I have been diagnosed with a bicornate uterus and we are trying to decide whether to have surgery to repair it before trying to get pregnant with kid #2. An important factor here is that we're not actually having any fertility issues. So on the one hand, we're thinking maybe we just got lucky with kid#1 and I am at risk for a miscarriage or pre-term delivery, but on the other hand, if it ain't broke, don't fix it. Any thoughts?
Some details:
I got pregnant quickly and easily, delivered a healthy baby boy at 36 1/2 weeks, and he just turned 1. He was breach from about 28 weeks until the end, delivered by cesarean because my water broke. Doctors discovered fibroids during pregnancy, but never the bicornate or septum situation. (I don't blame anyone for this; technology has its limits and my understanding is that he could have filled up one horn and the other one was sort of deflated and not easy to see.) 7 months after he was born, I had an ultrasound to measure the fibroids. They've shrunk, thankfully, but that's when the funky shape of my uterus was apparent.
I have now been referred to a doctor who specializes in uterine abnormalities. I've had an MRI, and HSG, and a saline ultrasound. So now we know its more of a bicornate uterus than a uterine septum. It's more like rabbit ears than like a heart. This doctor is the one who would do the surgery, he has a very good reputation, and his opinion is that this is a serious situation and the risk of pre-term delivery is the big problem, but he said he doesn't want to push this on me or freak me out.
I wouldn't mind having another kid at 36 weeks, but I wouldn't want one much earlier. I got a second opinion today, and she seemed also very smart and knowledgeable. She said it's a tough call. She did seem a little more divided about the issue than surgeon, for 2 main reasons. 1st, we're not having trouble getting pregnant, we haven't even tried yet. 2nd, she's not aware, though she's continuing research, that there's an increased risk of pre-term delivery with a bicornate uterus specifically. There's certainly studies that show an increased risk with uterine abnormalities generally, but no recent ones specifically focusing on bicornate. But I still have to send her MRI images, and she's going to look further into the medical literature.
Placental location:
As many of you probably know, with uterine abnormalities, a big factor in how well things go is where the placenta locates. You don't want it to be on a non-vascular area that doesn't get enough blood supply, like the septum, the thin ridge separating the two parts of a septate uterus. However, in this bicornate uterus I have, because it's more like rabbit ears, the part separating the cavities is pretty think and might have a decent blood flow, until you get down to the tip. To give you a visual analogy, if a septate uterus is like the letter V, the bicornate uterus is like the letter L.
Some things we're wondering: how lucky did we get on first pregnancy, and what's the likelihood the placenta will attach to a good place on the second one, and what are the potential risks of the operation? It's apparently an easy operation from the perspective of the patient - belly button camera, snip out the tissue, quick recovery.
I decided to have the surgery, and I'm pregnant again!
When the 2nd opinion doctor looked at the MRI, she changed her mind and said have the surgery, because the septum was so far down, pretty much to the cervix. The research we did made me realize that these cases of uterine abnormalities are so individual and you really have to go by individual medical opinions. Also, it's important to seek out a second opinion from a doctor you find on your own.
The surgeon told me he wanted my stomach and colon clear, so preparing for the surgery was difficult. No food after 2pm the day before. My Jewish friends due this every year, and wow, I have even more respect for that process! The surgery was in the morning and I was home by early afternoon. The worst part of recovery was the anesthesia wearing off, a lot of muscle pain and very tired. I had surgery on a Thursday and hoped to make it back to work Monday, but it was Tuesday instead, and a light work week.
After I got through one cycle, I went for the last follow up appt, and the surgeon gave us the go ahead to get pregnant. It only took two months! I feel really lucky. I'm now at 21 weeks. We're having another boy and all the prenatal testing indicates this kid is healthy.
More Answers
L.N.
answers from
Indianapolis
on
I have a bicornate uterus. I have been pg 6 times and had 3 succesful full term deliveries. The miscarriages were very early 6-10 weeks. My pg's that carried were very easypregnancies and easy deliveries at 40 weeks. I was told that the shape of uterus could have led to miscarriages but not necessarily so. This was diagnosed 30 yrs ago so the diagnostic tests available have changed and I don't really know to what degree my U shape was abnormal.
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L.H.
answers from
New York
on
All of the women in my family (grandmother, mom, 4 sisters) have a bicornate uterus. Between all of us, we have had 33 successful pregnancies. That being said, I don't know how serious the shape of all of ours is. I was never told there were any risks involved. The only abnormal thing that happened to me because of it was that I had a period during one of my pregnancies. One of my sisters had a septum removed during one of her C-sections. But that was on pregnancy #5 or something.
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R.Y.
answers from
New York
on
I think you need to get as much of an idea as you can of the potential risks and problems of having the surgery vs carrying another pregnancy with your uterus as is. Also, will the surgery really make things better for your next pregnancy. Hopefully your doctor will help you get the info needed to make a good decision (the second doctor sounds like a good bet for this).
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M.K.
answers from
Stationed Overseas
on
I guess it really depends on how severe your septum is. I have a septate uterus and will not be having the surgery to have it removed. I have one daughter who I know we are blessed to have and have been given the go ahead by the specialist and my regular OB to try again. After discussing with other women who have had the surgery I have totally decided against it for several reasons. I have heard that it usually takes more than one surgery to remove it, sometimes up to three different surgeries. Depending on how vascularized the septum is you could be looking at a lot of potential blood loss. Having it removed does not guarantee me to carry to term. For me there are too many what-ifs and I don't want to put all my hopes on surgery. Some women never even know about their BUs and have no problems carrying to term. I think it's great you are so knowledgable about your body and got a second opinion. It's hard to decide about a surgery that you may or may not need and the pros and cons of it as well.
