Bicornuate Uterus and the Role of Cervical Cerclage in Pregnancy Outcome

Background: Bicornuate uterus constitutes a unification defect of the Müllerian ducts. It represents 10-39% of Müllerian duct anomalies. Pregnancy loss due to cervival incompetence is a common feature of this anatomical variation. Cervical cerclage has been proposed to ameliorate pregnancy outcomes. The incidence of the anomaly and its treatment success rates vary between studies.

Objective: To investigate the incidence of bicornuate uterus, the percentage associated with cervical abnormalities and pregnancy outcomes with or without treatment consisting of cervical cerclage.

Methods: We searched pubmed and EMBASE using the terms “bicornuate uterus”, “cervical cerclage” and “pregnancy outcome”.

Results: Amongst patients with uterine malformations the percentage of bicornuate uterus is 3.4%. The incidence of cervical incompetence between patients with bicornuate uterus has been estimated to be as high as 38%. Preterm delivery varies from 61% to 100%. Late abortion rates are reported at 68%. In one study including 11 patients cervical cerclage was carried out according to ultrasonographic findings and all (100%) had preterm delivery.

Conclusion: Bicornuate uterus represents one of the commonest müllerian duct defects. Routine prophylactic cervical cerclage is usually the treatment of choice and should be considered even in the absence of cervical incompetence even though preterm delivery cannot be totally prevented.