Bicornuate uterus how to bear a child. Pregnancy with a bicornuate uterus

Some women have congenital anomalies in the development of the uterus. If deviations in the anatomical structure are pronounced, symptoms of a malfunction of the reproductive system may appear. But sometimes a woman does not even suspect that her uterus has an irregular shape, since the defect does not bother her. The onset of pregnancy in the presence of such a pathology is possible, but there is a possibility of complications. If the diagnosis is established, then before planning a pregnancy, it is recommended to do metroplasty. You can use the IVF method.

Content:

Features of the pathology

A bicornuate uterus is the result of a violation of the intrauterine development of a girl, which occurs at the very beginning of the formation of organs in the embryo (approximately at 6-8 weeks of pregnancy). The uterus and vagina are formed from the so-called Mullerian ducts. Pathology leads to improper fusion of these structures.

Normally, the uterus is a cavity that has branches (pipes) at the base and narrows at the exit to form the cervical canal. Pathological development leads to the fact that 2 sections (two horns) are formed in the cavity at once. They may be equivalent, but sometimes one of them is only a rudimentary process associated with the main cavity. If the fetal egg is fixed in this process, then the pregnancy in the bicornuate uterus will develop in the same way as an ectopic one. The danger is that when the embryo reaches a certain size, the vestigial horn ruptures, which leads to severe internal bleeding.

The neck of the organ may have a normal shape, but sometimes it can also be bifurcated (with complete division of the bicornuate cavity). It is even possible to have a second vagina, and this is not an obstacle to a normal sexual life.

The formation of a bicornuate uterus is observed very rarely, in about 0.5% of women. Most often, the presence of such a pathology affects the functioning of the reproductive system. How much depends on the degree of violation of the shape and structure of the genital organs.

Options for deviations from the norm

The bicornuate uterus can have a different shape. Several variants of its pathological development are observed.

Complete split. 2 horns appear, forming an angle. The bicornuate cavity may have a common neck, while there may be a septum dividing the vagina into 2 parts. The so-called absolute doubling can occur when 2 independent uteruses are formed, each with a separate neck extending into its own half of the vagina. If the branches are full, the onset of pregnancy, its normal course and the birth of a healthy baby is quite possible. Usually the fertilized egg is fixed in one of the horns from the side of the ovary where ovulation occurs. There are also extremely rare cases when, during the maturation of eggs in two ovaries, embryos develop in both parts of the bicornuate cavity.

Incomplete splitting. From the side of the bottom of the bicornuate uterus, a partition is formed, partially separating its cavity, but then both horns are connected, passing into a single neck. With this form of uterus, pregnancy is possible, but there is a high probability of miscarriage, especially if the fetal egg begins to develop in the region of the septum. Even if the fetus is located in an unbranched area of ​​the bicornuate cavity, it may not have enough room for growth or it may not be positioned correctly, which will complicate childbirth.

Saddle bicornuate uterus. Its bottom bends into the cavity, dividing it in half in the upper part. With this form of the organ, pregnancy occurs and proceeds as usual. But if the saddle shape is combined in a woman with a narrow pelvis, she will not be able to give birth on her own. In this case, the fetus is removed by doing a caesarean section.

Reasons for this anomaly

The main cause of improper fusion of the Mullerian ducts in the embryo and the congenital formation of a bicornuate uterus is a complicated pregnancy in the expectant mother. High blood pressure, the presence of cardiovascular diseases in a pregnant woman and other malformations leading to fetal hypoxia provoke developmental abnormalities.

This is also facilitated by the contact of a pregnant woman with harmful chemicals at work, the use of potent drugs, alcoholic beverages, and smoking. A bicornuate uterus can form in an embryo if a woman has had an infectious disease during pregnancy.

The lack of vitamins and minerals in the mother's body is extremely harmful to the health of the unborn baby. Hormonal abnormalities, metabolic disorders, endocrine pathologies (for example, thyroid diseases) can also cause the formation of a bicornuate uterus.

Such a pathology is hereditary and occurs in female relatives from generation to generation.

Signs of a split uterus

With this pathology, symptoms do not always appear. If both horns are developed normally, the woman's menstruation proceeds as usual. However, menstruation can be painful, especially if atresia occurs - narrowing of the horn cavity as a result of its partial overgrowth. There may be uterine bleeding.

It is possible to assume that a woman has a bicornuate uterus by the following signs:

• menstruation is plentiful and long, since the volume of the endometrium is larger, and its removal is difficult due to the irregular shape of the neck;
• for a long time a woman fails to get pregnant;
• pregnancy occurs, but it is not possible to bear the child, every time a miscarriage occurs;
• pregnancy in a woman develops normally, but body weight is added slightly, since the fetus grows more slowly than it should. The reason is that the space in which it is located is too small.

Addition: There may be other problems during pregnancy. The placenta is too close to the neck, there is a breech presentation of the fetus, a miscarriage occurs due to placental abruption. It is possible to reduce contractility, with a severe and prolonged course of childbirth.

If the fetus develops in one horn of a completely split cavity, the usual cyclic processes can occur in the other half, at one time even menstruation appears.

Possible Complications

In the bicornuate uterus, blood circulation is disturbed, especially in the area of ​​\u200b\u200bthe walls, which leads to improper formation of the endometrium. It may be too thin for the embryo to be fixed in it.

Violation of the structure of the body sometimes leads to endometriosis, tubal pregnancy. Long and frequent periods cause anemia. At the same time, iron deficiency affects the functioning of all organs and the central nervous system. Women with a bicornuate uterus have an increased risk of postpartum hemorrhage, stagnation of blood in the cavity (hematometers), inflammation of the mucous membrane (endometritis), formation of adhesions, accumulation of pus in them.

How is a bifurcated uterus diagnosed?

Diagnosis begins with a gynecological examination to determine the shape of the vagina. By palpating the lower abdomen, the doctor checks for abnormalities in the shape of the uterine fundus.

Ultrasound of the genitourinary organs is carried out both with the help of an external sensor (abdominal examination) and with the help of a vaginal one. In this case, it is established what shape the uterus has, what is the structure of the cavity. With minor deviations from the norm, it is not always easy to detect a bicornuate uterus in this way.

The cavity of the organ is examined using an optical instrument of the hysteroscope. Sometimes diagnostic laparoscopy is used, with the help of which it is possible to detect defects in neighboring organs, and if necessary, eliminate them without cutting the stomach.

Hysterosalpingography (X-ray with the introduction of a contrast solution into the bicornuate cavity) allows you to study the nature of the splitting. However, this method cannot detect a small branch from the main uterine cavity, as well as an atrezated horn (in which the lumen has been overgrown).

The most effective diagnostic methods in this case are CT and MRI, which allow you to get an image of a bicornuate uterus from different angles, accurately determine its shape, wall thickness, and location relative to other organs.

Video: Bicornuate uterus. Diagnosis and treatment

Treatment

If the bifurcation of the organ is the cause of infertility, persistent miscarriages or the birth of a stillborn child, then a woman who is striving for the onset of a normal pregnancy undergoes surgical treatment. There is no other way to eliminate such a defect as a bicornuate uterus.

The so-called metroplasty is carried out. During the operation, a rudimentary branch is removed, a septum is excised inside the bicornuate cavity, or the shape of the saddle bottom is corrected. In this case, low-traumatic methods of penetration into the organ cavity are used, such as laparoscopy under ultrasound control or hysteroscopy.

Operations are also carried out using a laser beam as a knife. These techniques avoid significant damage to the uterus.

Sometimes a woman is advised to resort to artificial insemination, if, in addition to the fact that the uterus is bicornuate, tubes are found to be blocked in it. IVF is also performed if a woman's follicle supply is depleted, the only chance for her to give birth to a child is the transplantation of donor eggs.

In most cases, the operation is successful, and the goal that the woman aspires to is achieved. 90% of patients after such treatment are able to endure and give birth to a healthy baby.

After the onset of pregnancy in a patient who has undergone surgical treatment, the development of the fetus and the condition of the expectant mother require especially careful monitoring in order to prevent spontaneous abortion or bleeding. If the threat of miscarriage occurs after the 26th week of pregnancy, the child is saved by giving birth by caesarean section.

Features of contraception

If a woman does not seek to become pregnant, uses contraceptives, then in the presence of a bicornuate uterus, she needs to be especially careful when choosing contraceptives. For example, contraception with an intrauterine device will not work for her if the bifurcation of the organ is complete or the septum separates most of the cavity. With a saddle-shaped uterus, such contraception is possible.

The most convenient method of protection against unplanned pregnancy in the presence of such a pathology is the use of condoms or combined oral contraceptives.

The bicornuate uterus and pregnancy is an urgent problem in obstetrics and gynecology, since it is this pathology that causes a third of cases of miscarriage in women with uterine malformations.

The bicornuate uterus is a congenital anomaly. The uterus begins to form from the Mullerian ducts of the embryo from about the 6th week of pregnancy. Due to genetic or teratogenic causes, these ducts do not merge, which leads to a bifurcation of the upper part of the uterus, and then the girl is born with a uterus bicornuate - a bicornuate uterus. And for adult women, a bicornuate uterus, pregnancy and childbirth represent a chain of problems with the birth of children.

ICD-10 code

Q51.3 Bicornuate uterus

Bleeding with a bicornuate uterus during pregnancy

The main cause of bleeding in a bicornuate uterus during pregnancy is placenta previa, which is a consequence of the implantation of the fetal egg not in the region of the back and side walls of the body or the bottom of the uterus, but in the endometrium of its lower part.

After implantation - from the 3rd week of pregnancy - the formation of the placenta begins, and the process of vascularization takes place inside the tissues of the uterine wall, that is, the formation of additional blood vessels. If the embryo has settled too low in the uterus, then the placenta (which is completed by the 13th week of pregnancy) can close its internal os. As a result, the pregnant woman has spotting or bleeding (with pain in the lower abdomen). And this is the main harbinger of abortion.

Bleeding with a bicornuate uterus during pregnancy most often occurs after 6-8 weeks of gestation and is observed in almost 35% of pregnant women. And partial placenta previa is noted on average in 40-45% of pregnancies with a bicornuate uterus.

If bleeding with a bicornuate uterus during pregnancy occurs in the later stages (after 30-32 weeks), then its etiology is due to the fact that the placenta previa cannot stretch as the size of the uterus increases and begins to exfoliate.

Bicornuate uterus and missed pregnancy

A frozen pregnancy - that is, the cessation of fetal development and its death - if a pregnant woman has a complete or incomplete bicornuate uterus, is a natural unfavorable outcome if the egg is attached not to the walls of the uterus, but to the septum.

The fact is that the tissues of these partitions do not have blood vessels, which means that the embryo cannot develop normally and dies

In addition, a septum in a bicornuate uterus - when the embryo is located close to it - can simply interfere with the natural growth process of the fetus due to insufficient free space in the uterine cavity.

Bicornuate saddle uterus and pregnancy

A bicornuate saddle uterus and pregnancy is the most favorable of the considered variants of this pathology. However, it can also lead to complications.

Obstetricians note that this type of bicornuate uterus can also lead to miscarriage (although much less often than with a complete or incomplete bicornuate uterus), and fetal fading, and premature birth. So, in 15-25% of pregnant women with a bicornuate saddle uterus, childbirth begins much earlier than the due date. And this increases not only the overall perinatal morbidity of newborns, but also the risk of death in premature infants.

Also, this congenital pathology of the uterus affects the position of the fetus, and most often doctors state a transverse or oblique presentation, in which a caesarean section has to be performed. And after a natural delivery, such a uterus contracts very poorly and bleeds for a long time.

Bicornuate uterus and twin pregnancy

Pregnancy with twins with the anatomical structure of the uterus, in this case - in the presence of a bicornuate uterus, does not have a direct causal relationship. After all, the conception of twins is the result of the fertilization of two follicles that have matured at the same time.

However, according to some reports, pregnancy with twins (single or fraternal) more often develops in women with anatomical pathologies of the structure of the uterus. At the same time, such a pathology as a complete bifurcation of the uterus is in the lead - that is, when the septum of the bicornuate uterus reaches the internal pharynx or cervical canal with the formation of two separate cavities.

A bicornuate uterus and twin pregnancy are obstetricians at a very high risk of miscarriage. There are even uterine ruptures. And childbirth after the 32-34th week of pregnancy with twins is 90%.

As a result of many years of clinical observations, it has been established that the probability of fertilization of two eggs with a bicornuate uterus or its complete bifurcation is only one in a million.

In the case when a bicornuate uterus and pregnancy - in terms of the ability to bear and give birth to a child - are mutually exclusive concepts, a woman can undergo an operation to restore the uterine cavity. This is open (with a dissection of the abdominal cavity) or hysteroscopic metroplasty. During this surgical intervention, the septum is dissected, and the uterus is “reconstructed” into a single cavity. In almost 63% of clinical cases, the reproductive capabilities of the uterus were completely restored.

Bicornuate uterus and pregnancy: features and complications

Among the pathologies that occur in the process of intrauterine development, uterine bicornuity is quite common: it is detected in approximately 0.5% of women of childbearing age. Does this pathology affect the ability to conceive? Most experts argue that a bicornuate uterus and pregnancy - in the sense of the possibility of becoming pregnant - are not mutually exclusive concepts. Many women, having such an anatomical defect of the reproductive organ, both become pregnant and give birth. It's all about how deformed the uterine cavity is.

With a complete bicornuate uterus, there is a septum in its cavity (sometimes two-thirds of the cavity depth), which divides the uterus into two parts, and the fetus can develop in one of them. With an incomplete bicornuate uterus, a slight separation of the cavity is observed in its upper third. And the so-called saddle-shaped (or arcuate) bicornuate uterus has only a slight depression at the bottom of the cavity.

It should be noted that pregnancy with any of the three types of bicornuate uterus is associated with complications and requires additional medical monitoring. The risks lie in such adverse outcomes as habitual miscarriages (miscarriage reaches 45-50% of cases) and miscarriage (about 5%).

Bicornuate uterus and pregnancy have other complications. This is the wrong presentation of the fetus and premature birth. Breech presentation of the fetus is fixed in 50% of pregnancies with a partial bicornuate uterus. And in 40% there is a foot presentation, which complicates the course of childbirth and threatens the newborn with asphyxia.

The number of preterm births in the presence of a bicornuate uterus ranges from 25% to 35%. Doctors explain this by increased overstretching of the uterus, which has an irregular shape. Because of this, childbirth begins ahead of time. Another factor that provokes preterm labor is the inability of the isthmus and cervix to withstand internal pressure and hold the growing fetus until the due date (this is called isthmic-cervical insufficiency of the uterus). So in 65-70% of cases, a caesarean section becomes the only way out.

Bicornuate uterus and pregnancy concepts are quite compatible. In some cases, pregnancy can proceed without features and complications. In severe cases with severe pathology, surgery can significantly increase a woman's chances of carrying and giving birth to a healthy child.

What is a bicornuate uterus

Congenital defects of the uterus are, fortunately, quite rare. A bicornuate uterus is the most common variant of the pathology. The uterine cavity is usually one in the lower sections and splits upward into two independent cavities, two horns. Both horns may be symmetrical and fully developed. In this case, pregnancy is possible in each of them. One of the horns may be underdeveloped, rudimentary. If a fertilized egg is fixed in it, the pregnancy passes as an ectopic one and may threaten to rupture the uterine horn. In rare cases, a full pregnancy occurs in both horns at the same time.

Symptoms

Often, a bicornuate uterus manifests itself as menstrual irregularities, amenorrhea, pain during menstruation and early miscarriages, as well as infertility. Sometimes not a single symptom appears, and the peculiarities of the structure of the uterus are found out only with a planned ultrasound during pregnancy.

Causes

Anomaly of the development of the uterus is laid in the first trimester of intrauterine development. The causes can be both alcohol and nicotine abuse, toxic poisoning, and infectious diseases, including influenza, rubella, toxoplasmosis.

Diagnostics

Pathology can be suspected with the help of ultrasound. To clarify the diagnosis, hysteroscopy, MRI and even laparoscopy are used. If a bicornuate uterus during pregnancy interferes with its normal course, or if conception does not occur at all, the main method of treatment is surgical intervention. The main objectives of the examination and treatment are the identification and excision of the rudimentary horn, the removal of the intrauterine septum and the restoration of a normal single uterine cavity. After the operation, pregnancy should occur no earlier than a year later. To do this, an intrauterine device is installed in the uterine cavity. Earlier onset of pregnancy is fraught with uterine rupture.

The prognosis after surgical restoration of the cavity is very favorable. The percentage of miscarriage is reduced several times.

Childbearing and childbirth

The course of pregnancy with a bicornuate uterus should always be under close medical supervision. In the event that the pregnancy is fixed in a full-fledged horn, and the intrauterine septum is missing or surgically excised, problems may begin only by the end of the first trimester. This is due to the fact that the fetus may not have enough space, and the blood supply to the fetus may also be impaired. At a later date, such pathologies of pregnancy development as placenta previa and early aging, isthmic-cervical insufficiency, and the threat of interruption may occur.

If necessary, starting from the 28th week of pregnancy, a caesarean section can be performed to save the life of the fetus.

The decision on how the birth will go will depend on several factors. First of all, this is the location of the fetus and the anatomical features of the woman. Very often, with a bicornuate uterus, there is a breech presentation. Natural childbirth is possible, but both the woman and doctors must be prepared for the fact that an emergency caesarean section may be needed.

A bicornuate uterus is not a sentence. With proper medical supervision, quite natural bearing and the birth of a healthy child is possible.

Collapse

A bicornuate uterus is a congenital deformity of the organ. In this case, the uterus has a septum in its cavity, which makes the organ look like a jester's cap. These two horns may or may not be the same size. Moreover, depending on the degree, one horn may be functional and the other non-functional. The reasons for this phenomenon are not fully understood. Of course, in the life of every girl sooner or later the question of pregnancy arises. With a bicornuate uterus, complete infertility can be observed. Yet in most cases, a woman manages to get pregnant. This is where the worries begin: will everything be fine with the baby, and will a girl with a two-horned organ be able to give birth herself? Let's figure it out.

Is pregnancy possible?

If we take the problem from the theoretical side, then the bicornuity of the organ is not a contraindication for pregnancy. A woman can conceive a child. But such a pregnancy will be different from the usual. Special advice and adherence to prescriptions is required. Depending on the type of bicornuate uterus, it will be clear whether pregnancy can occur. What are the types of this pathology?

• Full. The organ is divided exactly into two parts by a septum. Outwardly, it may seem as if a woman has two wombs. The horns are far apart. With such bipedalism, conception can occur. The fetus develops in one or another part of the organ. Often, doctors can make such a diagnosis for a woman "pregnancy with the location of the fetus in the right (left) part of the uterus." Childbirth will be normal.
• Incomplete. The organ is divided into parts only at the top. It doesn't appear to be very deformed. Such a pathology almost does not pose a danger to the normal development of the child.
• Saddle. Outwardly, the uterus looks like a saddle. At the bottom there is a bifurcation due to the septum. In this case, pregnancy can also occur if the fetal egg sticks far enough from the septum. Further recommendations will be given by the doctor.

In the event that one horn of the organ is not functional and the fetal egg is attached exactly there, this situation is considered as an ectopic pregnancy. The embryo is removed surgically.

Pregnancy in a bicornuate uterus

So, with a bicornuate uterus, it is possible to conceive a child. But such a pregnancy has a number of dangers. What?

Consequences for pregnancy

Pregnancy of this kind has a number of features. What affects it? The greater the distance between the horns, the more difficult the gestation process will be. Why? Because in this case, the fetal egg is attached quite low. Therefore, the fetus has little room for growth and movement. So there is a risk of premature birth, or miscarriage in the first weeks.

Main consequences:

• early discharge of amniotic fluid;
• early detachment of the placenta;
• transfer of blood flow from mother to child;
• malposition.

However, there are two most severe and serious consequences for a pregnant woman with such a pathology.

1. Bleeding. The main reason for this phenomenon is the low attachment of the fetus to the endometrium. Bloody discharge, which is accompanied by aching pain in the abdomen, is the main sign that the pregnancy may be terminated. With two-hornedness, this phenomenon occurs at 6-8 weeks of gestation. About 40% of women with a bicornuate uterus complain about bleeding during pregnancy. If this phenomenon is observed at 32 weeks, it means that early placental abruption has begun. In any case, a woman is placed in a hospital to save the baby.
2. Freezing of the child in the womb. Unfortunately, the death of the fetus in the womb with a bicornuate uterus is a frequent phenomenon. This usually happens if the egg is attached not to the endometrium, but to the septum. There are no blood vessels required for fetal development on this perestenium. The child does not receive all the necessary elements and simply freezes. Moreover, the partition does not give enough room for the growth of the baby. Pregnancy in this case does not reach childbirth.

Interestingly, before pregnancy, a woman may not know about the existing pathology. Sometimes the thought of the bicornuity of the female organ can be prompted by painful heavy periods. But if there are difficulties with conception or there are problems during pregnancy, described above, then the likelihood of uterine pathology increases significantly.

To prevent complications, it is important to constantly be under the supervision of a gynecologist.

Features of pregnancy and conception

Is there any difference in which uterine horn the ovum is attached? The main thing is that the egg attaches where there is more nutrition. The more bifurcated the organ, the more problems, but each has a chance to endure and give birth.

What if it's a twin? Yes, women with a bicornuate uterus have a chance of multiple pregnancies. Interestingly, it develops much more often in women with this pathology than in healthy ones. This is, of course, a huge risk. In the case of twins, the uterus may not withstand the load and there is a risk of rupture of this organ. Also, with a bicornuate uterus and multiple pregnancies, premature birth usually occurs. In this case, labor activity can be expected as early as 30 weeks.

In order for conception to occur precisely in that part of the organ where there is more nutrition, it is necessary:

1. Know from the results of examinations which side is the most functional.
2. During sexual intercourse, apply tricks so that the egg goes in the direction that is necessary. This fact is not scientifically confirmed, but empirically, some women use certain postures that direct the spermatozoa in the right direction.

If a woman really wants to conceive, and because of the serious pathology of the bicornuate uterus, it is not possible, doctors suggest correcting the situation with the help of surgical intervention. There are two types of operation:

• Strassmann's method;
• Thompson method.

During the operation, the normal shape of the uterus is returned by removing the septum. Then the risks associated with pathology are reduced from 90 to 25%. After the restoration of conception occurs without problems.

Is spontaneous childbirth possible with a bicornuate uterus?

The answer is simple: yes, it is possible. But again, with the bicornuate body, there are a number of features.

Firstly, women with this pathology quite rarely bear a child before the required time. Preterm birth is a common occurrence. The waters break very early, and labor begins.

Secondly, natural labor activity proceeds very sluggishly. Doctors use additional methods to stimulate labor. Without stimulation, there is a risk of birth injury, both for the mother and the child.

Thirdly, after childbirth with a bicornuate uterus, there is a severe postpartum recovery. The uterine muscles contract very weakly. There is a risk of developing blood stasis in the organ and the presence of inflammatory processes.

If a doctor offers a woman a caesarean section, you should not refuse it. With a bicornuate uterus, this is an excellent option to give birth to a child without consequences. This option will also be excellent if the fetus is not lying correctly with a bicornuate uterus.

Is it necessary to terminate a pregnancy with a bicornuate uterus?

The medical indication for terminating a pregnancy with a bicornuate organ is a conception that occurred in a non-functioning horn. In this case, the effect of an ectopic pregnancy occurs. Then the doctors terminate the pregnancy to save the mother's life.

What is the situation with abortion for non-medical reasons? It is important to remember that pregnancy with a bicornuate uterus is difficult and has special consequences. Moreover, very often it does not end with childbirth. Spontaneous abortion or rapid early labor occurs. Therefore, doctors recommend keeping the baby, especially if the pregnancy is the first. There may not be a second chance.

So, with a bicornuate uterus, pregnancy often occurs without problems. After conception, a woman requires special care and research. If you still can’t get pregnant, you should seek surgical intervention to correct the defect.