This anomaly depends on an incomplete fusion of the Müller ducts present in the abdomen during embryonic life. Therefore, the upper part of the uterus is divided into two hemicavities, converging in the lower part.
The bicornuate uterus does not affect fertility , but it can complicate pregnancy if embryo implantation occurs near the point where the uterine cavity diverges. In fact, this sort of residual “saddle” has little blood circulation and blood circulation in the implant area may not be sufficient to guarantee adequate nourishment to the fetus.
The bicornuate uterus can also favor spontaneous abortions in the 1st trimester, preterm birth and anomalies of fetal presentation with labor dystocia: as the gestation proceeds, in fact, the scarce elasticity of the uterine cavity does not allow it to adapt normally to the enlargement of the fetus , so the latter is expelled prematurely.
In order to avoid these complications, a corrective surgery (metroplasty) may be indicated to reunite the two “horns” of the uterine cavity. During pregnancy, however, a cerclage may be applied to the cervix .
Bicornuate Uterus And Pregnancy: What Are The Risks?
The bicornuate uterus often causes unpleasant consequences during pregnancy .
The major risks include:
- spontaneous termination of pregnancy (or miscarriage ). In this regard, unfortunately, it is not uncommon for many women to discover that they suffer from this pathology only after one or more spontaneous abortions;
- preterm or premature birth , very risky as it increases the possibility of health problems in the newborn. Some studies show that it affects between 15 and 25% of women with a bicornuate uterus. The cause seems to lie in the inadequate growth space due to the peculiar shape of the uterus itself. It can be of three types, depending on when the birth occurs:
- it is called late if it occurs between the 34th and 37th week of gestation;
- it is said to be serious if it occurs between the 25th and 33rd week of gestation;
- it is said to be extreme if it occurs before the 25th week of gestation.
- incorrect position of the fetus . According to some statistics, this occurs in 40-50% of pregnancies in women with a bicornuate uterus. The two most common incorrect fetal positions are:
- the breech position , when the fetus presents its feet towards the exit instead of the head;
- the transverse position , when the fetus presents one of the two shoulders towards the exit;
- different types of fetal deformities or malformations , more or less serious.
A woman with a bicornuate uterus can therefore become pregnant: her degree of fertility is the same as that of women with physiological uterine morphology. The only difference is that these women have a greater risk of problems during pregnancy , which therefore needs to be monitored.
What Other Conditions Could Lead To Fertility Problems?
A bicornuate uterus is not the only disorder that can cause fertility problems .
Other gynecological pathologies that could be responsible are:
- endometriosis , a disorder characterized by the presence of endometrial tissue outside the uterus, its natural location . It can therefore lead to the appearance of a pathological ovarian cyst known as an endometriotic cyst (or endometrioma). It frequently affects women of reproductive age;
- the unicornuate uterus , another uterine anomaly caused by the failure of the Müller horns to unite: one of the two stops developing or develops less and the result is a single ovary and a single tube. It is less frequent and can be asymptomatic or cause problems, such as reduced fertility, difficulty concluding a uterine pregnancy or even dysmenorrhea (pain during the menstrual cycle).
What Are The Consequences Of A Bicornuate Uterus?
Women with a bicornuate uterus may be asymptomatic or have disorders associated with this anomaly, such as miscarriages or other reproductive problems.
In general, the prognosis varies from woman to woman, depending on the severity of the condition.
Can It Be Cured?
It is not necessary to subject an asymptomatic woman to any therapy . However, if the pathology affects reproductive life, surgery may be necessary.
The first type of surgery is Strassman metroplasty (or Strassman abdominal metroplasty). This is a delicate laparoscopic operation , which corrects the abnormal morphology of the uterus. This is possible through the creation of a uterine cavity capable of welcoming and developing the fetus correctly.
Currently, combined laparoscopic-hysteroscopic therapy is practiced , which consists in abolishing, introducing the resectoscope through the uterine orifice, and resecting the septum that divides the two uterine horns, reaching up to a few mm from the external wall. It is advisable to wait about a year after this operation before becoming pregnant, which will then need to be carefully monitored.
Alternatively, women with a bicornuate uterus and cervical incompetence who have had multiple miscarriages at 14 to 18 weeks could resort to cervical cerclage . This consists in the application of a synthetic fabric tape at the level of the cervix , in order to strengthen the uterine cervix and increase its continence. The aim is to avoid (or at least reduce) the risk of premature birth .
There are two operational approaches for this intervention:
- the transvaginal approach , i.e. through the vagina. It is the most practiced: it represents 95% of all cerclages;
- the transabdominal approach , i.e. through the abdomen. This is an alternative if the first approach did not provide the desired results.