Understanding Uteruses

When it comes to hearts and the letter T, your uterus usually isn’t the first thing you think of. But, your baby’s home for the next nine months is truly an interesting place–and comes in a variety of shapes! There are many types of uteri, they all develop in various ways, and they can play a significant role in your pregnancy journey. Here are eight types and experiences to further understand just how unique uteruses are.


1. Fibroids

Uterine fibroids are noncancerous tumors that grow in the wall of the uterus. According to Dr. Ryan Dickerson, OB/GYN of Louisiana Women’s Healthcare Associates, “Fibroids are the most common uterine issue and tend to be more prevalent in African American women. They can affect or not affect a pregnancy depending on the size and the place it attaches in the uterus.” Typically, they are removable, and a woman will be able to get pregnant, but there is some risk for placental abruption, preterm delivery, or the labor failing to progress.


2. Cervical Insufficiency

The narrow part of the uterus that opens into the vagina serves as an important function throughout pregnancy as it makes sure baby stays housed in the uterus until he or she is ready. Dr. Dickerson mentions that “cervical insufficiency is typically a stand alone issue, and can be corrected with a cervical cerclage. Unfortunately, most of the time, women don’t know they have this until it’s too late, but it can be addressed in subsequent pregnancies.” Dilation of the cervix can happen prematurely and cause preterm birth or miscarriage. According to the American Pregnancy Association, this only happens with about 1 in 100 pregnancies.


3. Tilted Uterus

A typical uterus is in a straight vertical position. When the uterus dips towards toward the back of the pelvis, it is considered tilted. Dr. Dickerson says, “It isn’t an issue during pregnancy and can self adjust by the end of the first trimester. There’s typically no reason to be concerned about a tilted uterus because of this reason.”


4. T-Shaped Uterus

T-Shaped uteruses are exclusively linked to Diethylstilbestrol or DES exposure. According to the American Cancer Society, DES is a form of estrogen that was prescribed from 1938 until 1971 to help some pregnant women who have had miscarriages or premature deliveries. At that time, it was believed that these problems might have been caused by low levels of estrogen in the woman’s body.

The following types of Mullerian Duct Anomalies are all “conditions that are present from birth and are all variations of one another in a woman’s embryonic stage of development,” according to Dr. Dickerson.


5. Uterine Septum

Uterine septums (when a wall forms in the center of the uterus) often go unnoticed until a mom-to-be has had multiple miscarriages. Local mom Cassidy Saia had a placental abruption at 35 weeks with her second son and experienced two miscarriages at 11 weeks before her uterine septum was discovered and repaired. After Cassidy met with a fertility specialist, she learned how common her condition was. Cassidy’s doctor later told her that the reason she was able to have her two year old and 16 year old was because the fertilized egg implanted in a good spot in her uterus. “The two miscarriages must have implanted in the septum part and didn’t receive adequate blood flow to grow,” Saia shares. 

Pregnancy can be normal if an egg attaches to the main uterine wall, but if it attaches to the septum which has little blood flow, there isn’t much of a nutritional source. Second trimester miscarriage can often happen with a septate uterus, but surgery to remove the septum can increase the likelihood of carrying a baby closer to term. Cassidy is expecting her rainbow baby in August, and receives anatomy scans every four weeks to ensure her baby is doing well. 


Unicornuate Uterus

In a unicornuate uterus, only one half of the uterus forms, and thus, the uterus is only half the size of a regular one. There is an initial risk of ectopic pregnancy with unicornuate uteri. Cesarean sections are often recommended due to the baby lying in a difficult position.


Bicornuate Uterus

Bicornuate uteri are heart shaped and have two conjoined cavities whereas a typical uterus has only one cavity. The biggest risk factor is preterm labor as the baby tends to run out of room to grow due to the dip in the top of the uterus. Local mom Melissa Midkiff shares that she first learned about her bicornuate uterus during her first pregnancy. She has since delivered four children and had one miscarriage. “All of my children were delivered via c-section due to being breech. Once the babies got larger, they seemed to settle in breech on the right side,” she explains. 


Didelphic Uterus

A Bangladeshi woman recently made headlines after she gave birth to twins only a month after delivering her baby boy, and all of her babies were born healthy. An ultrasound can typically discover a didelphic uterus, but because she was from a rural area, she never knew about the dual pregnancies. In extremely rare occasions, a woman can have a double or didelphic uterus, and sometimes even a double cervix and/or vagina. 

Risks to baby can vary from not having any issues throughout pregnancy to having recurrent second trimester miscarriages, depending on if the egg is implanted in the underdeveloped uterus. 

“Most uterine abnormalities tend to carry some of the same risk factors,” says Dr. Dickerson, “They can all increase the likelihood of a breech birth, and raise the risk for a preterm delivery since the uterus doesn’t expand or get tighter in the same way.”


Mom Shares

“Every time I delivered, they would bring in students. We always joked, and said, ‘Come on in, the more the merrier. Come see the heart-shaped uterus!’” –Melissa Midkiff