Obstetric outcomes in women with mullerian duct malformations

Padmasri Ramalingappa, Urvashi Bhatara, Jayashree Seeri, Priyadarshini Bolarigowda


Background: Congenital uterine anomalies are associated with the highest incidence of reproductive failure and obstetric complications. This study aims to summarize the clinical characteristics and prenatal outcome of pregnancy in women with congenital uterine malformations.

Methods: This retrospective study evaluates the obstetric outcome of 24 in patients with uterine malformations with pregnancy in Sapthagiri Hospital from August 2010 to August 2013. A total of 60 randomly selected pregnant women with a previously confirmed normally shaped uterus were taken as a control group.

Results: A total of 2595 women were admitted for various obstetric reasons during August 2010-2013 (period of 3 years). Of them 24 cases had uterine anomaly, the rate of anomaly being 9.2 per 1000 pregnant women. A bicornuate uterus was present in 7 (29%) septate uterus in 6 (25%) arcuate in 5 (20.8%), and unicornuate with rudimentary horn in 2 (8.4%). Unicornuate uterus without rudimentary horn in 1 (4.2%) and uterus didelphys in 1 (4.2%). Transverse vaginal septum was seen in 2 (8.4%) patients. The rate of malpresentation was high in uterus didelphys, arcuate and bicornuate uterus. Abortion rates were equal in both septate and bicornuate uterus. A comparison of mode of presentation and termination of pregnancy is illustrated. Preterm deliveries (33.4%) and miscarriage rates (20.8%) were more common compared to controls. Less than half the women (45.8%) had term deliveries compared to controls where pregnancies which reached term were 86.7%. An assessment of mode of delivery, termination, period of gestation at delivery and birth weight between study group and control group is given.

Conclusions: Women with congenital uterine malformation usually have higher incidence of complications during pregnancy and delivery. Early diagnosis and treatment can improve obstetric outcomes.


Congenital, Mullerian anomalies, Obstetric outcome

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Moore KL, Persaud TVN, Torchia MG. The Urogenital System. The Developing Human, Clinically Oriented Embryology. 9th ed. Philadelphia: Saunders/Elsevier; 2013; 245-287.

Saravelos SH, Cocksedge KA, Li T-C. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update. 2008;14:415-9.

Grimbizis GF, Campo R. Congenital malformations of the female genital tract: the need for a new classification system. Fertil Steril. 2010;94:401-7.

Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C, Pellicer A. Reproductive impact of congenital Mullerian anomalies. Hum Reprod. 1997;12:2277-81.

American Fertility Society. The AFS classification of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, Mullerian anomalies and intrauterine adhesions. Fertil Steril. 1998;49:944-55.

Acien P, Acien MI. The history of female genital tract malformation classifications and proposal of an updated system. Hum Reprod Update. 2011;17:693-705.

Oppelt P, Renner SP, Brucker S, Strissel PL, Strick R, Oppelt PG. The VCUAM (Vagina Cervix Uterus Adnex Associated Malformation) Classification: a new classification for genital malformations. Fertil Steril. 2005;84:1493-7.

Grimbizis GF, Gordts S, Sardo AS, Brucker S, Angelis C, Gergolet M. The ESHRE-ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 2013;10:199-212.

Guimaraes Filho HA, Mattar R, Pires CR, Araujo E Jr, Moron AF, Nardozza LM. Comparison of hysterosalpingography, hysterosonography and hysteroscopy in evaluation of the uterine cavity in patients with recurrent pregnancy losses. Arch Gynecol Obstet. 2006;274:284-8.

Airoldi J, Berghella V, Sehdev H, Ludmir J. Transvaginal ultrasonography of the cervix to predict preterm birth in women with uterine anomalies. Obstet Gynecol. 2005;106:553-6.

Dabirashrafi H, Bahadori M, Mohammad K, Alavi M, Moghadami-Tabrizi N, Zandinejad K, Ghafari V. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol. 1995;172:105-7.

Puscheck EE, Cohen L. Congenital malformations of the uterus: the role of ultrasound. Semin Reprod Med. 2008;26:223-31.

Fakhrolmolouk Yassaee, Leila Mostafaee. The Role of Cervical Cerclage in Pregnancy Outcome in Women with Uterine Anomaly. J Reprod Infertil. 2011;12(4):277-9.

Lin PC. Reproductive outcomes in women with uterine anomalies. J Womens Health. 2004;13(1):33-9.

Raga F, Bonilla-Musoles F, Blanes J, Osborne NG. Congenital mullerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertil Steril. 1996;65:523.

Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D. Scholar search Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol. 2001;98(6):1099-103.

Maneschi F, Zupi E, Marconi D, Valli E, Romanini C, Mancuso S. Hysteroscopically detected asymptomatic müllerian anomalies. Prevalence and reproductive implications. J Reprod Med. 1995;40(10):684-8.

Sugiura-Ogasawara M, Ozaki Y, Suzumori N. Müllerian anomalies and recurrent miscarriage. Curr Opin Obstet Gynecol. 2013;25(4):293-8.

Shuiqing M, Xuming B, Jinghe L. Pregnancy and its outcome in women with malformed uterus. Chin. Med Sci J. 2002;17(4):242-5.

Ezquerra BR, Hernández CB, Dodorico GL, Vicén TC. Twin pregnancy in a bicornuate uterus. Ginecol Obstet Mex. 2012;80(11):725-8.

Agu PU, Okaro JM, Mbagwu UK, Obi SN, Ugwu EO. Spontaneous rupture of gravid horn of bicornuate uterus at mid trimester--a case report. Niger J Med. 2012;21(1):106-7.

Banu J, Fatima P, Sultana P, Begum N, Anwary SA, Chowdhury MA. A successful pregnancy outcome following abdominal metroplasty. Mymensingh Med J. 2013;22(4):848-51.

Martı́nez-Frı́as M, Bermejo E, Pinilla E, Frı́as JL. Congenital Anomalies in the Offspring of Mothers with a Bicornuate Uterus. Pediatrics. 1998;101(4):1-3.

Li S, Qayyum A, Coakley FV, Hricak H. Association of renal agenesis and mullerian duct anomalies. J Comput Assist Tomogr. 2000;24(6):829-34.

Oppelt P, von Have M, Paulsen M, Strissel P, Strick R, Brucker S et al. Female genital malformations and their associated abnormalities. Fertil Steril. 2007;87:335-42.

Ghi T, Casadio P, Kuleva M, Perrone AM, Savelli L, Giunchi S et al. Accuracy of three-dimensional ultrasound in diagnosis and classification of congenital uterine anomalies. Fertil Steril. 2009;92(2):808-13.

Bermejo C, Martínez TP, Cantarero R, Diaz D, Pedregosa PJ, Barrón E et al. Three-dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol. 2010;35(5):593-601.

Ghi T, De Musso F, Maroni E, Youssef A, Savelli L, Farina A et al. The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan. Hum Reprod. 2012;27(9):2671-5.

Kaplanoğlu M. The uterine sandwich method for placenta previa accreta in mullerian anomaly: combining the B-lynch compression suture and an intrauterine gauze tampon. Case Rep Obstet Gynecol. 2013;2013:236069.

Fedele L, Bianchi S, Marchini M, Franchi D, Tozzi L, Dorta M. Ultrastructural aspects of endometrium in infertile women with septate uterus. Fertil Steril. 1996;65(4):750-2.

Kupesic S. Clinical implications of sonographic detection of uterine anomalies for reproductive outcome. Ultrasound Obstet Gynecol. 2001;18(4):387-400.

Sparac V, Kupesic S, Ilijas M, Zodan T, Kurjak A. Histologic architecture and vascularization of hysteroscopically excised intrauterine septa. J Am Assoc Gynecol Laparosc. 2001;8(1):111-6.

Bettocchi S, Ceci O, Nappi L, Pontrelli G, Pinto L, Vicino M. Office hysteroscopic metroplasty: three diagnostic criteria to differentiate between septate and bicornuate uteri. J Minim Invasive Gynecol. 2007;14(3):324-8.

Faivre E, Fernandez H, Deffieux X, Gervaise A, Frydman R, Levaillant JM. Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging. J Minim Invasive Gynecol. 2012;19(1):101-6.

Deutch TD, Abuhamad AZ. The role of 3-dimensional ultrasonography and magnetic resonance imaging in the diagnosis of müllerian duct anomalies: a review of the literature. J Ultrasound Med. 2008;27(3):413-23.

Salim R, Woelfer B, Backos M, Regan L, Jurkovic D. Reproducibility of three-dimensional ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol. 2003;21(6):578-82.