Banana Shaped Uterus With Single Fallopian Tube – Pregnancy With Unicornuate Uterus
If you are one of those unfortunate ones who have been told that you have banana shaped uterus with single fallopian tube, you might have questions about the outcome of the pregnancy. Let’s see what exactly is this condition and how does it affects the pregnancy.
A unicornuate uterus is referred to a congenital uterine abnormality, meaning you are born with it. It is also known with the other term as Mullerian Duct Abnormality. A unicornuate uterus typically looks like a banana as mostly, it contains only one functioning fallopian tube instead of normal two. It is smaller than the normal uterus, almost half of the normal size.
Usually, the other side in a unicornuate uterus is a rudimentary horn which is not connected to the uterus and the vagina.
What is a rudimentary horn?
The other side of the uterus which is not developed is known as rudimentary horn. As much as 65 percent of women with unicornuate have a rudimentary horn. It may or may not be connected to the uterus and the vagina which can result in complications such as painful periods. This is because the menstrual blood can accumulate as it is unable to find a passage out.
If a woman does not have a rudimentary horn, she might not experience any signs and symptoms until she becomes pregnant. At this point of time, she may face trouble in getting pregnant or maintaining pregnancy.
Statistics - How common is unicornuate uterus?
While two to four percent of the women with normal reproductive histories have a certain type of congenital uterine anomaly, a unicornuate uterus is present in roughly 1 in 1000 women. The condition might not be known until it is diagnosed. However, women with history of repetitive miscarriages, the occurrence of unicornuate uterus ranges between 5-30 percent.
About 2-5 percent of women evaluated for infertility are diagnosed with unicornuate uterus.
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Unicornuate uterus – Pregnancy and miscarriage risks
This kind of uterus might be asymptomatic until the woman gets pregnant or develops certain problems while conceiving. This condition brings forth a lot of risks both in terms of miscarriage, ectopic pregnancy, and preterm labor. The reproductive performance of a woman with unicornuate uterus is generally poor. Risk of ectopic pregnancy is 2.7 percent.
Estimates may vary but the likelihood of full-term healthy delivery is roughly 50 percent. One-third of pregnancies end up in miscarriage while risk of premature birth is between 10-20 percent. Experts believe that high risk of miscarriage is due to abnormal blood supply to the unicornuate uterus that might interfere with the normal functioning of the placenta.
Other risks and complications include:
- Malpresentation or breech position
- Intrauterine growth restriction
- Premature rupture of membranes (water breaking)
- Placenta previa
- Placental abruption
- Preterm labor
Unicornuate uterus and preterm labor
Even after successfully conceiving, the risk of preterm labor hovers around due to lack of space in the uterus. The baby outgrows the limited space that can trigger preterm labor. This happens in about 20 percent of all the cases. In this case, the doctor might suggest a surgical procedure known as cerclage.
How unicornuate uterus is diagnosed?
A unicornuate uterus can hardly be detected using ultrasound or during regular pelvic examination. The doctor may suspect the condition based on your history of miscarriage, premature birth, and infertility. However, certain imaging techniques can confirm the diagnosis.
In this technique, a special dye is inserted via the cervix and into the uterus. Then x-rays are taken to visualize the fallopian tubes and the uterus.
Also known as three-dimensional ultrasound, in this procedure, a small telescope is inserted through the cervix to see inside of the uterus. The doctor can also use laparoscopy to confirm the diagnosis.
Is it possible to treat unicornuate uterus?
Currently, there is no treatment to fix this condition as the size of the uterus cannot be increased. However, researchers are working on surgical treatment techniques for the unicornuate uterus. These procedures include:
Surgical removal of rudimentary horn
If the rudimentary horn is causing problems such as painful periods, the doctor would suggest removing it surgically before you try to conceive. It will be then followed by careful monitoring of the pregnancy.
For women with incompetent or short cervix, especially those with history of miscarriages, the cervical cerclage might be the right option for them. In this procedure, the cervix is sewn closed during pregnancy. This maintains the cervix in its position and prevents preterm birth.
Risk of egg implantation in rudimentary horn
As mentioned, most women with this condition have rudimentary horn connected with the rest of the uterus. These women might face additional risk as the rudimentary horn is constricted and if the fertilized egg gets implanted there, there will be higher chances of uterine rupture. This is similar to the case with ectopic pregnancy in which egg is implanted in the fallopian tube.
The chance of uterine rupture is as much as 50 percent, if the egg is implanted in the rudimentary horn. This is the reason why doctor mostly suggests removing the rudimentary horn to avoid any pregnancy complications.
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Unicornuate uterus and IVF or IUI
The doctor may suggest in vitro fertilization or intrauterine insemination as to avoid the risk of complications. The male partner may have to go to the lab for sperm check. Many doctors prefer to go for surrogacy first before trying the usual in vitro.
Some may consider frozen embryo transfer as the best option. So the treatment would depend on case to case and general health condition.
If you have recently discovered that you have a unicornuate uterus, you might be frightened and frustrated. And knowing about the statistics may increase the frustration. However, you have to keep in mind that there are different variations of a unicornuate uterus and not all the cases are the same.
Some women may or may not have rudimentary horn while the size of the uterus may also vary. Moreover, it’s important to emphasize on the fact that approximately half of the women in few large researches have successfully delivered full-term babies. Even there are instances of healthy twins in women with unicornuate uterus.
So, if you have been diagnosed with a unicornuate uterus, make sure you put forward a barrage of questions to your gynecologist and explore your options.
1. Caserta D.,et al.(2014). Pregnancy in a unicornuate uterus: a case report read more
2. Chan YY, et al.(2011). Reproductive outcomes in women with congenital uterine anomalies: a systematic review read more
3. Heinonen PK(2016). Twin pregnancy in the congenital malformed uterus read more
4. Hiersch L., et al.(2016). The association between Mullerian anomalies and short-term pregnancy outcome read more