Unicervical bicornuate uterus

Unicervical bicornuate uterus, also known as bicornuate uterus or bicornis unicollis uterus, is a congenital uterine anomaly classified as a Müllerian duct malformation. In this condition, the uterus has two separate horn-shaped cavities (cornua) that share a single cervix. It results from incomplete fusion of the two Müllerian (paramesonephric) ducts during embryonic development, typically between the 6th and 9th weeks of gestation. The external surface of the uterus shows a heart-shaped or deeply indented fundus, while internally the two uterine cavities may communicate to varying degrees near the cervix. This anomaly primarily affects the female reproductive system. Many women with a bicornuate uterus are asymptomatic and may only be diagnosed incidentally during imaging for other reasons or during pregnancy evaluation. However, the condition can be associated with significant reproductive complications including recurrent miscarriages, preterm labor, preterm delivery, malpresentation of the fetus (such as breech presentation), cervical incompetence, and intrauterine growth restriction. Some women may also experience dysmenorrhea (painful menstruation) or abnormal uterine bleeding. 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 accurate classification. Treatment is not always necessary, particularly in asymptomatic women or those without reproductive difficulties. For women experiencing recurrent pregnancy loss or other significant reproductive complications attributed to the anomaly, surgical correction through a procedure called Strassman metroplasty may be considered. This procedure involves unifying the two uterine horns into a single cavity. Cervical cerclage may also be employed in cases of cervical incompetence during pregnancy. Management is individualized based on the patient's symptoms and reproductive goals.

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