Pregnancy in bicornuate uterus

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 Pregnancy in bicornuate uterus

Primigravida, full term, uneventful antenatal period, LSCS done for Transverse lie of the fetus, antenatal diagnosis by ultrasound, intraoperative diagnosis -fetus in oblique lie, alive male baby with APGAR 9 is delivered by breech extraction. Intra operative and post operative period was uneventful. Both mother and child were healthy at the time of discharge.

A small note about bicornuate uterus:

Bicornuate uterus (bicornate uterus) is an inborn abnormality of the uterus when it has two cavities. Bicornuate uterus is the most common among the abnormalities of the uterus. But in general, it is diagnosed only in 0,1-0,5 % of women.

In bicornuate uterus one cervix and one vagina are observed. But, the doubling of the cervix is also possible. One cavity of the bicornuate uterus may be rudimentary.

If the ovum is attached to the rudimentary cavity, pregnancy will be ectopic with the rupture of the cavity and peritoneal bleeding. Both the cavities may be developed properly and in both regular cycles with pregnancy and childbirth may take place.

Causes for a Bicornuate Uterus:

The formation of the bicornuate uterus may be caused by various factors that took place during the first months of pregnancy , the period in which fetal organs develop.

  1.  Intoxication (alcohol, nicotine, drugs, chemicals)
  2. Vitamin deficiency
  3. Psychological stress during pregnancy
  4. Endocrine diseases (diabetes, hyperthyroidism)
  5. Heart diseases
  6. Infections such as measles, rubella, influenza, toxoplasmosis, syphilis and other diseases have negative effects to the fetus
  7. Chronic fetal hypoxia and toxicosis during pregnancy have a negative effect

Bicornuate Uterus – Symptoms

The presence of the bicornuate uterus may not be accompanied by clinical manifestations., but may cause some symptoms like,

  1. Painful menstruation
  2. Uterine bleeding
  3. Miscarriage – usually happens during the first trimester. It may be caused by insufficient blood supply and small size of the cavity
  4. Infertility

Bicornuate uterus – pregnancy

Pregnancy usually takes place in one of the cavities, rarely in both. Pregnancy can be terminated in that case. Sometimes there are no problems during pregnancy and childbirth, but, some times problems may arise

The presence of the bicornuate uterus increases the risk of

  • Abnormal position of the placenta – placental abruption and bleeding.
  • Cervical incompetence.
  • Premature childbirth.
  • Violation of the contractive muscles activity of the uterus and
  • Postnatal bleeding.

How is A Bicornuate Uterus Diagnosed?

A bicornuate uterus may be suspected if patient’s complains of

  • Painful menstruation
  • Abnormal bleeding
  • Miscarriages
  • Infertility

 

Confirmation of diagnosis by

  • Ultrasound
  • Hysterosalpingography
  • MRI
  • Hysteroscopy
  • Laparoscopy

 

Treatment of Bicornuate Uterus:

  • Surgery should be performed only in case of 2-3 miscarriages or in the case of infertility. The surgery is aimed at restoration of the uterus with one cavity. More often the removal of the rudimentary cavity takes place (Strassman, Thomson operations).
  • Strassman surgery is a standard procedure. Basically, it is a laparotomy. Also, the surgery may be performed with the help of the hysteroscopy. After surgery, an intrauterine device should be used for at least 6-8 months.

 

Prognosis

With sufficient capacity of the uterine cavity, pregnancy goes without complications. In severe cases, there is a high risk of miscarriage or premature birth.