Abstract
To evaluate the association between congenital uterine anomalies (CUA) and adverse perinatal outcomes stratified by type of anomaly. A retrospective cohort study of all women delivered in one university affiliated medical center between 2010-2017 with CUA. Multiple pregnancies and pregnancies complicated by fetal anomalies were excluded. Arcuate and T-shaped uterus were also excluded as they represent only minimal deviation from the normal anatomy. Maternal and short-term neonatal outcomes were evaluated and compared between women with unification defects (including unicornuate, bicornuate or uterus didelphys), and canalization defects represented by septate uterus. P <0.05 was considered significant. Among 167 pregnancies with CUA, 92 (55.1%) had bicornuate uterus, 32 (19.2%) septate uterus, 26 (15.6%) didelphys uterus and 17 (10.2%) unicornuate uterus. Maternal demographics and obstetric characteristics were similar between women with unification and canalization defects. Rate of adverse pregnancy outcome was high for the entire cohort (Fig 1). There was one case of anterpartum death in the canalization defects group. In comparison to unification defects (unicornuate, bicornate and didelphys uterus), pregnancies in women with canalization defects (septate uterus), had increased risk for preterm delivery <32 weeks (12.5% vs 3%, p=0.02), and placental abruption (12.5% vs. 3%, p=0.02), however, a lower overall rate of cesarean delivery (46.9% vs. 67.4%, p=0.03). There were no differences in neonatal outcomes between the groups. Overall, women with CUA have a high prevalence of adverse pregnancy outcomes. Compared to unification defects, canalization defects represented by septate uterus have a higher rate of PTD <32 weeks and placental abruption, but overall lower rates of CD, probably due to a lower prevalence of malpresentation.View Large Image Figure ViewerDownload Hi-res image Download (PPT)
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