Uterine abnormality - problems with the womb

Some women have a congenital uterine abnormality, which is a womb/uterus that formed in an unusual way before birth.

Depending on the shape of the uterus, the risks of miscarriage or premature birth can be higher in these cases. Uterine abnormality is also linked to cervical insufficiency/incompetence, another factor leading to preterm birth.

Bicornuate (heart-shaped) womb

A bicornuate womb is heart-shaped. Women with a bicornuate womb have no extra difficulties with conception or in early pregnancy, but there is a slightly higher risk of miscarriage and preterm birth. It can also affect the way the baby lies in later pregnancy so a caesarean birth might be recommended. 

Unicornuate womb

Having a unicornuate womb is rare. It means your womb is half the size of a normal womb because one side failed to develop. There is an increased risk of ectopic pregnancy, late miscarriage or preterm birth. The baby may lie in an awkward position in later pregnancy so a caesarean birth might be recommended. Women with a unicornate womb can often conceive, although it is also true to say that the prevalence of unicornuate uterus is higher in women who are infertile.

Unicornuate uterus illustration

 

Didelphic (double) womb

The didelphic womb is split in two, with each side having its own cavity. Generally the duplication affects uterus and cervix but it can also affect the vulva, bladder, urethra and vagina. Women with a didelphic womb have no extra difficulties with conception and it is only linked to a small increased risk in premature birth.

Didelphys uterus illustration

Septate/subseptate womb

The septate womb has a wall of muscle coming down the centre splitting the space in two. Sometimes the wall only comes part-way down the womb (subseptate) and other times it comes the whole way down. Women with subseptate or septate wombs are more likely to have difficulties with conception. There is also an increased risk of first-trimester miscarriage and preterm birth. In later pregnancy the baby may lie in an awkward position.

Septate uterus illustration

Arcuate womb

The arcuate womb looks very like a normal womb but it has a dip at the top. Arcuate womb does not increase your risk of preterm birth or first trimester miscarriage but it does increase your risk of second trimester miscarriage. In later pregnancy your baby may lie in an awkward position so you may need to have a caesarean birth.

arcuate uterus illustration

How will I know if I have abnormal womb?

There are unlikely to be any physical symptoms in early pregnancy.

If you have a didelphic (double) womb or a unicornuate womb it may be spotted in your routine scans as it looks very different from a normal womb. In other cases, especially if the abnormality is not severe, it is unlikely to be picked up as routine pregnancy scans do not specifically look for this.

Most women are unaware that they may have an abnormal shaped womb when they become pregnant however some may already know as they have had investigations following recurrent first-trimester miscarriages (three or more), a gynaecological problem such as experiencing symptoms of abnormal bleeding including very heavy periods or bleeding between periods.

One of the following investigations will be offered: a hysteroscopy, a laparoscopy or a three-dimensional pelvic ultrasound scan.

Hysteroscopy

The hysteroscopy involves a small camera being sent through the cervix in to the cavity of the womb. In order to do this a fluid is introduced to increase the cavity of the womb order to gain a better view. During this procedure, the doctor can look at the shape of the womb as well as any other abnormalities such as fibroids and the thickness of the womb lining. 

There are some small risks as with any invasive procedure which including bleeding, infection and damage to the cervix, however these are rare and would be discussed in more detail before it takes place. After the hysteroscopy has finished it is normal to feel some period type pains and bleeding for a few days afterwards, it is important to avoid the use of tampons due to risk of infection, but use sanitary towels instead.

Laparoscopy

A fibre-optic instrument is inserted through the abdominal wall to view the womb.

A pelvic ultrasound scan

A pelvic ultrasound uses sound waves to make a picture of the womb.

Get information and support about miscarriage

What is the treatment for uterine abnormalities?

Operating on the womb is not normally performed because it is linked to later infertility and carries a risk of any scar opening during the pregnancy.

Once you have been diagnosed as having an abnormally-shaped womb you will be put into the care of an obstetric team and you will have extra scans and hospital visits to check up on you and your baby throughout the pregnancy.

If your baby ends up in an awkward position (upside-down or bottom first for example) in later pregnancy you will be offered a caesarean section.

Sources

  1. J David, Steer P et al (2010) High risk pregnancy, management options, Elsevier Saunders
  2. Chan YY, Jayaprakasan K et al (2011), Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol, 38: 371–382. doi: 10.1002/uog.10056
  3. RCOG (2011) Recurrent Miscarriage, Investigation and Treatment of Couples, Green-top Guideline 17, Royal College of Obstetricians and Gynaecologists 
  4. Reichman D. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886
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Last reviewed on October 5th, 2016. Next review date October 5th, 2019.

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Comments

  • By Lisa (not verified) on 13 May 2018 - 08:10

    Hi. I’m a bit worried at the moment. I lost my first baby a few moths ago at 10 weeks. The miscarriage was missed then incomplete so the whole process took about 6 weeks during which i had 4 scans. At first I was diagnosed with a bicornuate womb. However my last scan was 3D and they said it’s actually an arcuate womb (which is better) but with a septum all the way down. It’s this septum that’s worrying me. It could be removed with surgery But is have to lose 2 more babies first and then have the possibility of the scar opening during a successful pregnancy. I’m also 38 and finding this all out rather late. I can’t seem to find any stories about successful pregnancies with septate uterus. Can you help?

  • By Midwife @Tommys on 15 May 2018 - 10:24

    Hi Lisa
    I am afraid that this question is best directed to an Obstetric Gynecologist Consultant for the most accurate advice. You can request to be seen for a follow up appointment in your local early pregnancy clinic, or gynae clinic post miscarriage and there you can ask all of these questions. The team that have cared for you, and who would care for you again in another pregnancy, are best placed to help guide you forwards in planning another pregnancy. They will have full access to your medical notes and medical history and be able to give you "tailor made"advice based on you as an individual.
    I am sorry to not be able to give you much more advice than that, it just isn't a midwives remit of knowledge base.
    All the best
    Sophie,Tommy's Midwife

  • By Maria (not verified) on 31 May 2018 - 21:56

    I had duplicated reproductive organs, and was told I would miscarry. I had to go in every week for a scan and so on. Throughout my pregnancy I was stressed. However, in the end I went over my delivery date and had to be induced. I gave birth to a little baby girl. There was not complications and the birth was normal and well managed by the delivery team.

  • By Paula (not verified) on 11 Apr 2018 - 11:06

    I have a biocornuate uterus, my little boy was 6lbs but he was breech and settled into one horn while my placenta was in the other. I had a wonderful planned c section. Sometimes babies are breech for a reason and Mother Nature knows best. I carried him to 40 weeks with no complications. An ECV was offered at 36 weeks but it was at this point I told my consultant I thought I had an odd shaped uterus. She said an ECV would be painful and not work in my case and a c section would be the safest option. During my c section she confirmed my biocornuate uterus and took some pictures.

  • By Midwife @Tommys on 11 Apr 2018 - 11:52

    Hi Paula
    Thank you for sharing your story with us. We are glad to hear that you had such great care and that your little boy is doing well. How lovely!
    All the best
    Sophie, Tommy's Midwife

  • By Anonymous (not verified) on 9 Mar 2018 - 08:16

    Hi ladies , Iv got a bicornuate uterus ! One I had early at 38 weeks and the other at 39 weeks bothe were planned
    Csections

    It is possible to carry full term although both babies did get squished into one horn and it didn't allow them to turn , so ended in them being breech babies


  • By Angela (not verified) on 20 Mar 2018 - 22:37

    I’m 39 and just found out I have a bicornuate uterus and I have been pregnant 4 times with one being a miscarriage. Two of my kids were full term and my youngest was a month early but I was 35 and high risk. All three were vaginal births as well. I was surprised to find out. Good luck!!!

  • By Shey (not verified) on 24 Feb 2018 - 15:49

    Hello I am now 30 yrs old . I had my daughter at the age of 24. She was full term.I was told when I went to my local hospital that my uterus is shaped weird which may cause complications. I am now pregnant with my 2nd baby and I’m 6 weeks 6 days I’m nervous because I never experienced this before is this normal!?

  • By Midwife @Tommys on 26 Feb 2018 - 11:10

    Hi, If you have had a previous full term pregnancy, the shape of your uterus is unlikely to cause a problem this time around. Try not to worry.

  • By Elizabeth (not verified) on 5 Feb 2018 - 04:08

    I found out I had a bicornuate uterus at the age of 16 the doctors was amazed to see something different with my first pregnancy which I did miscarriage later on in life I got pregnant and went full term and I have a healthy almost 9 year and some years later I had my now 2 year had her at 39 Weeks got pregnant recently and lost my son at 5 months pregnant and I wonder was me having this abnormal uterus was the cause of the death like I know I had 2 healthy babies with no problems I wonder is this keeping me from having my final child ?

  • By Midwife @Tommys on 7 Feb 2018 - 10:35

    Hi Elizabeth
    The best thing for you to do is to be seen by an obstetric consultant at your local hospital. They can then go through your full medical and obstetric history and notes and make conclusions and a plan of care about how you can plan for the future if you were to try for another baby.
    I am so sorry to hear what a difficult time you have had, but hopefully things can be made clearer for you.
    All the best
    Sophie,Tommy's Midwife

  • By Jill (not verified) on 29 Jan 2018 - 21:31

    I have a Bicorniate uterus and had no trouble conceiving. I did however suffer with pain throughout my whole pregnancy and had to have a planned c section at 37 weeks to stop the pain. The doctor believed that my baby was lying in an awkward position and was putting pressure on my kidneys. Once she was born the pain instantly stopped. I feel so lucky she was born healthily but it has left me with a fear of going through that pain again x I have also suffered one miscarraige but I believe this may of happened if I did not have a Bicorniate uterus. I wish all you ladies luck with your pregnancies x

  • By Midwife @Tommys on 31 Jan 2018 - 10:34

    Thank you for sharing your story with us Jill
    Sophie, Tommy's Midwife

  • By Heather (not verified) on 19 Jan 2018 - 06:07

    I’ve been pregnant 9 times but I am a mom of two boys. I didn’t find out till my 8th pregnancy that I had a heart shaped uterus. My 2nd son also was not in a good position for delivery but they were able to turn him from the outside of my stomach to avoid a C-section. I fully believe that was worse than labor itself. Good luck to the moms out there and don’t lose hope❤️

  • By Amanda (not verified) on 9 Jan 2018 - 08:50

    I'm 37 and have had 3 miscarriages. I found out after my 2nd one. I was 23 when I lost my 1st baby and 25 on my 2nd and 32 on 3rd loss. I found out on my 2nd loss that my uterus was a Bicornuate Uterus. I was devastated about my loss. But after all of that I also found out that I have reoccurring cysts and endometriosis so I'm in constant pain in My lower back, my legs, my abdomen. I suffer everyday. I've tried using a heating pad, ibuprofen, aleve, aspirin, prescription ibuprofen,tylenol, hot bathes and everything but nothing helps so what can I do when I can't get no relief from this excruciating pain that keeps me down pretty much all the time on a daily basis but the Dr's refuse to give me anything stronger then mentioned above. It has been so bad that I have fell to my knees crying do to the pain. I truly need help so what can I do?

  • By Midwife @Tommys on 10 Jan 2018 - 11:43

    Hi Amanda
    It really does sound as if you need to be referred to a pain clinic and for further gynecological investigations. If your GP is not being very helpful in this, please know that you can ask to see a different doctor in your GP surgery. This is perfectly fine to do.
    Alternatively, if your pain is so great, you can go to a&e minors to be reviewed there. They can also make referrals for you, the same that your GP could also do. They may also be able to prescribe you stronger pain relief also.
    In addition, if you live in the U.K, you would be eligible to be seen in one of out three miscarriage -please see the below link for more information about what this is and how to be referred-
    www.tommys.org/our-organisation/help-and-support/clinical-trials
    Also feel free to call us on 0800147800 or email us directly to our midwife inbox on [email protected] where we can continue our conversation in a private way as this is a public forum. All the best, Sophie Tommy's Midwife

  • By Anonymous (not verified) on 4 Dec 2017 - 11:17

    Iam 34 weeks pregnant with a biconuate uterus with extremely long cervix am worried of how my labor will it be c section or normal viginal delivery?

  • By Midwife @Tommys on 4 Dec 2017 - 15:49

    A vaginal delivery would be possible in a woman with bicornuate uterus if the baby is lying in a good position. The shape of the uterus may though affect the baby's position making vaginal delivery difficult. Have you discussed delivery with your obstetrician?

  • By Anonymous (not verified) on 10 Nov 2017 - 12:00

    Hello. I am really sorry to read your message and it has struck a cord with me, as I am in a similar situation. After having a fibroid removed in April and over 13 weeks of consistent and heavy flooding, I had an emergency gynae appt and scanned showed another fibroid. Fast forward fainting, feeling poop and lots of ruined clothing.... I had my surgery on Tuesday. I also pushed for a laparoscopy, as I suspected endometriosis - this wasn't offered. During my pre-op consultant my surgeon/consultant thought the horrendous bleeding was due to hormones and wanted me to have another mirena coil fitted (!). The first migrated into my uterus wall and the 2nd one was expelled. Not only that, 2 separate people I have seen have told me to try for a baby during this fibroid-free window. Post-op I have been advised that my fibroid was much bigger than expected and trying to escape my uterus (fiend), I had several endo deposits and all removed, bar the top of the bladder, as too dangerous to address. I also have a biconuate uterus, but not supplied with any information. My next appt is in 4 months and with this fibroid free window, I am not sure whether we should start trying to conceive after my first pxeriod or not? Any help would really be appreciated.

    Laura xxx

  • By Midwife @Tommys on 15 Nov 2017 - 10:27

    Hi Laura, Thank you for sharing your story, it sounds like you have been through a lot. If you have been told by 2 specialists that it is ok to start to try for a baby during this window of opportunity then this would be a sign that you should go ahead. If you are still concerned about trying for a baby then it may be beneficial to you to speak to your GP about this as they will have all your medical records and can advice you further. Hope this helps, Take Care, Tommy's Midwives x

  • By Anonymous (not verified) on 30 Oct 2017 - 12:13

    In 2015 I got diagnosed with uterus didelphys (double cervix, double wombs and double vagina). And also last year I got diagnosed endometriosis, I also have fibroids. I giess i am one kind of special lady lol. My daughter was born preterm 7 years agone. And it took all this whole for the doctors to found out exactly what was wrong with me. After countless of symptoms. I would love to share my experience and sorry with ladies who may be going through the same or suffering in silence.

  • By Midwife @Tommys on 30 Oct 2017 - 14:55

    A very special lady indeed! Thanks for sharing x

  • By Ella (not verified) on 19 Aug 2017 - 19:08

    Hi!

    Recently, my doctor began investigations because he suspected I have endometriosis, so currently going through all the motions to get this diagnosed. But, earlier this month, I got told that I have a bicornuate uterus. Reading up about it, it looks like it's going to add to the complications I'm already facing. I'm 35, I don't have kids yet, although we are not trying just yet. Maybe I should start trying next year because I am genuinely afraid. I don't know.
    Thank you so much xxx

  • By Midwife @Tommys on 23 Aug 2017 - 15:46

    Dear Ella,
    It sounds like you have a lot going on at the moment. Are you expecting to get a diagnosis for the endometriosis soon?
    https://www.endometriosis-uk.org/
    I can imagine that the additional diagnosis of a bicornuate uterus sounds daunting but women with this condition don't have problems conceiving or in early pregnancy. It is associated with a slightly higher risk of miscarriage and premature birth though.
    Getting yourself and your partner ready to conceive is a great idea and this can sometimes help a couple feel more in control and less fearful which is a good place to start.
    https://www.tommys.org/pregnancy-information/getting-pregnant/top-tips-conception

    Good luck and please stay in contact. We are always here to bounce ideas off or answer questions.
    Anna-Tommy's Midwife

  • By MommyOF1&2ndonWAY (not verified) on 8 Sep 2017 - 20:54

    I also have a bicornate uterus,however I didn't know until I gave birth (premature 31weeks) and was told by the emergency OB. I had to have a c-section as well and everything ended up fine with no serious complications or long term issues. I'm currently pregnant with my 2nd baby and will also have a c-section. Keep your head up and stay positive, it will work out. Just get past the first term like any other pregnancy outthere worries about and its smooth sailing from there. They've come along way with being able to deal with abnormalities now....so you have nothing to worry about. Keep in contact with a doctor when you get pregnant. Wish you the best of luck!!

  • By Midwife @Tommys on 11 Sep 2017 - 16:24

    Thank you for sharing with our readers about your experience of pregnancy with a bicornate uterus. I'm sure it'll provide a lot of reassurance and relief for many women who maybe concerned about this.
    Good luck with your pregnancy - wishing you all the best!

  • By Anonymous (not verified) on 30 Jul 2017 - 07:41

    Hello, I have been trying to get pregnant for over 5 yrs now. I have a bicornuate Uterus, as well as many other factors, such as Endo, fibroids, one damaged Fallopian tube and one functioning ovary. I am going through the IVF process at the moment and the Doctor has suggested I have the top part of my uterus cut out so it is opened up more. I will then have a coil put in to avoid scarring. I have had a number of surgeries, but for some reason this one has me a little nervous. I am also 38yrs old, so I feel like my options are running out. Is this common to have it operated on and in your option are the risks minimal. Many thanks

  • By Midwife @Tommys on 31 Jul 2017 - 14:09

    Hi, I am sorry to hear that you are having problems. Unfortunately as a midwife it is not within my remit to advise about surgery and in fact I don't know anything about this. Please though ask the doctor to fully explain the procedure and the risks and benefits to you and take your time in your decision making. Best of luck x

  • By Anonymous (not verified) on 3 Jul 2017 - 08:18

    Hi there I have bicounate uterus. I have 1 healthy Daughter & have had a couple of miscarriages also a still born in 2015. It's been a rough road. Now I'm pregnant again only 6 weeks but today I have been having bleeding & cramping . Could this be the start of a miscarriage? I see my midwife tomorrow. Thank you

  • By Midwife @Tommys on 3 Jul 2017 - 15:54

    I am sorry to read about your struggle. It is quite true that you can have a successful pregnancy with a bicornuate uterus and your daughter is proof of this.
    Sometimes women have spotting in the early weeks of pregnancy and go on to have a normal healthy baby however, unfortunately it is also possible that this is the start of a miscarriage. I really hope it all goes well for you and best wishes from all of us at Tommy's x

  • By Midwife @Tommys on 2 May 2017 - 12:10

    Hi,
    thank you for posting I'm sorry that your Daughter has had such a long struggle to try and have a family. You mention that she has a split uterus so I assume that she has been diagnosed after investigations. Has she and her partner had other investigations due to the long history of infertility?
    This would be a good place to start by meeting the GP to action this referral asap.
    https://www.tommys.org/pregnancy-information/getting-pregnant/top-tips-conception
    Warm wishes
    Anna-Tommy's Midwife

  • By Earlene Schmidt (not verified) on 28 Apr 2017 - 17:57

    Your information was helpful! My daughter has a split uterus, she's been trying to get pregnant for 8yrs do you think she will be able to get pregnant? Can you recommend what they can do to increase chances to get pg

  • By Amanda (not verified) on 9 Jan 2018 - 09:10

    I'm not really a professional but I am also suffering from the same thing. It is possible for her to have a baby so tell her not to get discouraged, she's young and they have thing's to help her conceive and have a successful pregnancy and birth it's just gonna take a little extra care to do so.

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