Bicornuate uterus and pregnancy: the likelihood of getting pregnant, features of bearing, possible complications

2024 Author: Priscilla Miln | [email protected]. Last modified: 2023-12-16 00:21

Statistics notes that anomalies of the internal genital organs occur in one woman out of a hundred. Most often, they do not interfere with normal life until the moment when it comes to procreation. The bicornuate uterus is one of the most common pathologies. How are bicornuate uterus and pregnancy related? Is it possible to get pregnant and bear a he althy child without risking life with such a pathology?

Definition

Normally, the uterus has one cavity, from which the fallopian tubes extend in different directions. What does bicornuate uterus mean? This is an anomaly in which the reproductive organ is divided into two parts by a septum. Outwardly, it resembles a jester's cap. The uterine horns can both function, but there are pathologies in which only one of the organ cavities is active. The anomaly is congenital and may be the cause of some sexual diseases.system, including infertility.

Varieties of pathology

What is a bicornuate uterus in women and what are its types? A birth defect can have several varieties:

1. Saddle-shaped - the organ is not divided into two symmetrical parts, but its bottom has a pronounced depression. Outwardly, such a uterus resembles a saddle.



2. Incomplete bifurcation means that the uterus has two horns that merge into one neck.
3. Complete bifurcation means that the uterus is completely bifurcated into two separate functioning parts. Each of the horns has its own cervix. At the same time, the horns can be developed in the same way, have a closed functioning circle or an atrezated horn.

When planning a pregnancy, you should undergo a complete examination of the pathology to determine all the risks and opportunities of the reproductive system.

Causes of the anomaly

Since the pathology is congenital, the formation of an abnormal organ begins at the time of gestation. After a successful conception, the division of the egg occurs, with normal development, the laying of the internal genital organs occurs at the 10th week of pregnancy. At the same time, the Mullerian ducts are laid, which by the 12th week are transformed into the uterus and appendages.

Pathology occurs when the mechanism of fusion of the Mullerian ducts is disturbed, when a septum forms between them and the uterus begins to form improperly. Most often this happens if a woman during pregnancy (before12th week) consumed alcoholic beverages.

Diagnosis

In most cases, a woman is unaware of the pathology, as she only rarely has symptoms. Abnormal development of the uterus is determined only after an unsuccessful attempt to become pregnant. In order to diagnose pathology, the following methods are used:

1. Ultrasound diagnostics gives a detailed visual picture of the structure of the internal organ. In addition, this study is the most accessible and safe for women.
2. Hysterosalpingography is a procedure for introducing a contrast fluid into the cavity of an organ and monitoring its movement. During this study, several X-rays must be taken to record the results.
3. Hysteroscopy is performed using a hysteroscope - a medical device, which is a device with a tube, at the end of which a camera is placed. The device is inserted into the uterine cavity for its detailed study.
4. Laparoscopy - the introduction of manipulators with a camera into the abdominal cavity to examine an abnormally developed organ.

Diagnostic measures give a complete picture of the development of the uterus, as well as possible complications when trying to bear a child.

Is pregnancy possible?

Are the concepts of a bicornuate uterus and pregnancy compatible? In most cases, if there is a connection between the uterine cavity and the fallopian tubes, conception is possible. However, there is a high probability of miscarriages at 4-5 weeks,when the cycle is not yet over and the woman is unaware of pregnancy.

Features of pregnancy with a bicornuate uterus are that there is a danger if the fetus begins to develop in a rudimentary horn, which has a closed functioning cycle. In this case, pregnancy develops normally only until the moment when the fetal egg reaches the size of the cavity. After that, the uterine horn does not withstand the load and bursts, thereby provoking bleeding into the abdominal cavity. Such an abnormal pregnancy, in terms of symptoms, resembles an ectopic one, therefore it is very important to carry out an early surgical intervention to remove the fetus.

Complications during gestation

Features of gestation with a bicornuate uterus differ from normal pregnancy. In this case, there are many dangers that a pregnant woman may be exposed to:

1. Spontaneous miscarriages. With this pathology, there is an increased excitability of the myometrium, which can provoke a spontaneous miscarriage, especially in early pregnancy.
2. Incorrect attachment of the placenta. Most often, this anomaly is fixed with a saddle uterus. In this case, the placenta is attached to its bottom, which provokes the central and marginal presentation, when the placenta is located on the inside of the cervical os. Such an abnormal development can provoke frequent bleeding with high blood loss, which, in turn, can threaten the life of the mother and child. There is also a high chance of placental abruption, which leads to pregnancy failure.



3. Bleeding from the second horn. A bicornuate uterus and pregnancy in the right or left horn can cause bleeding from the second horn. The fact is that with complete bicornuity and the presence of pregnancy in one of the horns, the second continues to function in the same mode, which means that it will periodically menstruate. Often such bleeding can be taken as a threat of miscarriage, but they do not pose a serious danger to the woman and the fetus.
4. Insufficiency of the function of the cervix, which may manifest itself in insufficient closure of the pharynx. At the same time, it can open ahead of time, which provokes premature rupture of amniotic fluid and early birth. In order to avoid this, it is important to timely monitor the condition of the cervix using ultrasound. When threatened, a pessary or circular suture should be applied.
5. Wrong position of the fetus in the uterus. This is due to the fact that the organ is deformed, as a result of which the child can be located on the buttocks, back, forehead or face down. Most often, when diagnosing an incorrect presentation of the fetus, delivery is prescribed by performing a caesarean section.

Fortunately, not always the course of pregnancy can be pathological. In the case of incomplete uterine bifurcation, a woman can only find out about bicornuity during childbirth by caesarean section or manual removal of the placenta.

Complications during childbirth

Even if the risks of pregnancy with a bicornuate uterus have bypassed the woman, complications may occur duringdelivery:

1. Anomaly of labor activity, which manifests itself in the irregularity of uterine contractions and, as a result, weak contractions and the absence of attempts.
2. Prolonged labor - labor activity, the time of which exceeds 20 hours. With such a pathology, medical intervention is necessary to stimulate labor activity.



3. Bleeding that occurs when there is a violation of uterine contraction after childbirth. In particularly difficult cases, such bleeding can lead to the complete removal of the organ.
4. Pathology of placental attachment, which manifests itself in too tight attachment of the placenta. If the placenta has literally "grown" into the uterine cavity, then the removal of the organ is necessary.
5. High probability of ruptures, which occurs due to a violation of the elasticity of the uterus, appendages, vagina. This provokes a large number of ruptures of the vagina, cervix and body of the uterus.

Minor anomalies include early rupture of amniotic fluid, which provokes preterm labor. In the vast majority of cases, such a pathology ends positively.

Bicornuate uterus and twin pregnancy

Multiple pregnancy also has some difficulties with this anomaly. However, according to statistics, the probability of becoming pregnant with twins with a bicornuate uterus is much higher. At the same time, the risks increase both during the waiting period and during the birth itself. The most dangerous is the first trimester.

Two-horneduterus and pregnancy in the left horn or right twins are often complicated by premature labor for up to 30 weeks. In most cases, surgery is necessary to remove children from the organ cavity.

In addition, when carrying twins with a pathology of the development of the uterus, a woman needs to radically reconsider her lifestyle. Physical activity and emotional stress are strictly prohibited.

Difficulty getting pregnant

The more severe the pathology of the uterus, the more difficulties arise when trying to conceive, but there is still a chance of getting pregnant. Many women diagnosed with a bicornuate uterus are trying to find out which side is the most functional so that the seed gets in the right direction during intercourse. The effectiveness of this method has not been clinically proven, but it does occur.

In addition, modern medicine offers surgery if it is impossible to get pregnant and endure. In this case, the Thompson or Strassmann operation is performed, in which the septum that separates the uterine cavity is removed.

Independent birth

Unfortunately, a bicornuate uterus leaves a woman with little chance of giving birth on her own. In most cases, a caesarean section is required. Self-delivery is possible only in the case of a saddle uterus. In addition, such a pregnancy may end in premature birth, which also requires medical intervention.

With a bicornuate uterus, labor activity is very weak, the uterus is simply not able topush the child out on his own. This increases the likelihood of birth injuries in both the mother and the child. To avoid this, a caesarean section is performed.

Should I have an abortion?

Is abortion necessary for bicornuate uterus and pregnancy? In the presence of a non-functioning horn, pregnancy in it is an indication for an abortion, since it is not possible to bear a fetus.

If a woman wants to have an abortion, without medical evidence, it should be remembered that the bicornuate uterus has some features in which gestation and childbirth are significantly complicated. Therefore, doctors recommend leaving pregnancy, especially if it is the first, as there may simply not be a second chance to have children.

Conclusion

Despite the fact that the bicornuate uterus is considered a complex pathology, there is a chance to endure and give birth to a he althy child. To do this, it is important to consult a gynecologist in a timely manner and undergo the necessary examinations that monitor the normal development of the fetus.