Heart shaped or bicornuate uterus

My 7 week ultrasound showed what the tech called a heart shaped uterus. The actual report states only "abnormal uterine contouring". I am currently 11 weeks with first pregnancy and no problems other than nausea. Is the uterine abnormality considered high risk? My midwife says just to wait until my 20 week u/s. I have read that some women get u/s every2 weeks with this condition, cervical cerclage, preterm labor, early pregnancy loss, etc. Should my treatment and testing be more aggressive especially since we aren't sure what exacly is different about my uterus? Please and thank u!

[AnnieBrooke]

I carried to term and delivered safely with a heart-shaped uterus.  The uterus is pretty stretchy, and the baby stretches it, so even if the uterine contouring is 'abnormal,' it might look pretty normal once a baby is filling it up.  It's like the tech said "The empty balloon is wrinkled in an abnormal way," this doesn't say anything about what the balloon will look like once it is blown up.  

Cerclage is determined by the length of your cervix at a certain point in pregnancy, and does not have a lot to do with a heart-shaped uterus (unless there is a septum all the way down the middle that prevents the baby from being able to use both halves, AND if that causes the baby to press down on the cervix, and if that causes it to begin opening.  You could ask your midwife to do a cervix check at the proper point in pregnancy, just to rule that out.  (I think it is the 20th week, but am not sure.)  

You are at some risk of early labor, if the baby does not have enough room caused by the shape of the uterus.  However, there really has never been a proper set of research telling how serious this risk is, with a heart-shaped uterus.  In other words, there hasn't been a study with realistic numbers (the only study my doctor could show me had 20 people in it) that takes a bunch of women, analyzes their uterus shapes in advance to see how many have the usual pear-shaped uterus and how many have unusual shapes, and then follows those with unusual shapes through their pregnancies, and sees how many have no trouble and how many have a problem.  It is quite possible that lots of women have  heart-shaped uteruses and never have a problem, delivering on the normal schedule, and the doctor never knows they even have a heart-shaped uterus.  This means the normal births are under-reported in the literature.  Every piece of research my doctor could show me started with a population who had been identified as having unusual shapes of uteruses because they had trouble with a pregnancy.  None started with a whole population and included people with heart-shaped uteruses that had never had any trouble.  So I wouldn't let the research scare me into demanding an ultrasound every two weeks or anything like that.  You could certainly ask for an ultrasound between now and 20 weeks, however, and if you would like to consult with a doctor, your midwife should let you.

[snickerdoodle82]

Thanks Annie for all the info. I am so glad that your pregnancy went well and your daughter is healthy! I just wish she wasn't so low key about it. I almost felt like she didn't know much about it although she has been a practicing midwife for over 30 years. I am a nurse and am educated on healthcare and pregnancy so I feel like she should be a little more up front rather than avoiding the topic like she doesn't know! I definately want to be active in my treatment and I don't know if I am being overly concerned or if she isn't concerned enough!

[AnnieBrooke]

The main thing is, except for getting a cerclage if the cervix begins to open from the inside, there really is not a lot that can be done, medically.  The risks in the literature related to a bicornuate uterus are either that the baby will implant on the septum, in which case there is a risk that there won't be an adequate blood supply (and a miscarriage would happen rather quickly), or it will theoretically have not enough room and so be born early.  The latter is somewhat of an interesting question because the uterus is stretchy enough to accommodate multiples, so even if a baby was limited to half of the uterus, he or she should have as good a chance as the average twin.  And again, there is nothing that can be done to prevent the problem if it is going to happen.  I certainly didn't experience any problems based on having a heart-shaped uterus, the septum was just pushed aside by the growing baby and on we went.  Good luck, try not to worry, there are other things that can happen to a pregnancy that have nothing to do with the shape of the uterus, that probably you have higher odds of seeing.  Worry about gestational diabetes or morning sickness, don't obsess over uterine shape.  LOL  Take care.