The uterus of some women is subjected to several congenital abnormalities, affecting its shape and structure. Most of the time, the abnormalities stay unknown until the pregnancy. However, one woman out of thirteen (1/13), who is trying to find medical assistance for infertility, ends up having some kind of uterine abnormalities.
As a rule, a uterine abnormality, will not always affect a pregnancy and delivery. However, relying on the intensity of the abnormality, it might be more troublesome for you hold the baby throughout the nine months of your pregnancy. Thus, the uterine abnormality suggests, extra monitoring in the course of pregnancy.
Facts About A Normal Uterus
Before explaining a uterine abnormality, you have to know some basic fact about a normal uterus-
- Normally the uterus is formed inside a female child during the beginning of the 5th week of the pregnancy
- It begins close to the kidneys as two unrelated structures called horns. Then the structure will move down into the pelvis and the two horns join into one forming the uterus. The zone of fusion is marked by a septum isolating the two, and eventually is reabsorbed to make a typical intrauterine cavity
What Is A Bicornuate Uterus?
A bicornuate uterus is a uterus that has two horns and has a shape of heart. The uterus has a partition inside and an incomplete split outside. A bicornuate uterus is the most widely recognized inborn uterine anomaly, which can affect a woman’s reproductive capability.
The range of severity of this sort of uterus varies from incomplete bicornuate to a full bicornuate. With an incomplete bicornuate, just the top portion will dunk into the chamber. On the other hand, with a full bicornuate, the entire top portion folds down dividing the uterine cavity into two chambers. In both cases, the bottom part remains normal.
The degree of malformation is vital as far as pregnancy and delivery are concerned. Be that as it may, bicornuate uterus won’t be an only cause of infertility. Therefore, if you have a heart-shaped uterus and keep on struggling to get pregnant, there is most likely some other fertility issue going on.
How Is A Bicornuate Uterus Formed? Is Bicornuate Uterus And Septate Uterus Are Same?
Bicornuate uterus happens when the two horns migrate down into the pelvis, but do not completely fuse to form a normal uterus. The upper portion folds inwards and the lower portion remains normal. It is quite different from a septate uterus, in which, the inside of the uterus is divided by a muscular or a fibrous wall (partially or fully), as the upper and lower portion remains in normal shape.It’s more difficult to conceive with a septate uterus than with a bicornuate uterus.
What Are The Symptoms Of The Bicornuate Uterus?
The symptoms experienced by uterine malformation vary from woman to woman. As the uterine malformation happens when a girl is in her mother’s womb, most women think that what she is experiencing is quite normal. It is better to consult a gynecologist if you are experiencing:
- Irregular and severe painful menstrual cycles
- Heavy bleeding
- Pain and discomfort during the ovulating days
- Painful menstrual cramps
- Difficulty in getting pregnant
What Are The Outcomes Of Bicornuate Uterus Pregnancy?
As already explained, the bicornuate uterus is not directly related to infertility. Nevertheless, the shape can make getting pregnant challenging. If you manage to get pregnant, the bicornuate uterus can place you in a ‘high-risk pregnancy’ group. Several issues and impediments can be brought about on your pregnancy by a bicornuate uterus. Close monitoring of the pregnancy and providing medical attention on right time is inevitable.
Here are a couple of things you ought to remember in the event that, you have a bicornuate uterus, which will help you to understand the possible outcomes of your pregnancy:
- Your chance of miscarriage is very high: The chances of miscarriage are around 65%. The basic reasons of high risk of miscarriage are:
- Not having sufficient space for the growth and development of the baby
- Unlike the normal uterus, the bicornuate uterus is unable to stretch effectively. This is owing to the fact that the area of the septum cannot expand like the uterine wall. Therefore accommodating a growing baby will be challenging
- Abnormal presentation of the baby: With less space to move around, mostly the baby will be in an abnormal position, in addition to increasing the discomfort, the abnormally positioned baby increases the chances of preterm birth and decrease the chances of vaginal birth
- Your chance of preterm delivery is very high: The chances of preterm delivery are very high in a bicornuate pregnancy.The reduced chances of full-term pregnancy is due to:
- Insufficient space for the fetal development
- Increased chances of cervical incompetence
- Unusually shaped uterus creates issues to the uterine lining. Therefore, more progesterone is needed and is used for the thickening of the uterine wall. This can result in decreased progesterone level that can trigger preterm labor
- Increased chances of abnormal presentation of the baby: Though the chance of pretermdelivery ishigh, if your baby happens to get implanted on the larger portion of the bicornuate uterus, the full term pregnancy will be possible. Even then, the chance of vaginal birth is very less as most of the time the baby may be in a breech position or a transverse position. This is because with the leastroom to turn around, taking a head down position will not be possible for the baby
- Your baby has increased chances of experiencing growth retardation: Though very rare,fetal growth retardation is another possible outcome of bicornuate pregnancy
What Measures Can Be Taken To Complete A Bicornuate Pregnancy?
In spite of all of the above facts, healthy pregnancy, labor, and delivery are not impossible with a bicornuate uterus. There are several measures taken by the doctor, once you are diagnosed with bicornuate uterus to avoid the difficulty of the uterus to hold the pregnancy until the full term and for safe delivery:
- Early progesterone shots: Once diagnosed with a bicornuate uterus, the doctor will start to give the progesterone shots as early as possible. He will start the weekly shots from the early weeks until the 36th week of pregnancy. This increases the chances of a full-term birth
- Opting C-section: When it comes to the bicornuate pregnancy, mostly the babies arepositioned breech or transverse. Both are potentially dangerous positions. Opting for a C-section decreases the risk of delivery and health of the baby
- Cervical cerclage: Cervical incompetence can be dealt with cervical cerclage, a procedure in which the cervix is stitched closed during a particular stage to prevent the preterm delivery. In the case of a bicornuate pregnancy, this procedure is doneduring the second trimester. The stitch will be taken out towards the end of the pregnancy
- Correcting the bicornuate uterus: Surgeries and treatment are available for correcting the bicornuate uterus. If you are diagnosed with a bicornuate uterus before pregnancy, the doctor will suggest undergoing this surgery before getting pregnant
- Metroplasty: This is the most common surgical procedure followed to correct the bicornuate uterus. Its main purpose is to create a large uterine cavity with minimal damage to the uterine tissues.A thorough examination is done prior to surgery to confirm the uterus is really bicornuate. This includes the pelvic exam, hysterosalpingogram (HSG), sonography, hysteroscopy, etc. Metroplasty is a laparoscopic-assisted surgery.An incision is made to set apart the cavity of the uterus. After this, another incision will be made in a vertical position using a layered closure. This closure is fundamentally same as how a cesarean section is performed
You can get pregnant after waiting for three months. This is because your uterus needs at least 90 days to heal completely from the undergone surgery. This “three-month” rule should be strictly followed. Unless, unnecessarily you are increasing your risk of uterine rupture and internal bleeding, which is fatal for both mother and child.