During the embryonic development of a girl the internal genital organs, the upper part of the vagina, the womb or uterus, the fallopian tubes and the ovaries are formed. In the second month of gestation, the Müllerian ducts, which are two tubular structures that later move towards the center of the embryo and fuse, giving rise to the. If this shift or merge does not occur correctly the internal genitalia do not form well.

The fusion alterations of Müllerian ducts can produce different pathologies depending on at what level the lack of fusion occurs. Duplicity can occur in all central organs that derive from the Müllerian ducts: uterus, cervix and upper vaginal third, or only part of them.

At bicornuate uterus The alteration of the Müllerian ducts occurs at the uterine level and involves a cleft in the center of the uterus. This means that the uterine cavity is of normal shape in its lower part, but, the upper part of the uterus divides in two abnormally. When the cleft reaches the bottom of the uterine cavity, that is, to the cervix, it is a complete bicornuate uterus

What are the symptoms of a uterine malformation?

Uterine malformations, if they are not accompanied by vaginal septa, do not usually give symptoms until the desire to have children appears. Women who, in addition to uterine malformations, have vaginal malformations, have more discomfort during sexual intercourse or difficulty or inability to insert vaginal tampons or. If there is no vaginal malformation, the patient does not present any clinic and bicornuate uterus is usually a chance finding in a

Women with a bicornuate uterus have a higher rate of miscarriages, being a cause of repeat abortions. Also, they have a higher rate of premature births for a matter of space since the bicorne matrix presents less space for the fetus and, therefore, uterine contractions and deliveries occur earlier. In women with a partial bicornuate womb there is a higher frequency of fetuses that are placed in breech position since it is more comfortable for them.

Diagnosis of the bicornuate uterus

In general, the bicornuate uterus is diagnosed by ultrasound, in some cases in the ultrasound of the beginning of pregnancy in a woman who had not been previously diagnosed with any uterine malformation. Specialist in gynecology and obstetrics.

Types of Uterine Anomalies

A bicornuate uterus is part of a broader category of uterine anomalies, which include: 

• Septate uterus: A uterus divided into two halves by a septum (a wall of tissue). 
• Unicornuate uterus: A uterus that develops from only one of the Mϋllerian ducts. 
• Arcuate uterus: A less pronounced anomaly where there is a small indentation at the top of the uterus. 
• Didelphys uterus: A uterus that splits into two completely separate cavities, resulting in two uteri.

Causes of Bicornuate Uterus

A bicornuate uterus occurs due to incomplete fusion of the Mϋllerian ducts during fetal development. Factors that can influence this condition include: 

• Genetic predisposition: Some cases of uterine anomalies are hereditary. 
• Environmental factors: Certain chemicals or hormones might interfere with the proper development of the uterus. 
• Chromosomal abnormalities: Rare chromosomal issues can contribute to uterine malformations.

Symptoms of a Bicornuate Uterus

Many women with a bicornuate uterus do not experience symptoms, and the condition is often discovered incidentally during a routine pelvic examination or imaging for other health issues. However, some women may experience symptoms, including: 

• Recurrent miscarriages: Women with this condition may be at an increased risk of miscarriage due to the irregular shape of the uterus. 
• Preterm labor: The malformation can sometimes lead to premature birth. 
• Pelvic pain: Some women may experience pain or discomfort during menstruation or sexual activity.

Diagnosis of a Bicornuate Uterus

A bicornuate uterus can be diagnosed through imaging techniques, such as: 

1. Ultrasound: The first step in diagnosing uterine anomalies, which may reveal the abnormal shape of the uterus. 
2. Magnetic Resonance Imaging (MRI): Provides a clearer view of the uterine structure. 
3. Hysterosalpingography (HSG): An X-ray procedure where contrast dye is injected into the uterus to assess its shape. 
4. Laparoscopy: A surgical procedure where a camera is inserted into the abdomen to directly observe the uterus.

Treatment and Management

The treatment for a bicornuate uterus depends on the severity of the condition and whether it is causing problems. Management options may include: 

For Women with Recurrent Miscarriages 

• Surgical intervention: In some cases, a surgery called a metroplasty may be performed to correct the uterine anomaly and increase the chances of carrying a pregnancy to term. 
• Monitoring and support: Regular check-ups during pregnancy may help manage potential complications, such as preterm labor or fetal growth restriction.

For Women with Pain or Other Symptoms 

• Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) may help manage pain associated with menstruation or pelvic discomfort. 
• Hormonal treatments: In cases of hormonal imbalances, medications may be prescribed to regulate the menstrual cycle.

Outlook for Women with Bicornuate Uterus

Many women with a bicornuate uterus go on to have successful pregnancies, although the condition may increase the risk of: 

• Miscarriage: Due to the irregular shape of the uterus, a bicornuate uterus may lead to early pregnancy loss, particularly in the first trimester. 
• Premature birth: Women with this condition are at a higher risk of delivering prematurely. 
• Malpresentation: The fetus may be in a breech or transverse position during labor, increasing the need for cesarean delivery.

With appropriate medical management and prenatal care, women with a bicornuate uterus can successfully carry a pregnancy to term.

Key Points to Remember

• A bicornuate uterus is a congenital condition that may lead to reproductive challenges but is manageable with medical intervention. 
• Diagnosis is typically made through ultrasound or MRI. 
• Women with a bicornuate uterus may need extra monitoring during pregnancy to avoid complications such as miscarriage and preterm birth.

Sources:

• "Müllerian Duct Anomalies and Infertility" - The American Journal of Obstetrics and Gynecology. 
• "Reproductive Outcome of Women with a Bicornuate Uterus" - Fertility and Sterility. 
• "Management of Uterine Malformations: Clinical Practice Guidelines" - National Institutes of Health.