Does a pregnant woman with a history of bicornuate uterus and septal resection require early delivery?

Management of Pregnancy in a Woman with History of Bicornuate Uterus and Septal Resection

A woman with a history of bicornuate uterus who has undergone septal resection does not require early delivery based on this history alone, and can typically be managed with standard obstetric care with delivery at term.

Understanding Uterine Anomalies and Pregnancy Outcomes

Bicornuate uterus is a congenital uterine anomaly that occurs when the müllerian ducts fail to completely fuse during embryonic development, resulting in a heart-shaped uterus with two separate cavities. This condition is associated with:

• Increased risk of pregnancy complications when untreated
• Term delivery rates of only approximately 40% in untreated bicornuate uterus 1
• Higher rates of premature delivery and fetal mortality 2

However, surgical correction through septal resection significantly improves outcomes:

• Hysteroscopic septum resection can restore near-normal pregnancy prognosis 1
• Term delivery rates improve to approximately 75% after treatment 1
• Live birth rates increase to approximately 85% following treatment 1

Pregnancy Management After Septal Resection

Antenatal Monitoring

• Regular obstetric follow-up is sufficient in most cases
• No evidence supports routine early delivery based solely on history of corrected bicornuate uterus
• Ultrasound monitoring should follow standard obstetric protocols

Delivery Timing

• In the absence of obstetric complications, delivery should occur at term
• The Society of Radiologists in Ultrasound consensus does not recommend early delivery for patients with history of corrected uterine anomalies 2
• Vaginal delivery is appropriate in most cases 2

Special Considerations

• Monitor for potential complications that may occur at higher rates in women with history of uterine anomalies:
  • Preeclampsia
  • Intrauterine growth restriction
  • Malpresentation

Important Caveats

1. Individual Assessment: While early delivery is not routinely indicated, other obstetric indications for early delivery should be monitored:

   • Fetal growth restriction
   • Oligohydramnios
   • Maternal comorbidities

2. Imaging Accuracy: Ensure accurate diagnosis was made prior to septal resection:

   • MRI has been shown to be 100% accurate in diagnosing müllerian duct anomalies 2
   • 2D transvaginal ultrasound has 92% accuracy 2
   • Hysterosalpingography alone has only 16.7% accuracy 2

3. Documentation Review: Confirm the type of anomaly and extent of correction through surgical records to ensure appropriate management.

In conclusion, a woman with history of bicornuate uterus who has undergone septal resection can be expected to have a normal pregnancy outcome with standard obstetric care and delivery at term, as the surgical correction significantly reduces the risks associated with the uterine anomaly.