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I have a “unicorn uterus.” What are the risks associated with this condition?
Q: I’ve had two pregnancies and in both of them, I began having contractions between 28-30 weeks and had to be put on bed rest. I made it to week 38 with both children. I had an emergency c-section with the second baby because he was breech. When my c-section was performed, my physician discovered I have what she called a "unicorn uterus", where the left side of my uterus never developed. She said I have been carrying my babies with only half a uterus, and that might explain my difficult pregnancies. She explained that most people who have this condition usually end up miscarrying early on, and suggested that if my husband and I would like to have more children, we should consult a specialist before becoming pregnant. She said it might be necessary to place some stitches in my cervix for the next pregnancy. Could you tell me how a “unicorn uterus” occurs and explain the risks of this condition? What are my chances of having a miscarriage with the next pregnancy? Is there any known harm to the baby with this condition? Would it be possible to give birth vaginally the next time around, and are my chances of rupture greater with a smaller uterus?
A: Unicornuate uteri are uncommon but not unheard of. In most cases, we never know that a patient has this condition until it is diagnosed at cesarean section or because of recurrent miscarriages. While having an unusually shaped uterus does pose some increased risk of pre-term labor, it is obvious to me that you can successfully carry a baby since you’ve done it twice. The early contractions you’ve experienced are truly irrelevant since you did not deliver a pre-term baby.

Your doctor’s information is certainly accurate in the case of a woman with recurrent pregnancy loss, but it may be overly cautious for someone with your history. I think it would be an excellent idea to speak with a perinatologist (high risk obstetrician) before considering a future pregnancy. I believe wholeheartedly that they will reassure you and help you make the best decision.

An unicornuate uterus has no impact on your baby or its health. Regarding the advisability of having a vaginal birth after cesarean section, the shape of your uterus does not increase your risk of complications. Therefore, you do not have a higher risk than any other woman who has had a prior cesarean section. I say go for it, as long as three considerations are met: 1. You understand there are small risks associated with a vaginal delivery after a cesarean section; 2. Your doctor is comfortable with your decision; and 3. The hospital where you will deliver is equipped to support your care.

I can’t emphasize strongly enough the importance of finding a doctor and hospital prepared to handle your specific medical issues. For more information, please refer to my article on this web site titled, “Where Will Your Baby Be Delivered? Important considerations for choosing a hospital” for more details.