Statistics note that one out of a hundred women have abnormalities of the internal genital organs. Most often, they do not interfere with normal life until the moment when it comes to procreation. The two-horned uterus is one of the most common pathologies. How are the two-horned uterus and pregnancy related? Is it possible to get pregnant and carry a healthy child without risk to life with such a pathology?
Definition
Normally, the uterus has one cavity, from which the fallopian tubes depart in different directions. What does a two-horned uterus mean? This is an anomaly in which the genital organ is divided into two parts by a septum. Outwardly, it resembles a jester's cap. Uterine horns can both function, but pathologies occur in which only one of the organ cavities is active. The anomaly is congenital and can cause some diseases of the reproductive system, including infertility.
Varieties of pathology
What is a two-horned uterus in women and what are its types? A birth defect can have several varieties:
- Saddle - the organ is not divided into two symmetrical parts, but its bottom has a pronounced depression. Outwardly, such a uterus resembles a saddle.
- Incomplete bifurcation means that the uterus has two horns that merge into one neck.
- Complete bifurcation means that the uterus is completely bifurcated into two separately functioning parts. Each of the horns has its own cervix. At the same time, horns can be developed equally, have a closed functioning circle or an atresized horn.
When planning pregnancy, you should undergo a full examination of the pathology to determine all the risks and opportunities of the reproductive system.
The causes of the anomaly
Since the pathology is congenital, the formation of an abnormal organ begins at the time of bearing the fetus. After a successful conception, egg division occurs, with normal development, the laying of the internal genital organs occurs at the 10th week of pregnancy. At the same time, Muller ducts are laid, which by the 12th week are transformed into the uterus and appendages.
Pathology occurs when there is a violation of the mechanism of fusion of the Muller ducts, when a septum forms between them and abnormal uterine formation begins. Most often this happens if a woman used alcohol during pregnancy (before the 12th week).
Diagnostics
In most cases, a woman does not know about pathology, since she has symptoms only in rare cases. Abnormal development of the uterus is determined only after an unsuccessful attempt to become pregnant. In order to diagnose pathology, the following methods are used:
- Ultrasound diagnosis gives a detailed visual picture of the structure of the internal organ. In addition, this study is the most affordable and safe for women.
- Hysterosalpingography is a procedure for introducing a contrast fluid into an organ cavity and observing its movement. In the course of this study, several x-rays must be taken to record the results.
- Hysteroscopy is performed using a hysteroscope - a medical device, which is an apparatus with a tube at the end of which a camera is placed. The device is inserted into the uterine cavity for its detailed study.
- Laparoscopy - the introduction of manipulators with a camera into the abdominal cavity to examine an abnormally developed organ.
Diagnostic measures give a complete picture of the development of the uterus, as well as possible complications when trying to bear a child.
Is pregnancy possible?
Are the concepts of bicornuate and pregnancy compatible? In most cases, if there is a connection between the uterine cavity and the fallopian tubes, conception is possible. However, there is a high probability of miscarriages for a period of 4-5 weeks, when the cycle is not yet over and the woman does not suspect a pregnancy.
Features of pregnancy with a two-horned uterus are that there is a danger if the fetus begins to develop in a rudimentary horn, which has a closed functioning cycle. In this case, pregnancy develops normally only until the moment when the ovum reaches the size of the cavity. After that, the uterine horn does not withstand the load and bursts, thereby provoking bleeding into the abdominal cavity. Symptom-like abnormal pregnancy resembles an ectopic pregnancy, therefore it is very important to carry out surgical intervention in the early term to remove the fetus.
Complications during gestation
Features of gestation with a bicornuate uterus differ from normal pregnancy. In this case, there are many dangers that a pregnant woman may face:
- Spontaneous miscarriages. With this pathology, there is an increased excitability of the myometrium, which can provoke a spontaneous miscarriage, especially in early pregnancy.
- Incorrect attachment of the placenta. Most often, this anomaly is fixed in the saddle uterus. In this case, the placenta is attached to its bottom, which provokes the central and regional presentation, when the placenta is on the inner side of the pharynx of the cervix. Such an abnormal development can provoke frequent bleeding with high blood loss, which, in turn, can threaten the life of the mother and child. There is also a high probability of placental abruption, which leads to a fading of pregnancy.
- Bleeding from the second horn. A two-horned uterus and pregnancy in the right or left horn can cause bleeding from the second horn. The fact is that with full bicornism and the presence of pregnancy in one of the horns, the second continues to function in the previous mode, which means that it will periodically menstruate. Often, such bleeding can be taken as a threat of miscarriage, but they do not carry a serious danger to the woman and the fetus.
- Insufficiency of the function of the cervix, which can manifest itself in insufficiency of closure of the pharynx. At the same time, it can open prematurely, which provokes premature discharge of amniotic fluid and early childbirth. In order to avoid this, it is important to timely monitor the condition of the cervix using ultrasound. If threatened, a pessary or circular seam should be applied.
- Incorrect position of the fetus in the uterus. This is due to the fact that the organ is deformed, as a result of which the child can be located on the buttocks, back, forehead or face down. Most often, when diagnosing abnormal presentation of the fetus, delivery is prescribed by cesarean section.
Fortunately, far from always the course of pregnancy can be pathological. In case of incomplete bifurcation of the uterus, a woman can learn about bicornus only during childbirth by cesarean section or manual separation of the placenta.
Complications during childbirth
Even if the risks during pregnancy with a two-horned uterus have bypassed the woman, complications during delivery can occur:
- An anomaly of labor activity, which is manifested in the irregularity of uterine contractions and, as a result, weak contractions and the absence of attempts.
- Lingering labor - labor activity, the time of which exceeds 20 hours. With this pathology, medical intervention is necessary to stimulate labor.
- Bleeding that occurs when there is a violation of uterine contractions after childbirth. In especially complex cases, such bleeding can lead to complete organ removal.
- Pathology of placenta attachment, which manifests itself in too tight attachment of the placenta. If the placenta has literally "grown" into the uterine cavity, then organ removal is necessary.
- A high probability of ruptures that occurs due to a violation of the elasticity of the uterus, appendages, and vagina. This provokes a large number of ruptures of the vagina, cervix and uterine body.
Minor anomalies include the early outflow of amniotic fluid, which provokes premature birth. In the vast majority of cases, such a pathology ends positively.
Two-horned uterus and twin pregnancy
Multiple pregnancy also has some difficulties with such an anomaly. However, according to statistics, the likelihood of becoming pregnant with twins with a two-horned uterus is much higher. At the same time, risks increase both in the waiting period and in childbirth itself. The most dangerous is the first trimester.
A bicornuate uterus and pregnancy in the left horn or right twins are often complicated by premature labor for up to 30 weeks. In most cases, surgery is needed to remove the children from the organ cavity.
In addition, when carrying twins with a pathology of the development of the uterus, a woman needs to radically revise her lifestyle. Exercise as well as emotional stress are strictly prohibited.
Difficulty getting pregnant
The harder the pathology of the uterus, the more difficulties arise when trying to conceive, but the likelihood of becoming pregnant is still present. Many women with a diagnosis of uterine bicornism are trying to find out which side is most functional so that the seed gets in the right direction during intercourse. The effectiveness of this method has not been clinically proven, but it does.
In addition, modern medicine offers surgery if it is impossible to become pregnant and endure. In this case, an operation of Thompson or Strassman is performed, in which the septum that separates the uterine cavity is removed.
Independent birth
Unfortunately, the two-horned uterus leaves the woman little chance of giving birth on her own. In most cases, a caesarean section is required. Independent delivery is possible only in the case of a saddle uterus. Moreover, such a pregnancy may end in premature birth, which also requires medical intervention.
With a two-horned uterus, labor is manifested very weakly, the uterus is simply not able to push the baby out on its own. This increases the likelihood of birth injuries in both the mother and the child. In order to avoid this, a cesarean section is performed.
Do I need to have an abortion?
Is abortion necessary for a bicornus and pregnancy? In the presence of a non-functioning horn, pregnancy in it is an indication for abortion, since it is not possible to bear the fetus.
If a woman wants to have an abortion without medical indications, it should be remembered that the bicornuate uterus has some features in which bearing and childbirth are significantly complicated. Therefore, doctors recommend leaving the pregnancy, especially if it is the first, since there simply may not be a second chance to have children.
Conclusion
Despite the fact that the two-horned uterus is considered a complex pathology, there is a chance to endure and give birth to a healthy baby. To do this, it is important to consult a gynecologist in a timely manner and undergo the necessary examinations that monitor the normal development of the fetus.