Bicornuate Uterus

by chelseajin

We’ve had a few women with a bicornuate uterus, which is when the uterus is in a heart-shape and can even be completely split into 2 chambers.

This is me trying to draw again.

It seems that there really isn’t a treatment for having a uterus with this kind of structural abnormality. If the cavity can stretch to accommodate the growing fetus, a vaginal delivery can be done. There’s a number of risks with having a bicornuate uterus, such as deformity, 2nd trimester pregnancy loss, malpresentation (baby’s head is not pointing down), placenta accreta, cervical incompetence, and preterm labor.

I think that preterm labor is caused by the baby pushing against the walls of the uterus. If the muscles can’t stretch, it probably sends a signal saying that the baby has to come out now. Deformity is probably due to the same issue of space. Like oligohydramnios, where there’s not enough amniotic fluid, if the baby is pushing up against the walls of the uterus, its features must get mushed up.

The presentation of one of the patients we saw today now makes a lot more sense. The physicians were commenting on how she had to be watched carefully because she had actually been dilated in her past pregnancy but didn’t know it. That’s pretty much the definition of cervical incompetence, when there’s preterm dilation and effacement that occurs without pain or contractions. So, this seems like a pretty intense case. I wish I could follow her all the way up though delivery!

How do you address cervical incompetence? You could do a cervical cerclage, which is a suture around the cervix to help keep it closed. Another surgical procedure which I wish I could see in person.

Lastly, a nice ultrasound. But those arrows on the very bottom are pointing to cysts which shouldn’t be there.

RadioGraphics. [http://radiographics.rsna.org/content/23/6/1401/F23.expansion]
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