Bicornuate

Bicornuate describes a uterus with two horns that results from partial failure of fusion of the Müllerian ducts during embryonic development. The term combines bi- meaning two and cornua meaning horns. It is a congenital uterine anomaly that is often present from birth but may be discovered incidentally later in life during imaging or evaluation for infertility or pregnancy complications.

Anatomy and classification: The uterus has two horns separated by a fundal cleft of variable depth. If there is one cervix, the condition is bicornuate unicollis; if there are two cervices, bicornuate bicollis. Complete bicornuate refers to a deep external fundal indentation; partial to a shallow one. This is distinct from didelphys (two separate uteri) and from septate uterus (normal external contour).

Clinical significance: Most cases are asymptomatic. When present, patients may experience infertility, recurrent pregnancy loss, preterm birth, or malpresentation. The risk profile depends on the extent of fundal indentation and overlap of the two cavities.

Diagnosis: Imaging is essential. 3D transvaginal ultrasound or MRI delineates external fundal contour and internal cavity. Hysterosalpingography can suggest the anomaly, but MRI/3D ultrasound provides clearer distinction from other Müllerian anomalies.

Management: Asymptomatic individuals generally require no treatment. For those with reproductive issues, surgical metroplasty to unite the cavities may be considered, though less common today and reserved for carefully selected cases. In pregnancy, standard obstetric care applies; malpresentation often leads to cesarean delivery.