Congenital Uterine Anomalies in Pregnancy

Abstract

Congenital uterine, renal, and urologic anomalies arise from abnormalities during embryologic development. Congenital uterine anomalies encompass a spectrum of anomalies ranging from uterovaginal hypoplasia to arcuate uterus. While many cases are asymptomatic, some are associated with adverse reproductive outcomes which may warrant surgical management. Unicornuate, bicornuate, didelphic, and septate uteri are associated with poor obstetrical outcomes such as recurrent pregnancy loss, intrauterine growth restriction, preterm delivery, fetal malpresentation, and rudimentary horn pregnancy with subsequent uterine rupture. While surgery has not been found to improve pregnancy outcomes in women with unicornuate and didelphic uteri, uterine reunification procedures can be effective for increasing rates of fetal survival in select anomalies. Hysteroscopic septum resection is the most popular intervention for septate uterus with favorable outcomes in the setting of infertility or recurrent pregnancy loss. Jones and Tompkins metroplasties are also acceptable techniques for septum resection but less commonly utilized. Surgery is primarily reserved for patients who are symptomatic or at risk for poor reproductive outcomes. Prior to surgery for non-obstetric indications, women with uterine anomalies should be evaluated for the presence of associated renal abnormalities, ovarian maldescent, and endometriosis, as clinically indicated to aid in surgical planning.