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.

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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    Please note that these comments are monitored but not answered by Tommy’s. Please call your GP or maternity unit if you have concerns about your health or your baby’s health.
    • By Omg (not verified) on 6 Mar 2020 - 01:15

      I am 34 years old. I have had 3 healthy baby boys(13,12 and 9). I have had plenty of ultrasounds though out my years. 3 weeks ago I found out i was pregnant and had possible molar pregnancy all on same day after 4 days of ultrasounds and blood work my OBGYN stated I had a misscarriage. In ultrasound u can clearly see empty sac. So i had a D&C done 2 weeks ago. Today my 2 weeks ultrasound after D&C (routine) I am still so shocked when my OBGYN tells me i am 8weeks and 6days pregnant. I was diagnosed with double womb.. I can not wrap my head around this I have had endometriosis removed a year ago and 3 births. I do not and can not understand how everything i have been through that this has gone undetected for this long and someone- anyone tell me how does this happen?????

    • By Amber (not verified) on 10 Feb 2020 - 02:29

      I am 23 and was just diagnosed with a heart shaped uterus because I have been having constant cramping or sharp pains even when I’m not on my period and other symptoms. My cramps have been a little more intense lately. I’m still waiting for my gynecologist appointment. I’ve been reading a lot and most people don’t have symptoms. I’m getting worried the pain is something more serious. Is this pain normal? Does anybody else have symptoms other than with pregnancy? Will I have to deal with this pain forever?

    • By Olivia (not verified) on 3 Mar 2020 - 20:52

      Amber, I'm 29 and have never tried getting pregnant, and I have low grade cramping and occasional sharp pains not near my period or ovulation days as well, and I just found out via ultrasound that I have a septate uterus. You're not alone. <3

    • By Laura (not verified) on 31 Jan 2020 - 10:39

      Hi I’m currently 14 weeks pregnant I have a heart shaped womb I’ve had a previous still birth and I’ve got a healthy 4 year old son who I had via c section pregnancy went fine .. but this time I’ve been bleeding throughout the pregnancy and it’s not just spotting I’ve been hospital numerous times had scans etc everything is fine with baby but I’m still heavy bleeding and my stomach is killing has anyone had this before ?

    • By Katie (not verified) on 4 Feb 2020 - 18:17

      Hi I am currently 13 weeks and I have had 4 bleeds all have been heavy and quite different. I have been told the bleeding comes from the other side of the uterus where the baby is not growing. Each time I have gone to the EPU everything has been great with baby but it is still extremely worrying and hard to find information about women with similar stories. I don’t have any day to day pain however before a bleed starts I can be in severe pain. I haven’t had an official nhs pregnancy scan yet so I am still waiting for lots of answers myself but hope all goes well for you

    • By Jess (not verified) on 7 Feb 2020 - 14:52

      Hi Laura and Katie below!
      I am 14 weeks and have a 'complete' bicornuate uterus - I found that out at an early scan at 6 weeks. I would love to connect to ask more questions - there isn't much information out there about it! I have my appointment with the consultant on Monday so I am hoping she will be able to tell us more. I worry that because mine is a 'complete' bicornuate it means it is more severe and so wonder if this means I am at a higher risk for problems than if it was a milder version?

    • By Irenen (not verified) on 21 Feb 2020 - 06:03

      Hi. Me too. Also experiencing lower back ache? I have also bleeding. I am 6 weeks now

    • By Bobbie Leigh Steele (not verified) on 8 Jan 2020 - 12:33

      I have a heart shaped uterus but have had 3 successful pregnancys with naturel births but my babies where all in the 6lbs range

    • By Heather G (not verified) on 6 Jan 2020 - 23:21

      I was diagnosed with an arcuate shaped uterus after not being able to get pregnant for over a year (I was 36). I had my first baby at 37, and he came 2 days after his due date. I was in labor for 36 hours and after being fully dilating and pushing for an hour I was told to have a C Section b/c he was not descending and heart rate was dropping. He seemed to be in a slightly awkward position though no one confirmed that very clearly. He had moderate torticollis which was able to remedied with a year of PT and gentle cranial biodynamic osteopathy. I got pregnant easily second time around and due date is 4/5/20 (I'm 27 weeks now). I'm hoping for a VBAC but worried about a repeat long uncomfortable labor ending up in another C Section (very long and difficult recovery! not what I want with a toddler at home!). Any thoughts on if my arcuate uterus was a part of the problem with his positioning first time around and if it's workable to avoid another C Section this time?

    • By SL (not verified) on 13 Dec 2019 - 10:13

      i had 2 miscarriages during 6 weeks, found out that I had Uterus Didelphys (2 wombs, 2 cervix, 2 vaginas)

      Not sure what to do with limited information. Many questions going through my head, if I get pregnant again, will the fetus have enough space to grow? :(

    • By Doreen Wright (not verified) on 15 Oct 2019 - 21:16

      I have a unicornal womb and was pregnant in the sixties no scans had five miss car ages only found out when I had internal x ray have since adopted two babies now in their forties they are wonderful bought us such joy and grand children

    • By Araceli (not verified) on 17 Jul 2019 - 23:58

      Hi I had a miscarriage about a month ago at 9 weeks my ob said everything was good and normal and that my miscarriage was probably due to chromosomal abnormalities. However at the ER the sonographer told me I have a bicornuate and retroverted uterus. Is there a possibility my ob missed it? Also could the combination of those conditions affect my pregnancies? I just found out I’m pregnant again.

    • By Gee (not verified) on 12 Sep 2019 - 07:36

      After 4 months of trying for a baby I conceived and I had my first son at 42 weeks in 1980, no scan,delivered normally but had postpartum bleeding as afterbirth didn't fully come away so had D & C and it was found I had bicornuate uterus. Second son born 1981 at 40 weeks, no special treatment no bleeding.

    • By Yasmin (not verified) on 16 Jul 2019 - 18:06

      I had a saline scan today and was diagnosed with a T shaped uterus.
      I already had 4 miscarriages around 7-8 weeks. Has anyone had a successful pregnancy ?

    • By jaz (not verified) on 29 May 2019 - 10:29

      Hi, I am jaz I had two miscarriages. Both happened in first trimester during third month. During second pregnancy only doctor found that the uterus has septum.I undergone hysteroscopy to remove the septum. Hope everything will be fine afterwards.

    • By zainab (not verified) on 15 Aug 2019 - 10:36

      hi jazz, i have had a miscarrige two weeks ago, i knew i had a septate uterus on my six week scan, i miscarried at 12, iam advised for surgical septate removal as well, iam really scared and devastated

    • By Kelly jacobs (not verified) on 27 Apr 2019 - 18:38

      When I was pregnant with my daughter 5years ago it was mentioned to me I have a heart shaped uterus, however it turnt out to be a septate, I never really knew the complications of having this until I miscarried 3times first was in 2017 second was 2018 now the 3rd was this month 2019, I am currently waiting for a referral the the recurrent miscarriage clinic.

    • By Carmela (not verified) on 29 Mar 2019 - 20:59

      Hi i have a bicornate uterhs and had a son carried full term which had saggital syntosis .now i am lregnant again is there any chance mg second baby will have craniosintosis as well??is it related to my uterus???

    • By Ann (not verified) on 3 Aug 2019 - 08:21

      I had a son prematurely then 2 daughters both had cranial stenosis

    • By Natalie Evans (not verified) on 27 Mar 2019 - 22:03

      During my last pregnancy I had bleeding and went for a scan at 5 weeks and was told I had a bicornate/septated uterus. I have had 1 miscarriage and 2 successful pregnancies. Just wondering if this is something I should get investigated especially if I wanted to try to conceive again?

    • By Midwife @Tommys on 15 Apr 2019 - 15:00

      HI, If you have had 2 successful pregnancies this is unlikely to be of great consequence to you, especially if your pregnancies have gone to full term.

    • By Bicornuate uterus (not verified) on 11 Jun 2019 - 19:46

      I had two successful pregnancy both c-section my last pregnancy in 2015...the doctor told me I might not be able to have anymore kids but I did want more kids so I got a OBGYN specialist and she did all the test I even ended up having a small surgery because off a thick lining in my uterus but after the process off getting my uterus back healthy test results came back perfect and now my husband and I are trying for our 3...so my advice get a full screen check up before conceiving again.

    • By Amudha (not verified) on 25 Mar 2019 - 06:39

      Hi,few days ago i lost my baby as doctors said i am having bicornuate uterus so baby does not have enough growth and there is no blood circulation also. My baby was born during 32weeks... I want to know if again i conceive means this problem Will arise again???what i have to do for safe and healthy baby during pregnancy with this bicornuate uterus???

    • By Constance (not verified) on 25 Mar 2019 - 04:18

      I have a heart shaped uterus and was wondering if its even possible for my baby to not be breech and for me to give birth naturally? Im currently 24 weeks with baby #2 and baby #1 was footling breech.

    • By Regan (not verified) on 15 Apr 2019 - 15:03

      I have a heart shaped uterus and had a C-section the first time due to positioning( oblique and couldn't get his head down), the second time I had a successful vbac. Poor positioning is more likely, but not definite so its possible to have a natural birth.

    • By Anonymous (not verified) on 10 Jun 2019 - 15:52

      I also have a bicornuate uterus. I carried my baby to 39 weeks and had her vaginally.

    • By Hannah (not verified) on 27 Feb 2019 - 15:36

      Hi , my sonographer during my last miscarriage mentioned flippantly I have a heart shaped womb, I am 5 weeks pregnant again and have just been for an internal scan, there were 2 sonographer a present and both said my womb looked completely normal, but then did admit they had never even heard of a heart shaped womb. Can I ask. With me asking them to actually look for it, would they have failed to spot it even if they didn’t know what they were talking about? Thanks

    • By Midwife @Tommys on 27 Feb 2019 - 15:46

      Hi Hannah, I am a midwife, not a Sonographer, so this is not really my remit. However, a heart shaped womb is another name for a Bicornuate uterus. This should be visible on ultrasound scan. Please do ask to see an Obstetric Consultant for more on this question as they should be able to give you more information in relation to your own scan reports. All the best, Tommy's Midwife

    • By Jenn (not verified) on 11 Mar 2019 - 00:52

      Hi Hannah, I actually have a bicornuate. Since it’s super rare, let me know if you have any questions. My daughter has a mild birth defect as a result of the uterine shape.

    • By Shannyn (not verified) on 25 Mar 2019 - 07:37

      Hi hunny I have a bicornuate uterus. 3rd baby only discovered after my second baby. First was preterm at 25 weeks second difficult birth due to how baby was laying noone has been said by my consultants in regards to my bicornuate uterus in this pregnancy and I'm at a different hospital 40 weeks this week but unsure if it can still be a problem this late in pregnancy this is the longest I've ever been pregnant I know there could be problems with how baby is positioned but other than that is there any other complications I have looked and seen it can cause higher risk of birth defects, what are these? Can't find anywhere that states why or what this could cause. Thank you shan

    • By Annie (not verified) on 2 Apr 2019 - 03:00

      Hi Jenn, may I know what was actually the mild defect your child got? I have also have biconuate and currently pregnant for my first baby.

    • By Lee (not verified) on 6 Jan 2020 - 00:20

      I also have the same thing. I have many concerns birth defects being the Main one.. if u don’t mind me asking what was ur child’s defect ?

    • By Jill davies (not verified) on 28 Mar 2019 - 15:05

      After 3 miscarriages in the mid 1980’s I was told I had a bicournate uterus I saw the histosaligram and one side of my y shape was a bit bigger than the other . I had a cervical stitch put in at 8 weeks and had a beautiful perfect daughter - now age 31yrs . I had a ceaserian . She weighed 8 and a half pounds and was 2 weeks overdue as the other side of my uterus was blocking her exit!

    • By Astrid Rose (not verified) on 24 Feb 2019 - 19:19

      Hello, my son was born premature at 34 weeks, but I had been experiencing threatened labour since 27 weeks. He was Franklin breech and tried many times to turn over but couldn't, when he was born he was very badly squashed, his head and chest were pushed out of shape. No one could give me a reason for this. I have since wondered if maybe I have a Bicornuate Uterus, but surely that would have been picked up when a c section was performed?

    • By Midwife @Tommys on 27 Feb 2019 - 10:53

      Dear Astrid
      Yes, this should have been picked up on scan, so you can ask to see your pregnancy records. Alternatively, if it wasn't picked up, then you can ask for your GP to refer you for a gynae review if you are considering another pregnancy and wish to know before trying to conceive again.
      All the best, Tommy's Midwife

    • By Astrid Rose (not verified) on 6 Mar 2019 - 07:26

      Thank you for your reply

    • By Joe-lene (not verified) on 7 Feb 2019 - 05:00

      I am 41 yrs old,I have a 14 yr old daughter,deliverd at 36 weeks.thereafter just problems,pre eclampsia,lost baby at 26 weeks,thn 4 miscarriages at ( x2) 9 weeks,one at 17 weeks,last one at 6 weeks.
      Gynae told me my uterus was tilted and he had to perform a operation in 2014,before all my miscarriages,could there have been possible womb damage done during operation?

    • By Midwife @Tommys on 7 Feb 2019 - 16:01

      Hi - Thank you for your message, I am so sorry to hear what a difficult time you have had.
      It is difficult to advise without further details - please email us at [email protected] with further details if you would still like some advice.

    • By K (not verified) on 17 Jan 2019 - 09:50

      After having three early miscarriages I waited over 6 months for a womb abnormality ultrasound scan. I had asked my doctor/ consultant previously if being pregnant at the time of the scan would be a problem. He said it wouldn't. But it was.
      By the time of the scan I was six weeks pregnant. The sonographer said what she could see was ok, but it is possible for the pregnancy to push abnormalities out of sight. So she couldn't say for sure.
      Fast forward to my first 12 week scan, of course, delighted. But the baby was restricted by what the midwife said was a braxton hicks contraction. She didn't seem concerned, so neither was I.
      Then yesterday I had my first antenatal clinic, where the doctor did a very quick scan to check for a heart beat. We didn't see much, I I'm certain that ""contraction" was still present.
      Now I'm scared. I don't have another scan until my abnormalities scan in 6 weeks time. I'm considering going private just to put my mind at ease, or otherwise.

    • By Midwife @Tommys on 17 Jan 2019 - 09:58

      Hi - Thank you for your message.
      Throughout pregnancy, the uterus periodically contracts to facilitate better blood flow through the placenta and the fetus, so a contraction noted on a scan in itself is not an issue. If you are worried about having a uterine abnormality, please discuss with your Dr to see if they can advise and reassure.

    • By christine (not verified) on 12 Nov 2018 - 11:26

      Is there any possibility of getting pregnant
      with this condition. Confused

    • By Midwife @Tommys on 14 Nov 2018 - 11:26

      Hi Christine, Yes it is possible to get pregnant with this condition. If you are having difficulty conceiving, please see your doctor.

    • By Tess (not verified) on 27 Feb 2019 - 21:07

      Hello, I have a tilted & BU (heart-shaped ), I lost my right fallopian tube to an ectopic pregnancy a year after the birth of my first son, I went on to have a further two sons. I had an early scan with both and they confirmed that my left fallopian tube picked the egg from my right ovary. It was emotionally difficult trying to fall pregnant again as we were so uncertain but as soon as we stopped stressing (9 months of peeing on sticks) and just got on with life it happened.

      I hope this brings you comfort, good luck x

    • By Afton (not verified) on 28 Sep 2019 - 20:35

      Hi Christine. I have a bicornuate and tilted uterus. I lost my right Fallopian tube to an ectopic pregnancy and four months later conceived naturally. I had to have a caesarean because the uterus shape forced the baby into a transverse position but it is possible to conceive. Prior to the loss of my tube I had been trying for 3.5 years (with one miscarriage in the middle) and both me and my parter were cleared of any fertility issues.

    • By 22yrs between p... (not verified) on 1 Nov 2018 - 01:30

      When I was 17 I got pregnant with my daughter. She was delivered at 37 wks via c-section due to being sideways with one leg down and the other up by her head. At that time I was told I have a misshaped uterus. After an HSG test I was told I only have half a uterus and then after a laparoscopy told I had a bicorniate uterus and that the left side didn’t fully develope and my left tube was blocked with tissue from my undeveloped uterus and my left tube was then removed. For 22 years I could not get pregnant again until last year at the age of 40. At 36 weeks in March I had a placental abruption and my son died before birth. 2 months ago I became pregnant again which has resulted in a recent missed miscarriage. Over the past couple months I have had sonograms and another hsg (because all my medical records from 1995-2002 have been destroyed) but none of the recent tests show I have any uterus problems but Monday after I had my D&C from the miscarriage the doctor made a statement about me having a bicorniate uterus! I am so confused. Do I or don’t I and if I do is it was has caused my troubles getting pregnant and the abruption. And now my midwife is trying to get me a 3D scan done but they won’t do it without another sonogram to see if they feel it’s needed!?! I have had 5 sonograms since April so I feel like another one isn’t going to show nothing new therefore they probably won’t approve the 3D scan . I’d also like to add both my daughter and my son who I lost always stayed mostly to the right side and never on the left side . And by the 34-35 week with both I hurt so bad because I had no more room for them and they were not big babies she was 6lbs and he was 5lbs 9oz. I know that’s not super small but they weren’t 9lbs babies . I’m sorry for the book I am just so confused and frustrated so any opinions would be great .

    • By Midwife @Tommys on 5 Nov 2018 - 14:22

      Hi there. This is something that I cannot comment on, I am so sorry. The people best placed to give you this answer, would be the Dr's who scan you and review you. As I don't access to your scans or full obstetric and medical history, I would simply be guessing if I were to give you an answer. Perhaps you need to have another examination to confirm this one way or another- you should ask for this for confirmation and clarification. I wish you all the best and hop you get your answer. Tommy's Midwife

    • By Jenni (not verified) on 26 Sep 2018 - 23:09

      Hi,

      After having 2 first trimester miscarriages we had some private tests carried out and they found from a 3D scan that I have a subseptate uterus. I am currently 17 weeks pregnant and have been referred to a consultant but am not seeing them until 22 weeks. I am not sure what extra care I am entitled too and what other tests need to be carried out as my midwife didn’t seem to know anything when I informed her I had a subseptate. I can’t seem to find any information online as most seems only relevant for bicornuate. Any advice would be very welcomed.

    • By Midwife @Tommys on 28 Sep 2018 - 09:18

      Hi - Congratulations on your pregnancy. A subseptate uterus has a wall of muscle coming down the centre splitting the space in two. Sometimes the wall only comes part-way 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.
      Highlight your scan results to during your 20 week anomaly scan and ask then to discuss the results with your consultant.

    • By Stephanie (not verified) on 6 Sep 2018 - 11:40

      Hi, I have a bicornuate uterus - I had two miscarriages before giving birth to a healthy little girl at 36 weeks, then I’ve just had a missed miscarriage (this is my second). Both missed miscarriages the fetus was on the left, and if my calculations are right my other miscarriage would have been on the left also. My little girl was on the right side and she developed in the womb fine. Could it be that the left side can’t support the fetus to grow and the right can? Anyone else had this experience? x

    • By Midwife @Tommys on 11 Sep 2018 - 15:33

      I'm so sorry to hear about your miscarriages, but happy to hear that you now have a baby girl-congratulations!
      There are several variants of bicornuate uterus-some have increased risk of miscarriage and premature delivery-I have attached a link with more information for you-
      https://www.tommys.org/pregnancy-information/pregnancy-complications/uterine-abnormality-problems-womb

      As you say, the left side of your uterus may not be able to support a pregnancy, however it is not possible to predict which side the pregnancy implants on unless you have assisted conception such as IVF. I would advise that you discuss your concerns with your gynaecologist if you are planning another pregnancy

      Tommy's Midwife

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