Reproductive Outcome in Women with Congenital Uterine Anomalies

Abstract

Background:  Mullerian duct malformations delineate a group of congenital anomalies that result from arres-ted development, or incomplete fusion of the mesone-phric ducts. In many patients, uterine anomalies have been related with infertility, recurrent pregnancy loss, prematurity and other obstetric complications which increase perinatal morbidity and mortality rates, where as in others these malformations are asymptomatic and have normal reproductive performance.

Purpose:  To determine the reproductive outcome in women with congenital uterine anomalies.

Design:  Descriptive cross sectional survey.

Main Outcome Measures:  Miscarriages, Preterm delivery, Ecotpic pregnancy, Term delivery.

Material and Methods:  A total of 1600 infertile women in the age group of 25 - 35 years were rec-ruited in the outpatient department of Gynae and Obs-tetrics in Sharif Medical City Hospital from June, 2008 to June, 2009. The patients included in study were the women presenting with either primary or secondary infertility, bad obstetrical history, recurrent miscar-riage, preterm deliveries, and ectopic pregnancies. Combined finding of trans-vaginal ultrasonography and hysterosalpingography were used to diagnose con-genital uterine anomalies. 48 women were diagnosed with congenital uterine anomalies. Eight patients of primary infertility with uterine anomalies were excluded. The retrospective analysis of 40 cases with secon-dary infertility and uterine anomalies was done for reproductive performance.

Results:  Among 1600 infertile women, the average age of the study group was 30 years ± SD 4.77. Forty eight patients were diagnosed with congenital uterine abnormalities. Among infertile population the most frequent uterine anomalies was bicornuate uterus (45.83%) followed by arcuate uterus (33.33%). The overall frequency of congenital uterine anomalies was 3%. Women with secondary infertility (83.3%) had higher frequency of mullerian duct anomalies in com-parison to women with primary infertility (16.7%). In all these abnormalities, miscarriages (25%) and pre-term delivery (22.5%) were quite common. (P<.0750). The reproductive potential of the bicornuate uterus showed a live birth rate of (67%) and, arcuate uterus of (42.8%). Unicornuate and Septate uterus were associ-ated with poor obstetrical outcome.

Conclusion:  Congenital uterine anomalies are rela-tively frequent among infertile population and are associated with higher miscarriages and preterm births but may be compatible with normal reproductive out-come.

Key Words:  Uterine anomalies, preterm birth, mis-carriages.