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It’ll probably be no surprise to hear that, as an obstetrician, I am fascinated by everything about fertility, pregnancy and childbirth. I stay informed and up-to-date by reading articles in medical journals and in the popular press; this week, a report in Cosmopolitan about heart-shaped wombs caught my attention.

Your womb is the place where the fertilised egg implants and your baby develops and grows. It is a small muscular structure, with an incredible capacity to expand to adapt to the size of the fetus. However, sometimes problems with the mother’s development when she herself was in the womb can lead to abnormalities in the shape of the uterus.

Shape matters

Many women discover that their womb is shaped differently at their anomaly scan and continue to give birth with no problems. However, sometimes the shape of the womb can affect the attachment of the placenta, the healthy growth of the baby and the mother’s ability to carry the baby through to term.

 

In Cosmopolitan, James Nicopoullos, consultant gynaecologist and fertility expert, said that having a heart-shaped womb can “increase the risk of a low birth weight, increase the risk of preterm labour, and increase the risk of needing a Caesarean section.”  I agree, however it’s important to note that, when it comes to wombs they’re not just divided into normal or heart-shaped. There is a spectrum of uterine abnormality, with different shapes having different impacts on fertility, pregnancy and birth.

Bicornuate: This uterus is heart, rather than pear-shaped. Women with heart-shaped wombs usually have no problems conceiving a baby or during early pregnancy, but there can be difficulties later on, leading to an increased risk of mid-trimester loss, preterm birth, babies with abnormal lies and Caesarean deliveries.

Unicornuate:  This rare abnormality results in a womb that is shaped like half a heart. Many women with unicornate wombs can conceive, but because half of the uterus hasn’t developed, the womb is small and there is an increased risk of ectopic pregnancy, late miscarriage and premature birth. The shape and size of the womb mean that babies may lie awkwardly and Caesarean section is frequently indicated.

Arcuate: In many ways, the arcuate womb is in-between normal and heart-shaped. It has an indentation at the top and although fertility is usually normal, there is an increased risk of late miscarriage, abnormal lies and the need for a Caesarean birth.

Didelphic:This is a ‘double’ womb. The uterus is divided in two, with two separate cavities each with a cervix. Although this may sound alarming, women with didelphic wombs usually have no problems conceiving and the risk of an early birth is only slightly increased.

Septate or subseptate: These wombs are split (or partially divided if subseptate) by a wall of muscle. This means that the available space is significantly decreased leading to problems with conception, early miscarriage and abnormal lies or premature delivery of babies that develop.

What now?

If you’ve found out that your womb has a different shape, don’t panic. I have cared for many women with uterine abnormalities, who now have wonderful, healthy babies. We just ensure they have a little extra care and monitoring during pregnancy.

I always recommend that any woman who has a uterine abnormality and has suffered either a late loss or recurrent miscarriages should consider consulting a gynaecologist before planning any further pregnancies. The surgeon will expertly evaluate the anatomy of the womb and assess whether surgery, such as an operation to remove the septum, could make a difference.

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