Bicornuate Uterus: How Does It Affect Pregnancy?

The bicornuate uterus, commonly known as a heart-shaped uterus, can bring heartache with its frequent miscarriages and pain with its reproductive discomfort. Are you having frequent miscarriages and other female issues?

Key takeaways:
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    A bicornuate uterus is a heart-shaped uterus and is formed in utero before birth.
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    Though bicornuate uteruses are the most common uterine abnormality, they are classified as rare, affecting less than 0.5% of females.
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    A heart-shaped uterus increases women’s risk of miscarriage and increases the risk of complications during pregnancy.
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    Many women who have a bicornuate uterus never have pregnancy complications or any of the other common symptoms.
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    A bicornuate uterus is a congenital defect, but it is not hereditary and does not cause birth defects.

Keep reading to determine whether you need to speak with your obstetrician/gynecologist about the bicornuate uterus.

What is a bicornuate uterus?

A bicornuate uterus is an irregularly shaped uterus. Unlike a normal uterus, which is shaped like an upside-down pear, a bicornuate uterus has more of a heart shape. The wide-rounded part of the uterus is called the fundus.

In the bicornuate uterus, the fundus dips down into the hollow cavity of the uterus. This type of uterus is congenital, meaning that the uterus’ shape is formed in the womb. The uterus is normally formed between 10 to 20 weeks gestation.

Though it is congenital, this type of uterus is not genetic. If you have a heart-shaped uterus, this does not mean that your babies will also have this type of uterus.

How common is it?

It is difficult to determine the number of women who have a bicornuate uterus because many never experience the common symptoms of a heart-shaped uterus.

Though it is the most common uterine abnormality, it is still considered to be rare.

According to the Cleveland Clinic, less than 0.5% of females report having a bicornuate uterus.

Most women are not aware of their heart-shaped uterus until they become pregnant, and a routine ultrasound is performed. Sadly, other women experience multiple miscarriages before considering that the bicornuate uterus may be the culprit of their frequent miscarriages.

Bicornuate uterus and pregnancy risks

Under normal circumstances, a bicornuate uterus is not a bad thing nor is it dangerous. As previously mentioned, it often goes undetected. Most women do not experience the symptoms listed below.

Others do and don’t know why. When a woman is born with a heart-shaped uterus, often the symptoms feel normal. She may have never experienced intercourse or menstrual cycles that are not painful, so she never considers having it checked. The pain seems normal to her.

Some symptoms of the bicornuate uterus are:

  • Frequent miscarriages.
  • Atypical vaginal bleeding.
  • Painful periods (dysmenorrhea).
  • Painful sex (dyspareunia).
  • Pain in the pelvis.

Do I have a bicornuate uterus?

If you think you may have a bicornuate uterus, imaging can be performed to confirm the diagnosis. It is recommended to have imaging done to check the shape of the uterus when a woman has experienced multiple miscarriages or when she is experiencing some or all the common symptoms of a bicornuate uterus.

The two types of imaging commonly done to diagnose bicornuate uterus include ultrasound and/or an MRI (magnetic resonance imaging) scan.

  • Ultrasound is normally the first procedure done, and often a 3D ultrasound is also completed to achieve better visual imaging and to determine the depth of the septum. An ultrasound is a painless, non-invasive diagnostic test that can be done at your Ob/Gyn’s office.
  • MRI is also a painless, non-invasive diagnostic test. However, this procedure is normally done in the hospital setting, as it requires the individual to lie in a large, tube-shaped machine while the procedure is performed.

Types of bicornuate uteruses

There are two types of bicornuate uteruses: partial and complete.

As the name suggests, the partial bicornuate uterus has less degree of indention between the two uterine cavities. The complete bicornuate uterus has a more severe indentation of the fundus.

With the complete bicornuate uterus, the uterine cavities are more profoundly separated. Therefore, the pregnancy risks are also elevated with a complete bicornuate uterus.

What are my treatment options?

Normally, it is not necessary to undergo any treatment for a heart-shaped uterus since the symptoms are often non-existent or very mild. However, if you have a complete bicornuate uterus and are experiencing the common side effects, it is recommended to talk to your Ob/Gyn or another healthcare provider.

A surgery, called metroplasty, can be performed to correct the shape of the uterus. This laparoscopic procedure is minimally invasive and removes the tissue that causes the indentation of the fundus.

Since it is a laparoscopic surgery, women can expect to have three small incisions. The goal of this surgery is to restore the uterus to its proper upside-down pear shape. Since metroplasty is controversial and only done in specific situations, it is important to talk to your Ob/Gyn about your options.

If the procedure is performed, a three months wait is highly recommended before conception, as the uterus needs time to heal. If the uterus does not have time to heal properly, the woman is at increased risk of uterine rupture during labor.

Does the bicornuate uterus cause birth defects?

Bicornuate uteruses do not cause birth defects. Though the heart-shaped uterus may be a challenge for the developing embryo, the implications and complications are relevant only in utero and during labor.

Babies born to a mother who has a heart-shaped uterus have no more likelihood of a birth defect development than one developing in a normal-shaped uterus.

A bicornuate uterus is a rare abnormality that causes a change in the shape of the uterus. Instead of an upside-down pear shape, a woman is born with a heart-shaped uterus.

Many women never experience symptoms, and the abnormally shaped uterus may go completely undetected. Women who are experiencing some or all the symptoms of a bicornuate uterus should talk to their Ob/Gyn physician to determine treatment options.


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