Are Cerebral Palsy Risks Higher In Pregnancies With A Bicornuate Uterus?

A bicornuate uterus is one of the most common uterine abnormalities, affecting around 1 in 200 women. While most people experience no symptoms and aren’t even aware that they have this condition, a bicornuate uterus can cause a multitude of problems when a woman becomes pregnant.

What Is A Bicornuate Uterus?

Typically, the uterus is shaped like an upside-down pear. If the uterus is bicornuate (meaning “two horns”), the top of the uterus dips inward at the middle, making it more heart-shaped. Most of these cases are referred to as a “partial bicornuate uterus.” In a severe case, often called a “complete bicornuate uterus,” this separation in the uterine cavity can make it seem like the uterus is divided in half.

A bicornuate uterus is congenital, meaning it forms that way before birth. While most bicornuate uteruses cause no issues, women with them who become pregnant have an increased risk of miscarriage and other complications.

How Does A Bicornuate Uterus Increase Pregnancy Risks?

While a typical uterus is a rounded hollow cavity that expands to accommodate a growing baby, a heart-shaped uterus is not always able to fully expand, particularly in the case of a complete bicornuate uterus.

While most bicornuate uteruses remain undiagnosed in non-pregnant women, they’re usually identified during a routine pregnancy ultrasound. They’re also frequently discovered if an ultrasound is done to investigate the cause of multiple miscarriages. A bicornuate uterus usually does not affect a woman’s ability to conceive, but it can increase the risk for several pregnancy complications, including:

• miscarriage
• preterm birth
• low birth weight
• vaginal bleeding
• poor fetal positioning, including breech and transverse
• increased risk for cesarean delivery
• postpartum hemorrhage
• placenta previa or other placenta abnormalities
• pregnancy-induced high blood pressure
• incompetent cervix

Does Having A Bicornuate Uterus Increase The Risk Of Cerebral Palsy?

Cerebral palsy is caused by abnormal brain development or damage occurring to the brain before, during, or shortly after birth. This brain damage affects a child’s ability to control their muscles and is a life-long condition that has no cure. Most cases of cerebral palsy occur due to complications after a premature birth, but poorly managed labor and/or birth can also cause cerebral palsy if the baby goes into distress and is deprived of oxygen.

The most concerning complication of a bicornuate uterus, and the one that can lead to cerebral palsy in children, is placental abruption. A placental abruption occurs when the placenta separates from the uterine wall, depriving the baby of oxygen and nutrients. A bicornuate uterus makes the attachment to the placental wall more difficult because of the abnormal shape of the uterine walls.

Because of the uterus’s inability to expand properly, preterm labor is common in women with a bicornuate uterus, which means that these babies are often born too soon. Breathing problems, bleeding in the brain, and seizures can occur in a premature infant and can all increase the risk of brain damage, resulting in cerebral palsy.

Babies growing in a heart-shaped uterus can also become stuck in an awkward position, unable to descend into the proper head-down birthing position. In these cases, vaginal delivery can be very dangerous for both mom and baby. A C-section is often indicated for these babies, but poor prenatal care, insufficient fetal monitoring, or attempting a vaginal delivery with the baby in an unsafe birthing position can all increase the likelihood of cerebral palsy.

In addition to its inability to fully expand and its shape increasing the risk of a difficult birth, the smaller size of a bicornuate uterus means that the baby’s increasing size has the potential to compress the placenta and may compromise oxygen supply to the fetus before birth if it’s not identified early and monitored closely.

Can Anything Be Done To Lessen The Risk?

Despite the potential risks, many people with a partial bicornuate uterus can go on to have a completely healthy pregnancy and normal delivery. When the uterine divide is more severe, the odds of having a safe pregnancy and delivery without medical intervention are greatly reduced. When a bicornuate uterus is identified during a pregnancy ultrasound, healthcare providers will typically recommend frequent prenatal ultrasounds to observe and monitor the size and shape of your uterus, the baby's position, and the placenta's location and health. If it appears at any time that the baby would be safer outside of the womb than within it, a C-section may be recommended.

When a bicornuate uterus is identified after a miscarriage or before pregnancy occurs, some doctors will recommend surgery to remove the division in the uterus and give it a more “normal” shape. This surgery has its own set of risks, including:

• bleeding
• infection
• uterine scarring
• uterine rupture during labor (particularly if conception occurs before the uterus has fully healed from surgery)

Why Choose Ross Feller Casey?

Having a bicornuate uterus can increase the risk of complications like cerebral palsy even when doctors do everything right. Still, that risk increases dramatically when healthcare providers are negligent in their duty to provide a proper standard of care. If a doctor doesn’t notice that you have a bicornuate uterus, knows but fails to monitor your pregnancy, or monitors your pregnancy but fails to act when medically indicated, you could be entitled to a financial recovery if your child suffered a birth injury such as cerebral palsy.

Over the past four years alone, Ross Feller Casey's lawyers have recovered more than $1 billion for clients and resolved more multimillion-dollar birth injury lawsuits than any other Pennsylvania law firm. We operate on a contingency basis, meaning you won't pay a dime unless we win your case. Contact us today to schedule a free consultation with one of our leading birth injury lawyers.