Bicornuate Uterus

In 2021, the American Society of Reproductive Medicine (ASRM) Müllerian Anomalies Classification created 9 classifications: : Cervical agenesis. Müllerian agenesis. Unicornuate uterus. Bicornuate uterus. Septate uterus. Uterus didelphys. Longitucinal vaginal septum. Transverse vaginal septum. Complex anomalies . The most common subtype of Müllerian anomalies is the unification defect known as a bicornuate uterus (55.1%-73.5%). A bicornuate uterus arises from incomplete fusion of the paired Müllerian ducts during embryogenesis, typically between the sixth and tenth weeks of gestation. This anomaly results in a uterus with 2 distinct endometrial cavities and a single cervix, although variations exist (see Uterus Embryology).  Clinically, a bicornuate uterus is associated with an increased risk of infertility, recurrent pregnancy loss, preterm labor, malpresentation, and adverse obstetric outcomes. Accurate diagnosis, often requiring advanced imaging modalities such as 3D transvaginal ultrasound or magnetic resonance imaging (MRI), is essential to differentiate it from other uterine anomalies like a septate uterus, which has markedly different management implications. The risk of severe maternal morbidity for a bicornuate uterus is 3.0%.