Pregnancy Outcomes in Women with Incidentally Detected Unicornuate Uteri

Abstract

Objective To estimate the incidence of adverse pregnancy outcomes in women with incidentally detected unicornuate uteri.

Study Design This is a descriptive study. Database review identified patients with unicornuate uteri and singleton pregnancies at ≥12 weeks' gestation. Patients were excluded if the diagnosis of unicornuate uterus was made after a midtrimester loss or preterm delivery. Records were reviewed to obtain clinical outcomes. Chi-square test, Fisher's exact test, and Mann–Whitney U-test were used for statistical analysis.

Results Forty patients with 67 pregnancies were included. Most diagnoses were made during infertility work-up (76.2%). There was one midtrimester loss (1.5%). In the remaining 66 pregnancies, median gestational age at delivery was 38 weeks. There were 20 (30.3%) preterm births, 9 (13.6%) spontaneous preterm births, and 11 (16.7%) indicated preterm births. Women with indicated preterm births were more likely to have placental abnormalities. Of the available placental pathology, 45.2% had histological lesions of malperfusion. Cesarean delivery was performed in 77.3% of cases.

Conclusion Most women with incidentally detected unicornuate uteri gave birth at term. More than half the preterm births were indicated, with relatively high rates of placental abnormalities. In patients without a poor obstetrical history, rates of midtrimester loss and spontaneous preterm birth were lower than previously described.

Keywords

congenital uterine anomaly - incidental - lesions of malperfusion - Mullerian duct anomaly - placental abnormality - pregnancy outcomes - unicornuate uterus

• References

• 1 Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST. Female genital anomalies affecting reproduction. Fertil Steril 2002; 78 (05) 899-915
• 2 Acién P. Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 1997; 12 (07) 1372-1376
• 3 Simón C, Martinez L, Pardo F, Tortajada M, Pellicer A. Müllerian defects in women with normal reproductive outcome. Fertil Steril 1991; 56 (06) 1192-1193
• 4 Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 2011; 17 (06) 761-771
• 5 Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol 2011; 38 (04) 371-382
• 6 Acién P. Reproductive performance of women with uterine malformations. Hum Reprod 1993; 8 (01) 122-126
• 7 Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian duct anomalies. Radiographics 2012; 32 (06) E233-E250
• 8 Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 2011; 205 (06) 558.e1-558.e5
• 9 Fox NS, Roman AS, Stern EM, Gerber RS, Saltzman DH, Rebarber A. Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 2014; 27 (09) 949-953
• 10 Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update 2001; 7 (02) 161-174
• 11 Lekovich J, Stewart J, Anderson S, Niemasik E, Pereira N, Chasen S. Placental malperfusion as a possible mechanism of preterm birth in patients with Müllerian anomalies. J Perinat Med 2017; 45 (01) 45-49
• 12 Donderwinkel PF, Dörr JP, Willemsen WN. The unicornuate uterus: clinical implications. Eur J Obstet Gynecol Reprod Biol 1992; 47 (02) 135-139
• 13 Moutos DM, Damewood MD, Schlaff WD, Rock JA. A comparison of the reproductive outcome between women with a unicornuate uterus and women with a didelphic uterus. Fertil Steril 1992; 58 (01) 88-93
• 14 Ozgur K, Bulut H, Berkkanoglu M, Coetzee K. Reproductive outcomes of IVF patients with unicornuate uteri. Reprod Biomed Online 2017; 34 (03) 312-318
• 15 Golan A, Langer R, Wexler S, Segev E, Niv D, David MP. Cervical cerclage--its role in the pregnant anomalous uterus. Int J Fertil 1990; 35 (03) 164-170
• 16 Yassaee F, Mostafaee L. The role of cervical cerclage in pregnancy outcome in women with uterine anomaly. J Reprod Infertil 2011; 12 (04) 277-279
• 17 Wajntraub G, Milwidsky A, Weiss D. Prevention of premature delivery in a unicornuate uterus by cervical cerclage. Acta Obstet Gynecol Scand 1975; 54 (05) 497-498
• 18 Fenton TR, Kim JH. A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants. BMC Pediatr 2013; 13: 59
• 19 Redline RW, Boyd T, Campbell V. , et al; Society for Pediatric Pathology, Perinatal Section, Maternal Vascular Perfusion Nosology Committee. Maternal vascular underperfusion: nosology and reproducibility of placental reaction patterns. Pediatr Dev Pathol 2004; 7 (03) 237-249
• 20 Redline RW. Placental pathology: a systematic approach with clinical correlations. Placenta 2008; 29 (Suppl A): S86-S91
• 21 Redline RW. Classification of placental lesions. Am J Obstet Gynecol 2015; 213 (4, Suppl): S21-S28
• 22 Żyła MM, Wilczyński J, Nowakowska-Głąb A, Maniecka-Bryła I, Nowakowska D. Pregnancy and delivery in women with uterine malformations. Adv Clin Exp Med 2015; 24 (05) 873-879
• 23 Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online 2014; 29 (06) 665-683
• 24 Takami M, Aoki S, Kurasawa K, Okuda M, Takahashi T, Hirahara F. A classification of congenital uterine anomalies predicting pregnancy outcomes. Acta Obstet Gynecol Scand 2014; 93 (07) 691-697
• 25 Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 2009; 91 (05) 1886-1894
• 26 Chen X, Liu P, Sheng Y. , et al. The impact of unicornuate uterus on perinatal outcomes after IVF/ICSI cycles: a matched retrospective cohort study. J Matern Fetal Neonatal Med 2019; 32 (15) 2469-2474
• 27 Esh-Broder E, Ariel I, Abas-Bashir N, Bdolah Y, Celnikier DH. Placenta accreta is associated with IVF pregnancies: a retrospective chart review. BJOG 2011; 118 (09) 1084-1089
• 28 Fedele L, Zamberletti D, Vercellini P, Dorta M, Candiani GB. Reproductive performance of women with unicornuate uterus. Fertil Steril 1987; 47 (03) 416-419