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| Drawing simulating Bicornuate Uterus |
The day I found out I was pregnant was one of the happiest days of my life. It was my very first pregnancy, and it had taken us only four months to get there. When that urine test showed positive I immediately informed my husband and then it wasn't long after that we told our families. It was the natural thing to do, after all, you get pregnant, and you tell everyone you know that you’re having a baby because you’re excited about it, as it should be.
I was about five weeks pregnant when I showed the first signs of trouble, which I informed my doctor of right away. I was spotting. It was very scary and my doctor had me come in right away to check things out. When I told them the spotting had only been brown blood they weren’t really very concerned, but decided it was best to do an ultrasound. The pregnancy was still very early so they needed to do a vaginal ultrasound, and in a few seconds, there on the monitor they could see my uterus, and my little grain of rice -my baby. The pregnancy was confirmed and they actually were able to see the baby’s heartbeat, and the machine told them that I was six weeks along.
After I left the doctor’s office I felt much better about things. The next week, I started spotting again. This time the spotting was pink and they still weren't too concerned and just said to call if it became bright red. I will never forget that morning, about 4 A.M. when I saw the bright red blood. I put a frantic call into my doctors answering service and then he called back soon after. He said it could be a miscarriage but wanted me to come in to the office first thing. I did and by that time the bleeding had lessened. Unfortunately that baby was not meant to be and an ultrasound confirmed my worst nightmare.
After blood tests to check HCG levels about twice a week until they hit zero and I was cleared for trying again, I decided to wait. It did take weeks for the bleeding to stop and another two for my period to return. I waited longer until I was emotionally ready to try again. When we did, I got pregnant right away. This time we chose to wait to tell people until after my eight week appointment to confirm I was pregnant. The last pregnancy had only made it to seven weeks.
When I started spotting again in the second pregnancy I started to lose hope, fearing I would lose that baby too. The spotting stopped before my eight week ultrasound appointment, but I still wasn’t sure about things. When I had that ultrasound the technician performed it, and then went to get the on call doctor since I was not having this one done at my own doctor’s office, due to insurance reasons. He scanned me again and then informed me I had an anomaly in my uterus, and asked if I knew that already. Of course it came as a complete shock to me.
He explained I had what was called a bicornuate uterus and he was lucky that he’d found it, because typically by that point it no longer is visible due to the size of the baby and growing uterus. He’d told me that there was a wall, called a septum, that caused a dent, or dimple in my uterus and there are varying degrees of it, but that mine didn’t appear to be very serious, but he still wanted me to have a follow-up ultrasound in a few more weeks.
When I saw my doctor a week later he had been told of my condition and decided it was best to proceed as if I was a high risk patient as depending on severity, a bicornuate uterus can cause complications. It was then suspected that this could have been the reason for my earlier loss. Assigning me as high risk meant that I needed to see him on a monthly basis as well as the perinatologists at the perinatal center. This meant more visits then the average woman, and many, many more ultrasounds. The good thing about that was that I was being monitored so well, that if there would have been any sign of trouble, they would have spotted it early on, and I got to see my baby on T.V. much more than other women. I tried to look at the positives. I also got a 3D ultrasound and level two scan at no cost to me, other than my insurance co-pay.
So now you ask, what is a bicornuate uterus, and what complications can arise from having one? Well, like they kept telling me, it all depends on the severity. After that eight week ultrasound my uterus looked completely normal, other than it was also tilted. The two conditions just seemed to be coincidence though. A bicornuate uterus can cause other problems though. The biggest one is higher risk of miscarriage because if the baby’s placenta should attach to the septum, it will not thrive, or if the egg tries to implant in one the two horns there may not be viable uterine tissue there.
A bicornuate uterus is also known as a “heart-shaped” uterus which is a uterus that has two horns at the top causing a wall in the middle. This means that the uterus has two cavities, instead of the normal one cavity giving it a heart shaped appearance. The cause of the condition is genetic, a malformation when the reproductive organs were being formed while in the mother’s womb. In most cases there is no way to pinpoint the exact cause as to why the uterus did not form correctly. It’s no fault of anyone; it’s just one of those things that happen.
There is actually very little information on the internet about this condition, which is one of several Mullerian anomalies. WebMd and The Mayo Clinic turned up no results. There are several message boards, and blogs, and a few other various articles out there, mostly by women who have this condition. Of the few articles out there, several are very technical and unless you have the condition and spoke to your doctor about it, or you have a medical degree, you won’t understand most of it. The rest of the articles may or may not be written by medical professionals. The best thing you can do, if you’re told you have a uterine anomaly is to find out what type you have, and ask your doctor or your perinatologist (as you’re likely to see one) what it is, how bad it is, and what does it mean?
What did it mean for me? Well, as I said, after my eight week ultrasound with my son, my anomaly could no longer been seen on ultrasound and my perinatologist even questioned that I even had a bicornuate uterus. He suggested that after the baby was born I have an x-ray to confirm it because it’s usually very hard to detect on an ultrasound, but yet, that’s how I was first diagnosed. Everything went pretty well with that pregnancy. They continued to do regular ultrasounds looking for anything out of the ordinary, but other than my son being in the breech position, the pregnancy appeared normal.
So what were they monitoring me for, you might ask. Complications from a heart shaped uterus include, higher risk of first trimester miscarriage (weeks 1-12), higher risk of preterm labor (before 37 weeks), a chance for an incompetent cervix (a cervix that opens too early), failure to thrive or a baby that isn’t growing at the normal rate, and higher chance that you will have a breech or transverse baby which will require a c-section. When you have this sort of anomaly and your baby is not head down, the doctor will most likely not attempt to turn the baby because this could put you into labor, it’s better to wait or have the c-section.
Of the above mentioned complications the only one that I suffered, was a breech baby that required a c-section. My son was born on March 18, 2005 back-end first and weighed in at 7 lbs, 2 oz and was 21 ½ inches long, not bad for a baby who did not have the room in a uterus that would be slightly smaller than the average woman. I was 37 ½ weeks pregnant at the time of my c-section. When they performed the surgery I felt as though I was a freak show with everyone looking at my abnormal uterus, but at least it was confirmed that yes, I do in fact have one, and happily for me, it’s not all that severe.
With that pregnancy going fairly smooth, despite all of the extra doctors visits, my husband and I decided to try again when my son was 1 ½ years old. Again there was no trouble getting pregnant, which in some cases of these uterine anomalies can happen. That pregnancy however was not nearly as easy.My doctor, having had seen my uterus, decided there was no need to see the perinatologist that time as he knew what he was dealing with as opposed to last time. Of course right of the bat he said I would need a c-section because he did not perform vaginal births after c-sections (VBAC). That was disappointing, but I kind of expected that, so I was okay with it.
Right from the get go I began having spotting again. This spotting persisted for nearly 10 weeks. I had seen the doctor for my eight week check and called of course, but everything on ultrasound was perfect and since the spotting was pink, and light, they just put me on light activity. At my 11 week appointment, nearly out of the woods we thought, they could not find the baby’s heartbeat. My uterus was tilted again which the doctor claimed made it difficult for him. He said it looked like the baby had died, and called it a missed-miscarriage. I was shocked and devastated. How could that be? I was having no cramps, no bleeding, nothing, and I was sure I was starting to feel subtle movements, and I was starving all the time. I still felt pregnant.
We had planned on telling our family about the pregnancy after that visit, but instead my husband had to make calls and tell them we lost another baby and that I was still carrying the child waiting for my body to abort it, or I would need to have the baby removed surgically. My doctor wanted me back that Friday to be re-checked or to see if the miscarriage had gotten under way. I had a week to come to terms with another loss, and I didn’t understand why my body was not getting rid of that baby.
On Friday, my husband and I went into the office to brace ourselves for me having to get a D&C (Dilation and Curettage), to remove our baby from my uterus. I did not want to be there. I did not want to see my empty uterus on the screen, or my dead baby. I didn’t look while the ultrasound technician, not my doctor, performed the ultrasound on my stomach, not vaginally as my doctor had done. “There’s the heartbeat,” the woman proclaimed, just like that, like it was nothing. My husband and I thought she was being a cruel and both looked at her and were confused. They’d told me four days prior that my baby died, and here it was, living, with a very strong heartbeat of 160 bpm (beats per minute).
The nurse ran out to tell my doctor right away who came to me even though on lunch and hugged me and said how happy he was that he was wrong, and that it was why he wanted me to come back before doing anything drastic. I suppose most people would have gone to another doctor at that point, but I really liked my doctor and my office, and decided to stay. He could have sent me off right away to get the D&C, but he didn’t. Was I happy that he put me through that? No, but we are human, and we are fallible, others didn’t share my feelings about it.
So with that nightmare behind me the pregnancy progressed pretty normally for a while. Since I am high risk my office decided to monitor me with regular, bi-weekly, non-stress tests which took an hour each time, and counted the baby’s movements, and monitored her heartbeat. My baby girl did not like performing for them however and many times they were worried for lack of movement, but she constantly was moving away from the monitor not wanting her heart monitored.
They did regular ultrasounds after every non-stress test to see her development and watch her movements, but since she did not like performing for them, once had me sent to the hospital for another, longer, non-stress test, of which she still did not want to move, but her heart was strong, when they were able to find it. My daughter was notorious for hiding somewhere in my uterus. I did not feel as many movements with her as I did with my son, but not only was my uterus still tilted she was transverse (lying sideways).
On one non-stress test they discovered I was having contractions, and I was only about 27 weeks. I had many Braxton Hicks contractions during that pregnancy and they became concerned that I may go into preterm labor so they put me on medication to help. A few weeks later I began spotting again and having pink tinged mucus. After calling and telling my doctor, he thought that I may have lost part of my mucus plug (the plug that seals the cervix). That is sometimes the first sign that labor is coming, something that they did not want to happen with me, and I would have needed an emergency c-section given that she was transverse.
After examination everything appeared in tact and normal. The baby was growing fine and everything was right on track and was barely dilated. The spotting continued and then I finally learned that I had a low-lying placenta, which was the most likely cause. Apparently this can also happen with a bicornuate uterus. After all of this, I could not wait for the day that she would be born. Finally, I had made it to 38 weeks and my daughter was born on August 28, 2007 via c-section and was 6 lbs, 7oz and 18 inches long. She was smaller than her brother, probably in part due to her position. My daughter came out rear-end first, and stayed true to her fetal behavior and wiggled and wiggled to get away from the doctor. She came out screaming, where her brother was nearly silent.
If you get a diagnosis of a bicornuate or septate uterus, ask your doctor to explain what it looks like, what it means for the pregnancy, and what the outcome is. In severe cases they can perform surgery to correct it, but I think this only happens if you have repeated miscarriages due to the condition. Remember, having a c-section is not the end of the world. It is still very possible to have healthy children with a uterine anomaly.
If you develop any of the complications due to a bicornuate uterus your doctor has methods to address those, like, stopping labor, or closing an incompetent cervix. Medical professionals say uterine anomalies are rare, but there could be a higher percentage of women who have them then what they are aware of because of the high incidence of women having live children vaginally and therefore never learning of the condition unless there is some reason to look at the uterus surgically or by electronic means. An anomaly doesn’t always indicate a need for a c-section, in fact I am considered in the rare group where both of my children presented in breech positions.
Below is an ultrasound image found online and what a bicornuate might look like.
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| Not mine, but what mine possibly looked like |
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