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I just found out through an (AWFUL) HSG that I have a blocked right tube and a bicornuate uterus. Has anyone here had experience with either of these?

I guess from reading online, an HSG isn't a good way to diagnose a bicornuate uterus, that it could actually be a septate uterus. Is an ultrasound better about diagnosing which it is and how severe it is?

My other question is this: Is it possible to have a homebirth with a deformed uterus? What I read made it seem like this would automatically put me in the high risk category, and I'd be likely to have a pre-term birth and a c-section. Would it depend on how severe it is?

Thanks.
 

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I think there is a wide variance in bicornuate uterus. I had a uncomplicated pregnancy and delivery with my son. Then after a recent miscarriage they discovered a bicornuate uterus (upon vaginal US) which may or may not have contributed to miscarriage. My mw said it's very hard to determine the severity with US although she said she often can feel a septum upon physical exam.
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Anne - I saw your post on the homebirth forum and replied there in terms of birth.

Yes, there can be a wide variation in the severity of the cleft (dip) of a bicornuate uterus. Some just have the typical heart shape to them (what's usually thought of with bicornuate) and others are more severe. Mine was nearly a complete divison with only 8mm of conjoined uterine cavity (my uterus looked like bunny ears that were joined at the very bottom).

Please know, an HSG and/or an ultrasound do NOT accurately diagnose bicornuate vs. septate uterus, they can only tell you have some sort of mullerian anomaly. In order to accurately distinguish between the two you need to be able to see the outer contour of the uterus, not just the inside. A bicornuate and septate can look identical on an HSG or ultrasound. The difference between the two is that the fundus of a septate uterus will look normal (no dip) from the outside but show the dividing septum from the inside. A bicornuate uterus will have a cleft/dip at the fundus from the outside as well as the dividing wall from the inside. In both cases, from the inside, you'll see the dividing wall but not know a) what it looks like at the fundus from the outside or b) what type of tissue makes up the dividing wall.

When the uterus is formed it develops from the joining of 2 tubes, mullerian ducts. In a normal uterus, the ducts come together and the middle wall dissolves. In a septate uterus the top joins fine and the middle wall begins to dissolve but fibrous, typically poorly vascularized (poor blood supply), tissue remains, i.e a septum. The reason m/c is more likely with a septate uterus is because if the embryo implants on the septum it is likely that there is not adequate blood supply to sustain the pregnancy. Having a septate uterus surgically corrected is usually a simple and easy surgery (in the right hands) and is something I would encourage be done. The doctor goes inside the uterus and snips the septum until it is flat with the uterine wall.

With a bicornuate uterus, the middle wall of the 2 ducts remains along the length of the uterus to a greater or lesser extent and the tubes did not join at the fundus to a greater or lesser extent, resulting in the exterior cleft. That middle wall is made up of the same tissue that makes up the rest of the uterus - it has a good blood supply and it is muscular in nature just like the rest of the uterus. As a result, m/c is much less likely with a bicornuate uterus although there are increased risks (depending on the severity of the cleft) for breech, transvere, pre-term labor and 2nd trimester loss (although the majority do not have this problem). Surgical correction of a bicornuate uterus is rarely done and rarely needed. It is a very involved, complex surgery called a Strassman and not something I would recommend in most cases.

Also be aware that it is possible to have what's called the "combo platter" - a bicornuate uterus with a continuing septum. In this case, getting the septum corrected is usually the best course of action.

Unfortunately a lot of docs are grossly misinformed when it comes to mullerian anomalies and misdiagnosis are routine. An MRI can usually diagnose the difference between a septum and bicornuate because you can usually see the outer contour of the uterus. Sometimes a hysteroscopy (camera inside the uterine cavity) can be used to view the tissue making up the dividing wall to see if it is vascularized or not - if it isn't then it's pretty accurate to diagnose a septate uterus. If it is, it's still possible that it could be either septate or bicornuate. I've heard of some women having a septum that is somewhat vascularized and they've been misdiagnosed as bicornuate. The gold standard for a diagnosis is a laparoscopy where they can go in and actually examine the outer contour of the uterus and make a definitive diagnosis.

In terms of palpating to make a diagnosis - I firmly believe in the skills of palpating (I've been a massage therapist for years), but I personally would not rely on palpation in this situation for anything more than "something doesn't feel right, I'd suggest you get this looked at". There are so many variations and possibilities.

So there you have your crash course in MAs
There's a wonderful, incredibly knowledgeable yahoo group called Mullerian Anomalies. However, I don't think they would be a good resource for homebirth info. Many of them have had repeated losses, been through the wringer with misdiagnosis, etc. and would consider a homebirth to be an insane risk, rightly or wrongly. The majority are pretty mainstream in their birth choices. There's a fair bit of the "whatever it takes to get baby here safely" mentality and I've seen things get nasty when doctor's birth recommendations are questioned. Obviously we all want our babies to arrive safely, but I think because of that extreme fear there is less questioning about how it can be done. As a result, I think some of them are more prone to unnecessary c/s and think nothing of it. However, if you're looking for diagnosis and treatment information, I'd highly recommend them.
 
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