If at your last doctor’s appointment your OB-GYN stated, rather casually, that you have a bicornuate uterus, don’t panic. This condition rarely is serious and often does not have to affect fertility, pregnancy, or birth in and of itself. Let’s find out what a bicornuate uterus is and what it means for you, your pregnancy, and your baby.

What is a bicronuate uterus?

A bicornuate uterus is simply a uterus that is heart-shaped. Normally, uteruses are shaped more like an upside-down pear with the smaller end tucked down into the pelvis. Uterine-shaped abnormalities are pretty rare, with only about 3% of women having them. They are congenital, meaning a woman is born with a misshapen uterus. There are several different types of uterine anomalies including:

Uterine septum- This is one of the more common uterine abnormalities and consist of a fibrous tissue that divides the uterus. The placenta can often not grow properly in this case and women will often miscarry or have a preterm birth. It is resolved with surgery.

Unicornuate uterus- This is a horn-shaped uterus that generally causes the uterus to be smaller than normal. One side of the uterus does not develop normally, women usually only have one fallopian tube, and they often have very painful periods.

Dideplhic uterus- This is what is commonly known as a “double uterus.” It is very rare, it is often genetic, and women may even have two cervixes and two vaginas. Risk of miscarriage and preterm birth is high.

T-Shaped uterus- Some women with a t-shaped uterus will experience miscarriage or preterm birth, but others do not.

Tipped uterus- A tipped uterus is another uterine abnormality that isn’t usually worrisome. It often corrects itself during pregnancy. In rare cases, however, the tipped uterus can turn into something called a “incarcerated uterus” that can cause abdominal pain, rectal pain, and urinary obstruction in the second trimester.

Like the uterine abnormalities mentioned above, a bicornuate uterus is also a congenital defect, meaning that women are born with an abnormally shaped uterus. Luckily, a bicornuate uterus is not as dangerous as some of the other uterine abnormalities.

A bicornuate uterus will appear heart-shaped (i.e., there is a small dip at the top of the uterus, which makes it look like a heart shape). Many women do not even know they have a bicornuate uterus until they get pregnant or unless they have recurrent miscarriages or preterm births that warrant further investigation.

A bicornuate uterus does not seem to be a factor in first-trimester miscarriages but may increase the risk of second-trimester miscarriages.

What are the symptoms of a bicornuate uterus?

Many women with a bicornuate uterus do not even realize they have an abnormally shaped uterus until they get pregnant, or undergo an ultrasound or image testing. However, some women do experience other symptoms. These symptoms are common of other conditions, though, and even if you have them they don’t point exactly toward a bicornuate uterus. The symptoms may include:

  • irregular vaginal bleeding (bleeding that is separate from your period)
  • repeated miscarriages
  • painful periods
  • abdominal discomfort
  • pain during intercourse

Can I still get pregnant and have a full-term birth with a bicornuate uterus?

Having a bicornuate uterus does not generally affect a woman’s ability to get pregnant or carry a baby to term. In some women who have had preterm births or recurrent miscarriages have been found to have a bicornuate uterus, but many of those that have the heart-shaped abnormality are able to carry a child to term with no other issues.

It does, however, slightly increase your risk of miscarrying in late pregnancy or going into labor early. A study published in the Ultrasound in Obstetrics and Gynecology Journal found that the reason for early labor or miscarriage in late pregnancy due to a bicornuate uterus may be because of irregular uterine contractions or a smaller sized uterus.

What are some of the risks with a bicornuate uterus?

In addition to an increased risk of late-term miscarriage and preterm birth, having a bicornuate uterus also carries some additional risks. Some of these risks include:

Babies are four times more likely to be born with a birth defect, according to a study published in Pediatrics, which is the official journal of the American Academy of Pediatrics. This study found that the most common birth defects for children born to mothers with a bicornuate uterus include nasal hypoplasia, omphalocele, limb deficiencies, teratomas, and acardia-anencephaly.

In a report published by the Royal College of Obstetricians and Gynecologists, the risk of miscarrying ranges between 1.8 to 37.6 percent.

A baby may settle in a breech position before birth, which means that they will be feet first instead of head first which is dangerous during delivery.

You may have additional ultrasounds to monitor your baby’s position and growth in the womb.

Women with a bicornuate uterus have a higher risk of having a cesarean section due to the breech position of their baby.

Should I be tested for a bicornuate uterus?

Many women don’t even know they have a bicornuate uterus until they are pregnant. In fact, some women don’t even know their entire lives because their pregnancies and births occur without any issues that warrant further investigation. Many times women only find out if they are having complications, if they know of a family member with the same issue, or if they have recurrent issues that warrant further investigation.

There are several ways you can be tested for a bicornuate uterus. Those methods include:

  • ultrasound
  • MRI
  • Hysterosalpingogram
  • Pelvic exam
How is a bicornuate uterus treated?

Many times women are not treated for a bicornuate uterus because it does not affect their pregnancies or their births. However, there is a procedure called a Strassman metroplasty that can help repair the shape of the uterus. It is often conducted if women have recurrent miscarriages due to the bicornuate uterus.

The procedure, however, is considered controversial. One study found that 88% of women with recurrent miscarriages that had the surgery were able to successfully carry a child to birth. But many doctors do not think the procedure is necessary as many women are able to carry their children without any issues even if the mothers have a bicornuate uterus.

So what should I do if I know I have a bicornuate uterus?

There is no way to tell if your bicornuate uterus will affect your pregnancy before you get pregnant and try to carry a baby to term for the first time unless you have other underlying issues. The best thing a mother can do is make her medical team aware of her bicornuate uterus and opt for additional ultrasounds to watch your pregnancy closely.

Your pregnancy with a bicornuate uterus will be considered high risk, and you will have extra appointments and ultrasounds to closely monitor your progress. You may be asked to opt for a high-risk doctor instead of midwife or doula, and you may be instructed to labor and birth at a traditional hospital instead of having a home birth or giving birth at a birthing center.

Having any issue in your pregnancy can be a scary one. But like most mothers, you want to do everything you can to keep your baby safe and cooking until they are full term. It is important to keep an open mind about the progression of your pregnancy and keep in mind that a cesarean section may be necessary if your baby is breech and cannot be turned before labor.

It is equally as important to remember that many women are able to carry their babies to term with a bicornuate uterus. In fact, many women go their entire lives without even knowing that they have this particular uterine abnormality.

Still worried about having a bicornuate uterus? Read some of these encouraging words from mothers just like you:

“I have one. I had my first daughter no problem. The only issue is that she was frank breech so I had to have a c section but otherwise everything was fine.”

“I had one but I knew about it before conceiving my first so I had surgery beforehand. I did get pregnant shortly after the surgery and all was fine.”

“I have a heart shaped uterus too, but I was expecting I might, as my mom does. When I went for my first exam, I mentioned my mom, so they checked mine carefully and confirmed that I also have one. My mom's is very pronounced, and it caused my two older brothers to be born prematurely, although they ended up okay. My doctor told me preterm labor is one side effect, and the other is breeched babies. Because I also have type 2 diabetes (aka larger babies), as well as small pelvic bones, I will most likely be having a planned c-section.”

“...have a bicornuate uterus. Had a miscarriage 3 years ago, then had my son (6 weeks early) due to the shape of my uterus my water had broken but it was a very slow leak so I wasn't sure if it was just extra discharge or what. I knew something wasn't right. That happened on Wednesday and I finally went to the hospital on Saturday. My doctor kept telling me to count contractions but I wasn't in active labor so I didn't have a lot of contractions but really bad back pain and a lot of pressure. Ended up having a csection. This pregnancy they are planning a csection at 37 weeks. Hopefully we make it that far.”

Image: AePatt Journey