, you should immediately seek qualified help from a gynecologist for diagnostic measures.

Diagnosis of bicornuate uterus

From all that has been said above, it follows that diagnosing a bicornuate uterus using conventional gynecological examination methods is ineffective; additional research methods are required. Only after a thorough examination can the doctor make a conclusion and diagnose a “bicornuate uterus”, and build a tactic for further treatment.

Modern gynecology has a wide range of diagnostic capabilities, so gynecological examination involves the use of:

• probing of the uterine cavity and ultrasound examination of the pelvis using sensors;
• conventional and ultrasound hysterosalpingography;
• hysteroscopy;
• laparoscopy.

To make a final diagnosis of uterine malformation, hysteroscopy and laparoscopy are performed simultaneously. This is done to exclude the diagnosis: intrauterine septum, the picture of which is very similar to a bicornuate uterus.

Treatment of the anomaly

Since a bicornuate uterus is an anomaly of organ development, and not a disease in the broad sense of the word, treatment of this disease is carried out using surgical intervention according to indications. The latter is the full form of a bicornuate uterus identified during the examination as a factor of infertility after all other possible causes of reproductive dysfunction have been excluded. The main indicator for metroplasty, according to experts, is repeated miscarriages or premature births (more than 2 - 3 times).

The main method of surgical removal of a bicornuate uterus is the Strassmann operation, which involves transverse dissection of the uterus during laparotomy surgery, followed by excision of the septum and the application of a longitudinal suture to the uterus.

After successful completion of the operation, the woman is fitted with an IUD (intrauterine device) for a period of 6–8 months, since an early pregnancy after Strassmann’s operation can end tragically - uterine rupture.

Despite the fact that a well-performed Strassmann operation significantly increases the chances of a successful pregnancy with subsequent delivery (in 63% of cases, a woman’s fertility is completely restored), we must remember that the risk of uterine wall rupture remains high, as well as the likelihood of developing repeated infertility due to with the possibility of formation of adhesions. Important follow all recommendations gynecologist and carry out all necessary diagnostic and therapeutic measures in accordance with them. The process of recovery and subsequent motherhood is largely depends from the woman herself.

Therefore, pregnancy with a bicornuate uterus requires close attention from doctors and from the expectant mother.

Bicornuate uterus and pregnancy: main risks

Any deviation of an organ from normal functioning is always a risk and a threat to health, and in the case of the uterus, the stakes are doubly high. The possibility of a horny uterus and pregnancy is not mutually exclusive; in fact, there are frequent cases of successful pregnancy and no less successful childbirth with this anomaly.

There are still pitfalls and they are as follows:

• “I don’t have enough space, I have nowhere to turn around,” or insufficient volume of the intrauterine cavity for normal growth and development of the fetus;
• the embryo may accidentally choose the “wrong home” and attach to the avascular septum, and, consequently, be deprived of nutrition and oxygen;
• pregnancy with a bicornuate uterus is very often accompanied by a violation of the obturator function of the uterus, which provokes the threat of miscarriage or premature birth.

If a bicornuate uterus and pregnancy occur, then experts prefer not to interfere in the process of bearing the baby unnecessarily, but to closely monitor it. Since at any time at any time with such a pathology, 2 serious complications are possible:

• Bleeding, which is often caused by placental presentation (occurs in 40–45% of cases). This suggests that the embryo decided to attach not in the back or side parts of the mother’s womb, but “closer to the exit”, to the endometrium of the lower part of the uterus.

  Bloody discharge in the early stages, as well as bleeding, indicate that during the process of formation and growth, the placenta blocked the cervix of the uterus. Accompanied by pain in the lower abdomen, this sign is a harbinger of miscarriage, which occurs in 30–35% of pregnancies with a bicornuate uterus.

  With late bleeding after the 30th week of pregnancy, we are already talking about placental abruption.

• Frozen pregnancy. In cases where the embryo is attached not to any wall of the uterus, but to a vascular-free septum, it cannot feed and develop. As a result, its development stops and the embryo dies.

  Pregnancy can also freeze when the embryo is attached in close proximity to the septum. It will simply interfere with normal growth and development, which will also lead to the death of the embryo.

Pregnancy with an arcuate (saddle-shaped) bicornuate uterus

The most favorable option for pregnancy with a bicornuate uterus is considered to be in an arcuate or saddle-type uterus due to the fact that in this case there is no septum as such, there is a small ridge in the fundus. But even here there are plenty of possible complications. The dangers are the same as with other types of bicornuate uterus, only they appear somewhat less frequently. The most typical complications and threats during pregnancy for a saddle-shaped bicornuate uterus are:

• Premature birth, which is most often much ahead of schedule. This is observed in 15–25% of pregnant women with this type of pathology. As a result, perinatal morbidity and newborn mortality increase.
• Malposition. With this type of uterus, it is most likely that the fetus will be positioned transversely or obliquely, which is a direct indication for surgical delivery via cesarean section. If the birth took place naturally, the woman’s recovery period is very long, since such a uterus contracts poorly and will bleed for a long time.

Two horns - two children

The human body is mysterious and unpredictable. It would seem that with a bicornuate uterus, pregnancy is unlikely, not to mention anything more. It turns out that everything is so, but not so. And pregnancy with a bicornuate uterus can not only happen, but can also turn out to be multiple.

There are cases of twin pregnancy with complete bifurcation of the uterus, that is, when the splitting of the septum reaches the cervical canal and forms two uterine cavities. In this case, the pregnancy of each fertilized follicle most often develops in different horns. This happens extremely rarely; according to statistics, twin pregnancy with a bicornuate uterus is 1 case per million.

From the point of view of obstetrics and gynecology, this pregnancy falls into the category of extreme risk of miscarriage or uterine rupture. In 90–95% of cases, such a pregnancy ends in premature birth at 32–34 weeks of pregnancy.

Summing up

Regardless of “how much” the uterus is bicornuate and the pregnancy has already formed, the risk is very high. You can find quite a lot of information on this matter in specialized publications; pregnancy and a bicornuate uterus are actively discussed in forums.

It is important to remember that no matter what the experience of other women with a similar feature of the body and no matter what the books write, each case is special and requires an individual approach, taking into account the parameters of a particular organism.

Anomalies in the development of the female genital organs are an uncommon, but by no means unique, phenomenon in modern gynecological practice. Sometimes this structural feature does not affect the functioning of the reproductive system and is an accidental diagnostic finding. But quite often, developmental defects become the cause of various complaints, which brings patients to see a doctor.

The most common are various anomalies of the uterine body. According to medical statistics, they occur in almost 5% of the female population. And in ¼ of cases (approximately 0.5-1% of patients) the so-called bicornuate uterus is diagnosed. Whether this is bad depends on the severity of the defect and the functional usefulness of the walls of the abnormally developed organ. Quite often there are situations when bicornus becomes an accidental diagnostic finding and does not have a clear negative impact on a woman’s well-being and her reproductive health.

What does a bicornuate uterus mean?

A bicornuate uterus is a developmental defect accompanied by doubling of the organ body with incomplete separation of the resulting cavities. The pathology refers to anomalies of the Müllerian (paramesonephric) duct. This is the name given to the temporary paired formation that gives rise to the uterus, fallopian tubes and vagina in female embryos.

Normally, the Müllerian duct consists of 2 halves fused in the distal part. If the process of fusion of its lower parts is disrupted or if one part is underdeveloped, the fetus develops various uterine defects. It may be septate, saddle-shaped, unicornuated, bicornuate, or completely duplicated. These anomalies are sometimes combined with malformations of the cervix and vagina. Concomitant disorders of the formation of the kidneys and urinary tract are also possible.

What does a bicornuate uterus look like?

With this pathology, the abnormally developed organ is shaped like a jester's cap with 2 halves (horns) diverging to the sides. They have formed internal cavities that communicate with each other in the distal part or open into the cervical canal. The severity of the divergence of the horns can be different, which depends on the degree of development of their medial walls and the length of the internal uterine septum.

This doubling of the uterus is usually not accompanied by a disruption in the formation of its tissues. Therefore, the walls of the organ, despite the abnormal shape, in most cases have developed and functionally complete layers. But there are also asymmetrical forms, when one of the horns does not achieve sufficient development or is completely atretic.

For some mammals, this shape of the uterus is normal, but in humans it is a pathology. Indeed, normally this reproductive organ has the shape of a triangle with an upward-facing base and a single internal cavity. The appearance of any partitions and splitting of the uterine fundus is a sign of abnormal organogenesis.

Causes of pathology

It is not possible to reliably identify the causes of congenital malformations of the Müllerian ducts. It is believed that an anomaly in the development of the uterus is formed as a result of a violation of early organogenesis at 2-3 months of intrauterine development of a female fetus. The reason for this may be a variety of unfavorable factors:

• Toxic substances of exogenous and endogenous origin that have a teratogenic effect. These include, but are not limited to, certain medications, nicotine, alcohol, and industrial emissions into the environment.
• Infectious diseases suffered in early pregnancy.
• Various pathological conditions leading to hypoxia of tissues of the developing embryo.
• Metabolic disorders in a pregnant woman, especially those caused by clinically significant endocrine pathology.
• Severe vitamin deficiency and significant deficiency of essential nutrients.

In addition, in some cases, a hereditary predisposition to malformations of the genitourinary system can be traced.

Basic anatomical variants. Classification

There are several variants of pathology:

• Saddle-shaped bicornuate uterus, it is also called arcuate (uterus arcuatus). This is the most favorable type, with a mildly expressed structural defect. The bottom of the organ has a depression in the middle, and the internal cavity is practically not deformed.
• Bicornuate uterus with a partial (incomplete) internal septum (uterus subseptis). The uterine cavity is divided into 2 halves, which communicate near the cervix. The length of the partition may vary. This anomaly is due to incomplete reabsorption of the confluence of the Müllerian ducts.
• A bicornuate uterus with a complete septum (uterus septis), which partitions the internal cavity into 2 isolated halves and extends from the fundus to the internal os.
• Uterus with a doubled (divided) body and a common cervix (uterus bicollis unicollis). In this case, there are 2 separate uterine cavities that open into the common cervical canal.
• Duplication of the uterine body, accompanied by atrophy and/or atresia of one horn. In this case, it is necessary to differentiate between congenital underdevelopment of a part of the organ and post-traumatic fusion of its lumen. A medical abortion with a bicornuate uterus most often leads to cicatricial deformity.
• Bicornuate uterus with atresia of the internal cavity. This option is explained by the absence of fusion of the Müllerian ducts with simultaneous closure of their lumen. The organ has a solid structure or contains a small isolated cavity in the area of ​​one horn.

It is also possible that the uterus is bicornuate and the cervix is ​​double (uterus bicollis bicollis). In this case, the cervical canals can be mutually isolated with the help of a septum or open in the upper third of the vagina independently of each other. Many experts attribute this type of malformation not to bicornus, but to complete doubling of the organ.

Abnormalities of the body and cervix can be combined with pathology of the vaginal structure. In such cases, a complete or incomplete vaginal septum or 2 isolated fully formed vaginas are diagnosed.

A simplified classification is also used. According to it, the saddle uterus, incomplete and complete types of organ cleavage are distinguished.

Clinical picture

Symptoms of a bicornuate uterus are nonspecific. Their presence does not allow one to suspect a developmental defect until a set of studies is carried out. In addition, a fairly large number of patients do not have obvious clinical manifestations.

The most likely symptoms include abnormal menstruation, infertility, and complicated pregnancy.

In most cases, malformations of the Müllerian ducts are not accompanied by an abnormality of the ovaries and the appearance of any external stigmata. Therefore, patients with such a congenital pathology are not characterized by a late onset of menarche, severe endocrine disorders and obvious phenotypic abnormalities. The frequency of hormonally caused disorders of the ovarian-menstrual cycle in them is almost the same as in women with normally developed internal genital organs.

Menstruation with a bicornuate uterus is most often painful and quite abundant. It is also possible that the duration of menstruation may lengthen, which is explained by the increased volume of rejected endometrium and the difficulty of evacuating blood from well-developed uterine horns.

In addition, an enlarged abnormal uterus has a greater mechanical impact on surrounding organs and nerve plexuses. Therefore, physiological premenstrual tissue swelling may be accompanied by significantly more pronounced pain.

The pain of menstruation (algodysmenorrhea) is also explained by fairly strong spastic contractions of the menstrual organ, which is necessary for the effective separation of the functional layer of the endometrium. In addition, significant physical discomfort can be caused by blood stagnation in the horizontally located uterine horns.

Bicornus usually does not affect the quality of sexual life unless it is accompanied by vaginal malformations. Women are capable of experiencing sexual desire, arousal and orgasmic release, and coitus in most cases does not cause them discomfort.

Infertility is by no means a mandatory symptom. The absence of a developing pregnancy is explained not by ovulatory and endocrine disorders, but by impaired implantation of the fertilized egg or its rejection in the early stages of gestation. A woman with a bicornuate uterus is able to conceive naturally, carry and give birth to a healthy child. But the presence of a malformation is a risk factor for the development of various complications during pregnancy, childbirth and the early postpartum period.

Pregnancy and childbirth with a bicornuate uterus

Is it possible to get pregnant with a bicornuate uterus - a question that worries young women and women who have not yet given birth. Yes, pathology in many cases does not prevent natural conception, although the resulting pregnancy in almost 70% of cases occurs with complications or is completely terminated spontaneously.

The main reasons for the negative impact of bicornus on the process of bearing a child include:

• reduced (compared to a normally developed uterus) volume of the cavity available for the development of the fertilized egg;
• increased contractile activity of the myometrium in an abnormally formed organ;
• anatomical and functional inferiority of the uterine wall, especially in the area of ​​bifurcation and septum;
• frequent anomalies of innervation and blood supply to the walls of a partially bifurcated organ;
• a change in the ratio and angle of location between the body and the cervix, which significantly increases the risk of developing isthmic-cervical insufficiency.

Bicornus can lead to disruption of implantation of a normal fertilized egg. That is, fertilization occurs, but pregnancy does not prolong. In this case, the embryo is removed from the uterine cavity during the next menstruation, which may occur on time or with a slight delay.

Women with this malformation are also likely to have a frozen pregnancy and spontaneous abortion in the early stages of gestation. In addition, this situation is considered a risk factor for the development of various anomalies in the structure of internal organs in the embryo.

When pregnancy occurs in a woman with a bicornuate uterus, the fertilized egg is implanted in one of the horns, usually on the side of ovulation. In this case, the least favorable options are its attachment in the zone of bifurcation of the walls, to the existing septum or near the cervix. The second horn remains free. The endometrium in it undergoes all the characteristic gestational changes. Pregnancy in the right horn and pregnancy in the left horn have no fundamental differences.

Sometimes a woman ovulates two eggs in different ovaries at the same time. With their fertilization and successful implantation, a unique situation arises: a bicornuate uterus and twins with the development of each fetus in a separate horn. But such children are rarely born full-term.

With a bicornuate uterus it is also possible. This is due to structural and functional disorders in the area of ​​the mouths of the fallopian tubes while maintaining their patency for sperm.

Safe prolongation of pregnancy after the 1st trimester does not mean the disappearance of risks for the mother and fetus. The more the walls of the pregnant uterus stretch, the greater the likelihood of their functional inferiority and isthmic-cervical insufficiency. This threatens the development, rapidly progressing with its intrauterine death. Frequent complications are also bleeding during pregnancy, fetal malnutrition due to breech presentation of the child.

But in many cases, a woman manages to carry and give birth to a healthy child, despite the presence of a defect.

Childbirth

Pregnant women with diagnosed uterine malformations should be closely monitored by an obstetrician-gynecologist. In most cases, a decision is made about their antenatal hospitalization, which is sometimes required as early as 26-27 weeks of gestation.

If increasing and uncorrected fetal hypoxia is diagnosed, a decision is made on emergency delivery by. In this case, the patient is considered to be at high risk for the development of postpartum uterine bleeding, hematomas, etc.

But natural childbirth is also possible with a bicornuate uterus, even if this defect is combined with abnormalities of the cervix and vagina. The medical literature describes cases of successful independent delivery of women even with a complete type of organ cleavage and vaginal duplication. But, of course, such births are often accompanied by injuries to the tissues of the genital organs in patients and usually require an episiotomy.

In the postpartum period, patients with a bicornuate uterus require special attention, because they have an increased risk of delayed contraction of the organ and the development of hematometra.

Why is a bicornuate uterus dangerous?

Bicornus is not an abnormality incompatible with life; it does not affect the viability of the fetus or the overall development of the child after birth. With moderately pronounced defects, a woman may not even suspect that she has a developmental defect, especially if the functionality of the organ is preserved. However, a bicornuate uterus can also pose a danger to the patient’s health.

The most unfavorable situation is partial atresia of the lumen of one horn. This is accompanied by the formation of a closed cavity with a functionally complete endometrium. Natural cyclic changes in the mucous membrane with regular rejection of its functional layer in this case will cause the formation of hematometra. The most dangerous complication of this condition is suppuration with the development of endometritis and subsequent melting of the walls of the organ.

Hematometra can also occur due to severe difficulty in evacuating menstrual blood from a deformed horn that is clearly deviated from its physiological position. Infection of such pathological contents of the uterine cavity is fraught with the development of pyometra, often complicated by the development of purulent peritonitis and sepsis.

Another possible and quite dangerous consequence is a tendency to. This threatens the development of severe posthemorrhagic anemia with clinically significant dysfunction of vital organs.

Diagnostics

Diagnostics include:

1. Gynecological examination. Allows you to identify the presence of vaginal septums, a double cervix, and with a bimanual examination, the doctor can determine the deformation of the uterine fundus (in the case of divergent horns).
2. using abdominal and vaginal sensors. At the same time, the structure of not only the reproductive system, but also the urinary tract is assessed. A bicornuate uterus may not be detected on an ultrasound in a timely manner, which depends on the qualifications and skills of the diagnostician and the quality of the equipment used. Unreliable results are most likely if the deformation of the internal cavity is slight. Therefore, 2D ultrasound is not a diagnostic method that confirms or excludes a diagnosis. The 3D technique is more informative, although it cannot be used as a key study.
3. Survey radiography. Gives the doctor a picture of the external contours of the organ, but does not help to accurately determine the type of abnormality.
4. – determination of the contours of the uterine cavity using a radiopaque substance, which is injected through the cervical canal. But this technique does not allow us to evaluate the structure of rudimentary and atretic horns and isolated cavities.
5. – examination of the uterus using an endoscope. Allows you to evaluate not only the shape of the uterine cavity, but also the structure of the endometrium, the existing septum, and the patency of the orifices of the fallopian tubes.
6. – a minimally invasive surgical technique that can be used to determine the condition of the uterus and appendages, and to identify concomitant defects of the urinary tract and kidneys. If necessary, laparoscopy is also used as a therapeutic technique.
7. – a highly informative way to visualize anatomical formations and identify malformations of their development. Allows you to accurately determine the shape of the uterus, the structure of the layers of its wall, and the correct formation of other organs.
8. CT can be used as an alternative to MRI.

Hysterosalpingogram of a bicornuate uterus

A study prescribed by a doctor should be aimed not only at confirming the presence of malformations of the internal genital organs in a woman. The most important tasks of the diagnostics are to determine the functionality of the bicornuate uterus, the possibility of pregnancy, and the prospects of surgical treatment to restore reproductive function.

Treatment

Treatment of a bicornuate uterus is only surgical. It is carried out to restore the maximum possible functionality of the abnormal organ. And the main indications for surgery are infertility, recurrent miscarriage, a history of stillbirth and other pathologies associated with pregnancy. A rare reason for emergency intervention is a hematometra in the isolated cavity of one horn.

The main type of operation is metroplasty of the bicornuate uterus, aimed at creating a single uterine cavity. To do this, one rudimentary horn can be removed, or a complete or incomplete septum can be excised. Often, partial removal of the uterine wall in the bifurcation area is performed, followed by displacement of the surgical wound from the frontal plane to the sagittal plane and the formation of a new fundus.

Currently, preference is increasingly being given to minimally invasive techniques. In this case, the main manipulations are performed hysteroscopically or laparotomically. Laser operations are widely used. These newer treatment methods can significantly reduce surgical trauma, reduce the risk of postoperative complications (including atresia) and significantly improve the prognosis for the onset and successful pregnancy.

According to medical statistics, the risk of various gestational complications after successfully performed metroplasty is reduced from 70% to 30%. In addition, surgical treatment allows in many cases to cope with infertility.

At the same time, to increase the likelihood of pregnancy in women who have undergone surgery or in patients with a minor defect, assisted reproductive technologies can be used. They are indicated if additionally diagnosed, depletion of the ovarian reserve, a combination of male and female factors of infertility.

Since such patients usually fail to become pregnant naturally, it becomes an almost irreplaceable method of treatment for a bicornuate uterus with concomitant pathology. The protocol is selected individually.

What else is important to know?

Malformations of the uterus usually make it difficult, but do not exclude pregnancy. Therefore, women of reproductive age with this pathology should carefully select a method of protection. Hormonal contraception is also suitable. But whether it is possible to install a spiral if the uterus is bicornuate, the doctor decides on an individual basis.

The presence of a septum of any severity and formed horns is a contraindication for such contraception. After all, in this case, the spiral cannot be placed so that it affects almost the entire surface of the endometrium. And with the saddle type of pathology with slight deformation of the uterine cavity, sometimes a decision is made on the advisability of using intrauterine methods to prevent pregnancy, especially if the patient has contraindications to the use of oral contraceptives.

Detection of bicornus does not unambiguously mean that a woman has a severe hereditary pathology. Of course, such patients require genetic consultation to assess the risk of developing defects in future children. But in most cases it is not possible to identify obvious genetic disorders. After all, anomalies in the development of the Müllerian duct are most often caused by the influence of unfavorable factors, and not by severe inherited mutations.

A bicornuate uterus is not just a pathology, but a problem that can cause abnormal uterine bleeding, dysmenorrhea, failure to carry a fetus to term during pregnancy, and even the inability to become pregnant. A bicornuate or double-headed uterus can be detected through such procedures as: ultrasound, hysterosonography, hysteroscopy, laparoscopy. If correction is required, surgical intervention is performed endoscopically or the Strassmann operation is performed. Pregnancy in the presence of such uteruses is quite possible, but is usually accompanied by a huge risk and miscarriage.

Are bicornuate uterus and pregnancy compatible?

Bicornuate uterus - this means the division of the cavity into two horns into two parts and fusion at the bottom.

It is worth noting that depending on how strongly the cavity is split, a uterus with two horns can be:

• Saddle-shaped;
• Full;
• Incomplete.

Complete doubling means that the cavity is completely divided in half, and each horn extends in its own direction, located at the level of the uterosacral ligament. With this pathology, the angle of deflection of the horn can be very different. If the separation is too pronounced, then the formation of two niches is possible, each of which will resemble a separate one-horned uterus located next to the other.

Such a two-horned uterus may well be used to bear a fetus, but the baby will develop in a specific, for example, the right horn.

Incomplete splitting means that the bifurcation does not occur completely, but only in the third part and there is a shallow opening between both horns. In this case, the shapes and sizes of both horns remain identical. The saddle uterus is a type of bicornuate uterus in which the fundus resembles a depression, which becomes saddle-like in shape. It is possible to conceive a baby with such a diagnosis, but everything depends solely on the individual characteristics of the body and the woman’s physiology. There is a high probability that spontaneous abortion will occur, especially if women have a narrow pelvis or have previously been exposed to obstruction of the tubes.

Diagnosis of bicornuate uterus: what is it?

There are different types of bicornuate uterus, but each of them is an anomaly and is very bad for the body. According to statistical studies, bicornus is diagnosed in 3% of women out of 100.

And the formation of such pathology occurs:

• In case of intrauterine development disorders;
• If the mother lacks the hormone at the beginning of pregnancy;
• Due to the heredity of physiology.

As for development during the period of embryogenesis, this mainly occurs at the moment when the formation of the fusion of the Müllerian ducts occurs, which is not completed and becomes the cause of bicornuity. Quite often, with this pathology, the presence of one cervix and one vagina is diagnosed, but it is quite possible that the organs are duplicated, as well as the presence of an incomplete septum between the two vaginas.

Typically, one horn in a bicornuate uterus is considered vestigial.

The horny curved uterus can function for fertilization and gestation, however, if the attachment of the amniotic sac occurs in the cavity of the rudimentary horn, then if not detected in time, this can lead to rupture of the horn and intra-abdominal bleeding. In 50% of cases, the development of horns is uniform and each can be used to fertilize the pregnancy.

Information: bicornuate uterus, is it bad?

A bicornuate uterus is already bad, but many women have to deal with what it is and how it is treated. It is quite possible to remove the pathology, but it is advisable to familiarize yourself with the symptoms.

Mostly with a bicornuate uterus it manifests itself:

• Algodismenorrhea;
• Uterine bleeding;
• Spontaneous abortion.

Most often, with an ordinary bicornuate uterus, miscarriages occur or it is impossible to get pregnant at all, but there is a chance of conceiving a baby and bearing offspring, and this can be twins and triplets, and the birth will be as positive as possible. To remove bicornus, an operation is performed, however, only after: an accurate diagnosis, confirmation of the diagnosis, and the absence of a contraindication from the body.

If spontaneous abortion does not occur in the first trimester of pregnancy with a bicornuate uterus, then it will not occur until the end of pregnancy. This fact is confirmed by numerous statistical studies. In addition, with this diagnosis, the formation of such an anomaly as low placement of the placenta is possible, which can cause its premature detachment and even bleeding.

There are other more serious consequences such as:

• Isthmic-cervical insufficiency;
• Breech presentation of the fetus;
• Premature birth;
• Disturbances in muscle contractile activity;
• Postpartum bleeding.

If the fetus is in an oblique or transverse presentation, then a cesarean section is performed.

Reviews: bicornuate uterus and pregnancy

Gynecology is a fairly serious and extensive field of activity, but you need to visit a specialist in this field regularly to avoid the formation and development of serious health problems. For example, it is the gynecologist who, based on patient complaints, can initially make a diagnosis and identify problems such as: internal bleeding, threatened miscarriage, infertility. If there are symptoms or the likelihood of such problems, in addition to the usual examination, additional probing of the uterine cavity may be performed.

Thanks to this, parameters such as:

• Form;
• Size;
• Anatomical features.

A bicornuate uterus can be detected by ultrasound of the pelvic organs using a vaginal and abdominal sensor, and in addition, studies such as hysterosalpingoscopy, hysterosalpingography, MRI, hysteroscopy, laparoscopy can be carried out.

Causes of a bicornuate uterus

There are many women who gave birth with such a pathology as a bicornuate uterus, and at the same time their periods are the same as usual, and the reviews are very different, since everyone has a different body, physiology and medical indicators of the body. The reasons for the formation of pathology may be different, but this is mainly due to disturbances that occur during the intrauterine development of the fetus.

Among the factors that can lead to such consequences are::

• Consumption of alcohol, drugs, nicotine, medications and chemical agents;
• Presence of vitamin deficiency;
• Presence of mental trauma;
• Endocrine diseases such as diabetes mellitus or thyrotoxicosis;
• The mother has a heart defect.

In addition, the presence of pathogens in the mother’s body can lead to disruption of fetal development: measles, rubella, influenza, toxoplasmosis, syphilis. Severe toxicosis has an extremely adverse effect on the baby, which can lead to fetal hypoxia.

Is it possible to get pregnant: bicornuate uterus

You can see what a bicornuate uterus looks like in close-up on an ultrasound by visiting any IVF center that deals with reproductive medicine. It is worth noting that if a pregnant woman has such a pathology, treatment is strictly prohibited, but on the contrary, in order to achieve fertilization, she will have to undergo therapy, use special positions during sexual intercourse and make sure that if the uterus starts to hurt, then you need to immediately contact specialist.

If the pathology is treated or removed correctly, it is quite possible to become pregnant in the future and bear a child without problems.

As a rule, surgical intervention is possible if a woman has already had at least 3 miscarriages for this very reason. The purpose of this procedure is that the uterus of two types undergoes restoration of the cavity and the two parts are connected into one. Basically, operative gynecology uses extirpation of the rudimentary horn, or in other words, the septum that separates the two cavities is simply removed.

Features of surgery:

1. For a bicornuate uterus, an operation called Strassmann therapy is performed.
2. During the operation, a laparotomy is performed, during which the fundus of the uterus is dissected through a transverse incision and the median septum is excised with further suturing of the lining of the uterus.
3. Surgical correction of a bicornuate uterus can be carried out using a hysteroscopic technique, and after surgery, the uterine cavity becomes single and suitable for fertilization only after 1 year.

There are different prognoses for those who suffer from a bicornuate uterus. For example, after surgery, the risk of miscarriage is reduced from 90 to 30%.

Bicornuate uterus (video)

So, if a woman suffers from insufficient volume of the uterine cavity or the possibility of miscarriage remains, then motherhood is impossible. However, if you use assisted reproductive technologies, for example, artificial insemination, then there is a way out. As a last resort, you can use surrogacy, but not everyone agrees to do this, as this may lead to serious mental problems. Strassmann's operation is not performed on everyone. It is better not to place an IUD in such a uterus.