Bicornuate uterus

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Bicornuate uterus
Bicornuate Uterus.jpg
A human bicornuate uterus
Classification and external resources
Specialty Lua error in Module:Wikidata at line 446: attempt to index field 'wikibase' (a nil value).
ICD-10 Q51.3
ICD-9-CM 752.34
DiseasesDB 33376
Patient UK Bicornuate uterus
[[[d:Lua error in Module:Wikidata at line 863: attempt to index field 'wikibase' (a nil value).|edit on Wikidata]]]

A bicornuate uterus or bicornate uterus (from the Latin cornū, meaning "horn"), commonly referred to as a "heart-shaped" uterus, is a uterus composed of two "horns" separated by a septum. In humans, a bicornuate uterus is a type of uterine malformation, but in some other mammalian species, including rodents and pigs, it is normal.


A bicornuate uterus is formed during embryogenesis. The fusion process of the upper part of the paramesonephric ducts is altered. As a result, the lower part of the uterus is unitary while the upper part is bifurcated.


Transvaginal ultrasonography showing a cross-section of a bicornuate uterus, with two cavities (or "horns") to the left and right, respectively. The one to the right contains a gestational sac.

It is possible to diagnose a bicornuate uterus using gynecologic ultrasonography,[1] specifically sonohysterography, and MRI.[2] However, as there is no indication to do such procedures on asymptomatic women, the presence of a bicornuate uterus may not be detected until pregnancy or delivery. In a C-section (usually done due to malpresentation), the irregular shape of the uterus will be apparent.

Other less reliable diagnostic imaging methods include hysterosalpingography and hysteroscopy; these procedures are typically done during the course of an infertility investigation.


Usually bicornuate uterus has good reproductive outcomes. Therefore, the pure type rarely require treatment. In case of hybrid types hysteroscopic metroplasty is needed.[3]


There are many degrees of a bicornuate uterus. There is a continuous range of the degree and location of the fusion of the paramesonephric ducts, and existence of a spectrum, rather than a fixed number of types corresponding to strict medical definitions. Two processes that occur during the embryonic development of the paramesonephric ducts — fusion and reabsorption — can be affected to different degrees.[4] This degree of fusion and reabsorption can determine the likeliness of a pregnancy reaching full term.

There is also a hybrid bicornuate uterus: External fundal depressions of variable depths associated with a septate uterus can be seen by laparoscopy, indicating the coexistence of the two anomalies. These cases are candidates for hysteroscopic metroplasty under appropriate sonographic and/or laparoscopic monitoring.[5]

An obstructed bicornuate uterus showing uni or bilateral obstruction might also be possible. The unilateral obstruction is more difficult to diagnose than the bilateral obstructive. A delay in the diagnosis can be problematic and compromise the reproductive abilities of those cases.[6]


The occurrence of all types of paramesonephric duct abnormalities in women is estimated around 0.4%.[7] A bicornuate uterus is estimated to occur in 0.1-0.5% of women in the U.S. It is possible that this figure is an underestimate, since subtle abnormalities often go undetected. Some intersex individuals whose external genitalia are perceived as being male may nonetheless have a variably shaped uterus.

Effect on pregnancy

Pregnancies in a bicornuate uterus are usually considered high risk and require extra monitoring because of association with poor reproduction potential.

A bicornuate uterus is associated with increased adverse reproductive outcomes, such as:

  • Recurrent pregnancy loss[8]
  • Preterm birth: The rate of preterm delivery is 15 to 25%. A pregnancy may not reach full term in a bicornuate uterus when the baby begins to grow in either of the uterine horns. A short cervical length seems to be a good predictor of preterm delivery in women with a bicornuate uterus.[9]
  • Malpresentation (breech birth or transverse presentation): a breech presentation occurs in 40-50% of pregnancies with a partial bicornuate uterus and not at all (0%) in a complete bicornuate uterus.[10]
  • Deformity: Offspring of mothers with a bicornuate uterus are at high risk for "deformities and disruptions" and "malformations."[11]

Previously, a bicornuate uterus was thought to be associated with infertility,[12] but recent studies have not confirmed such an association.[13]

Effect on intrauterine device usage

Usage of intrauterine device (IUD) with copper requires one IUD in each horn to be effective in case of bicornuate uterus. The same practice is generally applied when using IUD with progestogen due to lack of evidence of efficacy with only one IUD.[14]

Evidence is lacking regarding progestogen IUD usage for menorrhagia in bicornuate uterus, but a case report showed good effect with a single IUD.[15]


  1. Nicolini U, Bellotti M, Bonazzi B, Zamberletti D, Candiani GB (Jan 1987). "Can ultrasound be used to screen uterine malformations?". Fertil Steril. 47 (1): 89–93.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  2. Marten K, Vosshenrich R, Funke M, Obenauer S, Baum F, Grabbe E (2003). "MRI in the evaluation of müllerian duct anomalies". Clin Imaging. 27 (5): 346–50. doi:10.1016/S0899-7071(02)00587-9. PMID 12932688.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  3. El Saman AM a,* , Jennifer A. Velotta b and Mohamed A. Bedaiwy a,b a Surgical Management of Müllerian Duct Anomalies Current Women’s Health Reviews, 2010, 6, 183-196 183 1573-4048/10 $55.00+.00 © 2010 Bentham Science Publishers Ltd. Department of Obstetrics & Gynecology, Assiut University, Assiut, Asyut, Egypt; b Department of Obstetrics and Gynecology, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, OH 44106, USA
  4. Acién P, Acién M, Sánchez-Ferrer ML (2008). "Müllerian anomalies "without a classification": from the didelphys-unicollis uterus to the bicervical uterus with or without septate vagina". Fertil. Steril. 91 (6): 2369–75. doi:10.1016/j.fertnstert.2008.01.079. PMID 18367185.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  5. El Saman AM, Shahin AY, Nasr A, Tawfik RM, Saadeldeen HS, Othman ER, Habib DM, Abdel-Aleem MA. Hybrid septate uterus, coexistence of bicornuate and septate varieties: a genuine report. J Obstet Gynaecol Res. 2012 Nov;38(11):1308-14. doi:10.1111/j.1447-0756.2012.01866.x. Epub 2012 May 21. PubMed PMID 22612567.
  6. El Saman AM, Nasr A, Tawfik RM, Saadeldeen HS. Müllerian duct anomalies: successful endoscopic management of a hybrid bicornuate/septate variety. J Pediatr Adolesc Gynecol. 2011 Aug;24(4):e89-92. doi:10.1016/j.jpag.2011.02.013. Epub 2011 Apr 21. PubMed PMID 21514191.
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  8. Rackow BW, Arici A (2007). "Reproductive performance of women with müllerian anomalies". Curr. Opin. Obstet. Gynecol. 19 (3): 229–37. doi:10.1097/GCO.0b013e32814b0649. PMID 17495638.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  9. Airoldi J, Berghella V, Sehdev H, Ludmir J (2005). "Transvaginal ultrasonography of the cervix to predict preterm birth in women with uterine anomalies". Obstet Gynecol. 106 (3): 553–6. doi:10.1097/01.AOG.0000173987.59595.e2. PMID 16135586.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  10. Heinonen PK, Saarikoski S, Pystynen P (1982). "Reproductive performance of women with uterine anomalies. An evaluation of 182 cases". Acta Obstet Gynecol Scand. 61 (2): 157–62. doi:10.3109/00016348209156548. PMID 7113692.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  12. Shuiqing M, Xuming B, Jinghe L (2002). "Pregnancy and its outcome in women with malformed uterus". Chin. Med. Sci. J. 17 (4): 242–5. PMID 12901513.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  13. Proctor JA, Haney AF (2003). "Recurrent first trimester pregnancy loss is associated with uterine septum but not with bicornuate uterus". Fertil. Steril. 80 (5): 1212–5. doi:10.1016/S0015-0282(03)01169-5. PMID 14607577.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  14. Amies Oelschlager, Anne-Marie; Debiec, Kate; Micks, Elizabeth; Prager, Sarah (2013). "Use of the Levonorgestrel Intrauterine System in Adolescents With Known Uterine Didelphys or Unicornuate Uterus". Journal of Pediatric and Adolescent Gynecology. 26 (2): e58. doi:10.1016/j.jpag.2013.01.029. ISSN 1083-3188.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>
  15. Acharya GP, Mills AM (July 1998). "Successful management of intractable menorrhagia with a levonorgestrel-releasing intrauterine device, in a woman with a bicornuate uterus". J Obstet Gynaecol. 18 (4): 392–3. doi:10.1080/01443619867263. PMID 15512123.<templatestyles src="Module:Citation/CS1/styles.css"></templatestyles>