Bicornuate Uterus

This anomaly is a result of incomplete fusion of the uterine horns at the level of the fundus. The distinguishing aspect of this anomaly is the presence of two separate but communicating endometrial cavities and a single cervix. It represents 10% of müllerian duct anomalies. The external uterus has a sagittal cleft of variable length. The cleft extends to the internal cervical os in the complete bicornuate and to a lesser degree in the partial bicornuate uteri. The degree of incomplete müllerian fusion appears to affect reproductive outcome. Studies have reported a 29% incidence of preterm delivery in women with a partial bicornuate uterus and a 66% incidence of preterm delivery in women with complete bicornuate uterus. Overall, the spontaneous abortion rate is approximately 32%, the premature birth rate is approximately 21%, and the fetal survival rate is approximately 60%. A hysteroscopy is fundamental in diagnosing a bicornuate uterus, however, surgical correction can be achieved only with a Strassman metroplasty (open procedure). This is most often reserved for selected patients with repeated pregnancy loss or premature births.