Uterus Bicorne

Generality

The bicorne uterus is a congenital anomaly of the uterus.

Figure: depiction of a bicorn uterus.

From the site: mulleriananomalies.blogspot.it

Like the didelfus uterus and the septum uterus, it is included in the list of anomalies of the Müllerian ducts, pathologies with unknown causes originating from a developmental error during embryonic life.

The presence of the bicorne uterus is often the cause of unpleasant consequences during a pregnancy.

For a correct diagnosis, several instrumental examinations are often required.

If women with a bicornor uterus do not experience disorders associated with the abnormality, they should not undergo any treatment. Otherwise, doctors consider the possibility of surgical intervention.

Short reference to the uterus

Unequal and hollow, the uterus is the female genital organ that serves to receive the fertilized egg cell (that is, the future fetus) and to guarantee its correct development during the 9 months of pregnancy.

Figure: depiction of a normal uterus. According to the most accurate descriptions, the uterus presents two other areas, in addition to the body of the uterus and the uterine cervix: they are the isthmus of the uterus and the fundus (or base) of the uterus. The isthmus of the uterus is the narrowing that divides the body and the neck of the uterus. The fundus (or base of the uterus) is the upper portion of the body, located above the imaginary line that connects the two fallopian tubes. It is rounded in shape and protrudes forward.

It resides in the small pelvis, precisely between bladder (anteriorly), rectum (posteriorly), intestinal loops (superiorly) and vagina (inferiorly).

During the lifetime, the uterus changes its shape. If up to the prepubertal age it has an elongated appearance similar to a glove finger, in adulthood it looks a lot like an inverted (or upside down) pear, while in the post-menopausal phase it gradually reduces its volume and is crushed.

From a macroscopic point of view, doctors divide the uterus into two distinct main regions: a larger and larger portion, called the uterus body (or uterine body ), and a narrower portion, called the cervix (or cervix ). The uterine cervix protrudes, to a minimum extent, inside the vagina: it is the so-called "tench snout".

Measurements and weight of the uterus in an adult woman.
Medium length	7-8 centimeters
Transverse diameter	4-5 centimeters
Antero-posterior diameter	4 centimeters
Weight	60-70 grams

What is the bicorn uterus?

The bicorne uterus is a malformation of the uterus, in the presence of which this important genital organ takes on the ideal shape of a heart (instead of an upturned pear) and has two "horns", converging in the lower part of the uterine body but separated by a septum.

The bicorne uterus is a congenital anomaly, that is, present since birth.

UTERO BICORNE IS SYNONYMOUS OF UTERO A CUORE

Sometimes doctors call the condition of a bicornum uterus with the alternative term uterus at heart . As it is quite understandable, this is due to the morphological similarity existing between the uterus and a heart.

IN ALL ANIMALS IS AN ANOMALY?

If for humans the bicorne uterus is a malformation, for other animals it is not.

In fact, several species of mammals, including rodents and pigs, usually present a heart-shaped and two-horned uterus.

SUBTIPES OF UTERO BICORNE

There are two possible subtypes of the bicornum uterus: the bicolle and the unicolle .

The difference between the two conditions is very simple. While in the bi-tern bicolor uterus there are two cervical channels (ie of the cervix), in the unicolle uterus there is only one.

As regards the two bifurcations, these have an overlapping aspect.

Causes

To learn more: Symptoms Uterus Bicorne

Despite numerous and thorough studies, doctors and scientists have not yet succeeded in identifying the causes that lead to the appearance of the bicorne uterus.

But what they have been able to understand is the basic pathophysiological mechanism.

PATHOPHYSIOLOGY

According to the various researches carried out, the bicorne uterus would derive from an incorrect development of the paramesonephric ducts, during embryogenesis (confirming the fact that the bicorne uterus is a congenital condition).

The paramesonephric ducts, or ducts of Müller, are small genital ducts, present in the embryo, which with stimulation by estrogens give rise to the uterus, the fallopian tubes and the vagina.

In other words, the paramesonephric ducts are the embryonic structures from which some of the main female genital organs are born.

In the case of the bicorne uterus, for reasons still unknown, the embryonic process to which the Müller ducts go is not successful and has two effects:

The union of the lower part of the uterus e
The bifurcation of its upper part.

Because of the involvement of the Müller ducts at the origin of the bicorne uterus, the doctors include the aforementioned uterine malformation among the so-called " Müllerian duct anomalies ".

To be even more precise, the heart-shaped uterus represents the class IV Mullerian anomaly.

Also in the male embryo the paramesonephric ducts are present, however these regress around the 11th week of development, as they do not undergo the same estrogenic stimulations that occur in the female embryo.

The anomalies of the Müllerian ducts.
Uterine agenesis	Class I
Unicorn womb	Class II
Uterus didelphus or double uterus	Class III
Bicorne uterus	Class IV
Uterus septum	Class V
Arched uterus	Class VI
T utter	Class VII

Epidemiology

The bicorne uterus is a congenital anomaly of the underdiagnosed uterus (ie the cases diagnosed are less than those actually existing); therefore its exact incidence is unknown.

In a country like the United States, it appears to affect between 0.1 and 0.5% of women.

According to the most recent research, exclusively in the context of Müllerian duct anomalies, it would represent about 25% of these particular malformations.

According to some statistical studies, congenital uterine abnormalities would affect about 1.5% of female individuals.

Sintom and consequences

Among pregnant women, the presence of a bicornor uterus can have various consequences, including:

Interruption of involuntary pregnancy (ie spontaneous abortion) . It is a very recurrent phenomenon and, often, many women discover they have a bicorn uterus just after a miscarriage.
Preterm birth (or premature birth) . Doctors define a birth as premature when it takes place at least three weeks before the fortieth and last week of pregnancy.
The negative effects that a preterm birth can have on the unborn child depend on how long before the birth takes place. In other words, the more premature the childbirth is, the more serious are the health conditions in which the baby is born, when the mother gives birth to it. This is quite intuitive, given that the permanence in the uterus serves to guarantee the fetus its correct development.
Depending on the period in which it takes place, a premature birth can be defined as: late, if it occurs between the 34th and 37th week of gestation; severe, if it occurs between the 25th and 33rd week of pregnancy; extreme, if the child is born before the 25th.
According to some statistical studies, the probability of a preterm birth in women with a bicorne uterus varies from 15 to 25%.
From the pathophysiological point of view, the lack of adequate growth space for the fetus leads to premature birth. In fact, the fetus is born earlier than expected when it begins to grow inside the two horns.
According to what the experts report, a short-length uterine cervix with poor muscle tone (incompetence or cervical insufficiency) promotes birth prematurely.
Bad position of the fetus . Some statistical research reports that the fetus takes a wrong position in 40-50% of pregnancies conducted by women with a bicornor uterus.
The most common bad fetal placements are two: the breech position and the transverse (or transverse) position. A fetus is in a breech position when it has feet instead of its head towards the exit; while it is in a sideways position when it presents, towards the exit, one of the two shoulders.
Fetal deformities of various kinds . Unfortunately, it happens quite frequently that children with deformities or more or less severe deformities are born as mothers with a bicornor uterus.

THE UTEROUS BICORNE IS ASINTOMATIC

Generally, the bicorne uterus does not produce any particular symptoms in female carriers.

These, in fact, discover that they are affected only when they become pregnant or undergo some particular gynecological examination.

UTERO BICORNE AND INFERTILITY?

In the past, doctors and gynecology experts claimed that women with a bicorne uterus were predisposed to infertility.

Some recent scientific studies, however, have excluded the aforementioned association, establishing that women with uterus at heart are as fertile as women with normal uterus.

Thus, the only difference between the two categories of women is the greater tendency of the former to develop problems during pregnancy.

Diagnosis

Doctors can diagnose the condition of a bicorn uterus by:

A hysterography (or hysterosonography ). It is a gynecological ultrasound that serves to evaluate the inside of the uterine cavity and is very useful in identifying malformations of the uterus, endometrial thickening, polyps and fibroids.
Like any ultrasound examination, it involves the use of an ultrasound probe, which the doctor inserts into the uterus through the vagina (transvaginal route).
But before this operation, it is necessary to stretch the uterine cavities: to achieve this, the doctor uses a particular sterile physiological solution, which he injects through a small 1.2 mm catheter (equally sterile).
A nuclear magnetic resonance (RMN) . It is a painless diagnostic test, which allows to visualize the internal structures of the human body without the use of ionizing radiation (X-rays). In fact, its operating principle is based on the creation of magnetic fields, which emit signals that can be converted into images by a detector.
Hysterosalpingography . It is a diagnostic procedure of the radiographic type, therefore it foresees the exposure of the patient to a certain X-ray quota. With its execution, it is possible to evaluate the morphological aspect of the uterine cavity and the fallopian tubes. For the analysis of these compartments, doctors use a particular contrast liquid, opaque to X-rays, which they inject specifically into the cervix.
Hysterosalpingography is an examination that gynecologists prescribe to women with a suspected fertility problem, so its execution is less frequent than the two previous investigations described above.
It is a minimally invasive procedure because it involves exposing the patient to a (minimum) dose of X-rays that are harmful to health.
Hysterosonosalpingography . It has the same purposes as hysterosalpingography, but it is an ultrasound examination, just like the hysterography (with which it shares some procedural steps).
Like any ultrasound, it does not include the patient's exposure to ionizing radiation harmful to health.
Its realization is more frequent among women with a suspected fertility problem.

Treatment

Doctors can try to solve the bicorne uterus problem by performing a surgical procedure, known as Strassmann's metroplasty .

However, it should be pointed out that the use of this procedure occurs only when women with a uterus at heart have a history of spontaneous abortions or other reproductive problems. In fact, in all those cases where the pregnancy or pregnancy is regular, it is not necessary to resort to any surgical intervention.

For those women with bicornor uterus and cervical incompetence, who have not yet become pregnant in their life (so they do not know the evolution of a possible pregnancy), the possible therapy consists in the so-called cervical cerclage .

STRASSMANN METROPLASTICS

Strassmann's metroplasty (or Strassmann's abdominal metroplasty) is a delicate surgical procedure, which the attending physician performs in laparoscopy and which allows to correct a uterus with an abnormal morphology.

The ultimate goal is to create a uterine cavity capable of receiving and adequately developing a fetus.

Laparoscopy is a minimally invasive surgical technique, whereby the operating physician can access the abdominal cavity and pelvic cavity of a patient, without resorting to the large incisions provided by traditional open surgery.

In fact, the operations in laparoscopy foresee the realization of a small number of small incisions on the abdomen, which serve for the introduction of the surgical instrumentation.

CERVICAL RIDING

Cervical cerclage is a surgical procedure, during which the attending physician applies, at the level of the cervix, a strip of synthetic tissue, in such a way as to strengthen the cervix and increase continence. All this should avoid or at least reduce the tendency to preterm labor.

There are two operative approaches with which to perform a cervical cerclage: the transvaginal approach (ie through the vagina) and the transabdominal approach (ie through the abdominal wall)

The transvaginal approach is the most practiced one (NB: it represents 95% of the circles) and surgeons can carry it out according to the McDonald or Shirodkar technique.

The transabdominal approach, on the other hand, is more than an alternative to the transvaginal approach, when the latter has not provided the desired results.