Abstract
Congenital uterine anomalies (CUA) may influence reproductive performance, resulting in adverse pregnancy associated complications. This study aimed to assess the association of CUA subtypes with reproductive, obstetric, and perinatal outcomes. We performed a systematic search of the MEDLINE, EMBASE, and Cochrane libraries for studies comparing pregnancy outcomes between women with CUA and those with a normal uterus. The random effects model was used to estimate the odds ratios (ORs) with a 95% confidence interval (CI). Women with CUA had a lower rate of live births (OR 0.47; 95% CI 0.33–0.69), and a higher rate of first trimester miscarriage (OR, 1.79; 95% CI, 1.34–2.4), second trimester miscarriage (OR 2.92; 95% CI 1.35–6.32), preterm birth (OR 2.98; 95% CI 2.43–3.65), malpresentation (OR 9.1; 95% CI 5.88–14.08), cesarean section (OR 2.87; 95% CI 1.56–5.26), and placental abruption (OR 3.12; 95% CI 1.58–6.18). Women with canalization defects appear to have the poorest reproductive performance during early pregnancy. However, unification defects were associated with obstetric and neonatal outcomes throughout the course of pregnancy. It may be beneficial for clinicians to advise on potential complications that may be increased depending on the type and severity of CUA.
Highlights
The prevalence of congenital uterine anomalies (CUA) varies significantly, with reports ranging from 0.06 to 38% [1,2,3,4,5,6,7,8]
The classification system used in each study to define the subtypes of CUA was inconsistent, but approximately half of the included studies used the classification of the American Fertility Society (AFS)
Based on the results of this meta-analysis, the presence of CUA has a negative impact on most pregnancy outcomes, further supporting the theory of inadequate implantation, fetal development, and pregnancy maintenance in CUA
Summary
The prevalence of congenital uterine anomalies (CUA) varies significantly, with reports ranging from 0.06 to 38% [1,2,3,4,5,6,7,8]. As medical attention starts with dysfunction (such as miscarriage or infertility), most studies have reported an increased prevalence of CUA in patients with reproductive problems. The female reproductive tract differentiates from two Müllerian ducts, which develop within the first six weeks of fetal life [9,10]. Normal development of the female reproductive tract occurs through multistep processes, such as differentiation, migration, fusion, and subsequent absorption of the Müllerian system [11]. Depending on the failure of organogenesis and varying degrees of fusion or absorption defects, CUA can be divided into unification defects of the Müllerian ducts (unicornuate, bicornuate, or didelphys uterus) and canalization defects from incomplete resorption of the midline septum (subseptate or septate uterus) [15]
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