Bicornuate uterus

Bicornuate uterus is a congenital uterine anomaly classified as a Müllerian duct malformation, in which the uterus has two horn-shaped cavities (cornua) that share a single cervix, resulting from incomplete fusion of the two Müllerian (paramesonephric) ducts during embryonic development. It is categorized as a Class IV uterine anomaly under the American Fertility Society classification. The condition affects the female reproductive system and is typically present from birth, though it is often not discovered until adolescence or adulthood, frequently during evaluation for reproductive difficulties or through incidental imaging findings. Many women with a bicornuate uterus are asymptomatic and may have normal reproductive outcomes. However, the condition can be associated with an increased risk of adverse obstetric outcomes, including recurrent pregnancy loss, preterm labor, preterm delivery, malpresentation (such as breech presentation), cervical incompetence, and intrauterine growth restriction. Some women may also experience dysmenorrhea (painful menstruation) or abnormal uterine bleeding. The degree of separation between the two uterine horns can vary, ranging from a partial bicornuate uterus (with a minor indentation at the fundus) to a complete bicornuate uterus (with a deep cleft extending nearly to the cervix). Diagnosis is typically made through imaging modalities such as pelvic ultrasound, hysterosalpingography, magnetic resonance imaging (MRI), or three-dimensional ultrasound, with MRI considered the gold standard for definitive classification. Treatment is not always necessary, particularly in asymptomatic women or those without reproductive complications. When surgical intervention is indicated — usually for recurrent pregnancy loss attributed to the uterine anomaly — a metroplasty (Strassman procedure) may be performed to unify the two uterine cavities. Cervical cerclage may be considered in cases complicated by cervical incompetence during pregnancy. Management is individualized and often involves close obstetric monitoring during pregnancy.

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