The uterus is the most fundamental organ in a female’s reproductive system, and its anatomy has a very deep influence on fertility and pregnancy. Among all the anomalies of the uterus, bicornuate and septate are two conditions that often get misclassified as they resemble one another. These are congenital abnormalities of the uterus that arise from the failure in the formation or fusion of the Mullerian ducts during embryogenesis.
However, their causes, anatomy, and impact on reproductive performance as well as pregnancy outcomes differ. Knowledge of the differences between a bicornuate uterus and a septate uterus would provide a good guide for appropriate diagnosis, appropriate treatment, and better reproductive health management. This article brings out the main differences between these two conditions.
Overview
A bicornuate uterus and a septate uterus are examples of congenital anomalies of the uterus that result from developmental defects in the Mullerian ducts. Though they often have similar profiles in imaging diagnostics, their underlying differences in structural features, aetiology, and fertility implications remain different.
- A bicornuate uterus is a congenital anomaly where the two Mullerian ducts do not completely fuse together; therefore, a uterus will present with two distinct cavities but a single outer contour. The condition falls into the category of a fusion defect, and a wide-angle separation is common between the cavities.
- In contrast, a septate uterus develops due to incomplete resorption of tissue between the two Mullerian ducts; hence, it results in a fibrous or muscular septum dividing the uterine cavity. In comparison with a bicornuate uterus, the external contour of the uterus is normal, and the angle between the cavities is sharper.
Both conditions can affect a woman’s ability to conceive or maintain a pregnancy, but they require different diagnostic approaches and treatments. Accurate differentiation is critical, as a bicornuate uterus typically does not require surgical correction, whereas a septate uterus can often be successfully treated with hysteroscopic surgery.
What is a Bicornuate Uterus?
A bicornuate uterus is an abnormal condition wherein the uterus has the shape of a heart rather than taking on the rounded shape that a normal uterus would have. The shape of a normal uterus is an upside-down pear; the wide, rounded upper part is called the fundus. The uterus, in a bicornuate case, has its top side curved inward in the middle and assumes a heart-like shape. For this reason, it is commonly referred to as a heart-shaped uterus.
The uterus is essentially a single, hollow cavity with the capacity to expand for accommodating a developing baby. With a bicornuate uterus, though, the top portion is split by a ligamentous band. The depth of this division can range from slight, almost negligible, up to a depth that may actually cause complications during the pregnancy, for the uterus could not stretch appropriately.
This is a congenital condition acquired due to abnormal development in fetal growth. Normally, a bicornuate uterus does not have problems, but it carries risks of various pregnancy complications, such as miscarriage and preterm labor, in most cases. Most of the patients are asymptomatic and unaware of the fact that they are suffering from a bicornuate uterus. Others might suffer from severe menstrual cramps or repeated spontaneous abortions.
Prevalence of Bicornuate Uterus
A bicornuate uterus is one of the more commonly reported abnormalities of the uterus but still an uncommon condition. It affects fewer than 0.5 percent of AFABs. The condition is very unsuspected, and in many people, this is detected after a series of unsuccessful pregnancies or, at times, complications occurring in pregnancy.
Is Having a Bicornuate Uterus Bad?
No, a bicornuate uterus is not dangerous or harmful. Most women never know that they have a heart-shaped uterus since most of them do not have symptoms of which they are aware. At times, it can cause some problems with the pregnancy. Discussing your condition with your healthcare provider can be helpful in understanding the implications for your health and fertility.
Symptoms and Causes
What Are the Symptoms of a Bicornuate Uterus?
While some people with a bicornuate uterus may have no symptoms, others could experience:
- Recurrent miscarriages (typically more than three).
- Vaginal bleeding.
- Painful menstrual cycles.
- Pain during intercourse (dyspareunia).
- Pelvic discomfort or pain.
In other instances, it may remain asymptomatic until complications in pregnancy start to show up or reoccurring miscarriages. Due to the congenital nature of a bicornuate uterus, anything felt may become normal to a person.
What is the cause of a bicornuate uterus?
A bicornuate uterus is a congenital anomaly, thus forming before birth. During fetal development—that is, at 10 to 20 weeks of pregnancy—the Mullerian ducts are meant to merge to form one unified uterine cavity. However, when they fail to fuse completely, the two uterine cavities develop, resulting in a bicornuate uterus. The degree of separation can vary from a shallow indentation to a more pronounced division. This is not a hereditary condition and cannot be passed on to children.
Diagnosis and Tests:
How is a bicornuate uterus diagnosed?
Most patients diagnosed with a bicornuate uterus are diagnosed following several recurrent miscarriages or in routine ultrasound scans. Diagnosis commences with pelvic examination and subsequent imaging studies that confirm the diagnosis and the degree of uterine separation.
Common diagnostic methods include:
Ultrasound: This is the most common test that can first diagnose a heart-shaped uterus. A 3D ultrasound shows a more accurate picture of the uterine structure.
MRI (Magnetic Resonance Imaging): Provides clear and multi-dimensional pictures. This helps to confirm the diagnosis and establish the degree of abnormality.
What are the different types of bicornuate uterus?
The condition can be categorized into:
- Partial Bicornuate Uterus: In this type, the separation is less pronounced; thus, the uterus is heart-shaped, but it only has a slight division.
- Total Bicornuate Uterus: Here, the division is extreme and, therefore, leaves two uterine cavities.
Management and Treatment
How Is a Bicornuate Uterus Treated?
In most cases, surgical treatment of a bicornuate uterus is not usually recommended unless certain complications arise.
Metroplasty: This surgical procedure corrects the shape of the uterus by removing the dividing tissue and restoring it to a typical pear shape. Metroplasty is minimally invasive and can be performed hysteroscopically. Following the procedure, individuals are advised to wait at least three months before attempting conception to reduce the risk of uterine rupture during labor.
What are the risks of treatment for a bicornuate uterus?
The risks of surgical correction include:
- Hemorrhage.
- Infection.
- Uterine adhesions or scarring.
- If surgery is advised, your healthcare provider will explain the procedure, risks, and its potential to improve pregnancy outcomes.
(Frequently Asked Questions) FAQs
1. Can I Get Pregnant with a Bicornuate Uterus?
Yes, it is possible to conceive and have a baby, although the condition puts one at risk of complications associated with pregnancy because the uterus would not be able to accommodate your baby adequately. Your gynecologist will advise you on many precautionary measures to help you navigate your pregnancy safely and effectively for a successful delivery.
2. How Does a Bicornuate Uterus Affect Pregnancy?
In most instances, conception is not the issue; however, in the case of a bicornuate uterus, there may arise several complications of pregnancy:
- Miscarriage.
- Preterm delivery.
- Low birth weight.
- Vaginal bleeding.
- Abnormal baby positions (e.g., breech).
- Cesarean delivery.
- Placenta complications.
Close monitoring through regular ultrasounds is essential to track the baby’s growth and position. Many pregnancies progress healthily with proper care, although a c-section is often recommended due to the likelihood of breech presentation.
3. Does a Bicornuate Uterus Affect Labor and Delivery?
Labor might be affected due to the misshapen shape of the uterus, creating a small area for the baby to move inside. This usually causes awkward positions. A cesarean delivery is often used to ensure a safe delivery.
4. Will My Baby Have a Birth Defect?
A bicornuate uterus doesn’t cause any birth defects, but it might cause preterm labor, thereby increasing the chance of premature delivery.
5. When to see a doctor?
Contact your healthcare provider if you have irregular vaginal bleeding, pelvic pain, or signs of preterm labor, such as cramping or ruptured membranes.
A Note from Origyn IVF
If you are diagnosed with a bicornuate uterus, talk to your gynecologist about the risks involved. Your gynecologist will be able to evaluate the risks associated based on your medical history and symptoms. A bicornuate uterus increases the incidence of specific complications associated with pregnancy; however, if the condition is monitored carefully and properly, most women with this condition will deliver babies in good health.
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About Dr. Rashmi Sharma:-
Dr. Rashmi Sharma is an IVF specialist Consultant Reproductive Medicine and Director Origyn Fertility & IVF New Delhi MBBS (BHU), MD(BHU), DNB, MNAMS, FICOG, Diploma IVF and reproductive Medicine (Kiel University, Germany) Web Editor, Indian Fertility Society (2024-26) Former HOD, IVF dept, Moolchand Hospital, Delhi (2009-13) and Max Hospital, Pitampura, Delhi (2013-17), Director, Origyn Fertility & IVF, which has 4 branches across Delhi.
Origyn IVF has been accredited for 1-year fellowship in IVF and reproductive medicine along with an MSc in Clinical Embryology under Amity University and IFS Collaboration. Recipient of the “C. S. Dawn Award” for best paper presentation on her work on IVF /ICSI with genital tuberculosis, at All India Congress Of Obstetrics and Gynecology (AICOG 2010) Recipient of “Hall of Fame – Best IVF specialist in India – North” at Economic Times – National Fertility Awards,2019 and 2023 & 2024.
Origyn IVF received “Best IVF center in North India” and “Most integrated team in IVF, India – North” at Economic Times – National Fertility Awards, 2019 & 2024 Recipient of “Best IFS Executive” at Fertivision – 2018, Kochi. Authored various chapters in infertility books of repute. Many national and international paper presentations and publications.
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