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 Anonymous (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 Anonymous (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 Anonymous (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

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