Getting Pregnant with a Bicornate Uterus

Posted by on Nov 30, 2012 in Diseases & Dysfunctions |

Getting Pregnant with a Bicornate Uterus

A bicornate uterus is a condition in which the uterus has developed abnormality with two so-called “horns” at the upper ends. (The word “bicornate” itself translates to mean two-horned.) A woman with this condition was born with it, and may not be aware of it until or unless it interferes with an attempt to conceive or bear a child. In most cases of bicornate uterus, the shape of the womb has no adverse effect on the woman’s ability to conceive a child, but it can prove problematic in maintaining the pregnancy after conception has been achieved.

Multiple miscarriages are often the result of this condition when a woman is trying to have a child. The abnormally shaped uterus does not properly allow for the growth of a fetus, so even a pregnancy that survives the early term may still result in a dangerously premature birth. This is especially likely if the embryo originally implanted further up inside one of the “horns” of the uterus, rather than in the central area shared between the two.

A young woman with a bicornate uterus is unlikely to know that she has the abnormality. Her hormonal regulation and menstrual cycles are likely to have progressed normally as she reached puberty and adulthood, giving no sign that anything was out of the ordinary. In fact, she may not have any notion of a problem until she tries to have children, and when a woman has had multiple miscarriages, she and her physician—or a fertility specialist—will have the task of identifying the cause of her difficulty. It is likely that (along with a number of questions on recent health history) the physician will order an ultrasound or other type of view of the woman’s reproductive system, which might give the first clue about the bicornate shape of the uterus. A definitive diagnosis can be made via hysteroscopy or hysterosalpinogram (or HSG), or with laparoscopy or a three-dimensional ultrasound view.
Depending on the specifics of an individual woman’s case, the physician may recommend treatment for the misshapen uterus before she attempts again to become pregnant. The two types of surgical treatment available for the condition are called metroplasty surgery and cervical cerclage (or tracheloplasty). The metroplasty creates a larger uterine cavity in which a baby might be able to form and grow properly, while cervical cerclage reinforces a cervix to keep it firmly closed through the pregnancy to keep the developing baby safely within. The two surgeries may be performed together if the physician believes it is called for.

Alternatively, a woman might go forward armed with the knowledge of her unusually shaped uterus, but without attempting to correct or alter its shape. Since the shape does not usually prevent conception itself, she can theoretically get pregnant and then work closely with her doctor to monitor the pregnancy and ensure that the baby stays as healthy as possible, and that the pregnancy lasts as long as possible.

In most cases when a bicornate uterus has been identified, a ceasarean section should be scheduled rather than planning on a vaginal delivery. A baby does not have sufficient room to grow or move within the unusually shaped womb, and is therefore often in the breech position (facing the wrong direction for vaginal delivery) even when it has come to full term. With the careful monitoring and planning that is due to any higher-risk pregnancy, it is possible for many women with the condition of bicornate uterus to enjoy motherhood of a healthy child.