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Reproductive outcomes in 326 women with unicornuate uterus
Reproductive outcomes in 326 women with unicornuate uterus
REVIEWED BY | Sarah Srayko Robinson ASA SIG: Women’s Health
REFERENCE | Authors: Tellum T, Bracco B, de Braud LV, Knez J, Ashton-Barnett R, Amin T, Chaggar P and Jurkovi D. Journal: Ultrasound in Obstetrics and Gynaecology 2022; eISSN 1469-0705. Open Access: Yes
WHY THE STUDY WAS PERFORMED
To evaluate and compare gynaecological and obstetrical outcomes in women with unicornuate uteri to those with no congenital uterine anomaly.
HOW THE STUDY WAS PERFORMED
This was a single centre, retrospective cohort study of women over 16 years of age presenting with a unicornuate uterus compared to a control group who had a normally shaped uterus. All women were examined using either transvaginal or transrectal ultrasound, using a 4–9 MHz probe with 3D facility. A dynamic 2D transvaginal ultrasound was performed to assess the position and morphological appearances of the pelvic organs. The examination of the uterus included performing a series of parallel transverse sections and a right to left sweep in the longitudinal plane to visualise the endometrium and perform a measurement of its thickness. 3D transvaginal ultrasound volumes of the uterus were also acquired in all women.
WHAT THE STUDY FOUND
Outcomes of the study focused on live birth rate, rates of pregnancy loss, ectopic pregnancy and the proportion of women who suffered recurrent miscarriages. Further outcomes focused on rates of preterm delivery and mode of delivery. Included in the results were findings of women diagnosed with endometriosis, adenomyosis, uterine fibroids, and genitourinary and anorectal tract abnormalities.
Three hundred and twenty-six women were included in the final analysis in addition to 326 matched controls, resulting in a study population of 652 patients. A rudimentary horn was observed in 218/326 women with a unicornuate uterus, with non-functional horns being more common than the functional type. There were a total of 88 vaginal, urinary tract or cloacal abnormalities in 68/326 women with unicornuate uteri, compared to a single abnormality in the control group.
The rate of miscarriage was significantly higher in women with unicornuate uteri compared to the control group, resulting in a significantly lower live birth rate. However, there was no apparent difference in the number of total pregnancies, miscarriages, or miscarriage rates between women with and without a functional rudimentary horn. Another important finding of this study was that having a unicornuate uterus significantly increased the risk of ectopic pregnancy of any type. The number of women diagnosed with endometriosis was significantly higher in women with unicornuate uteri compared to the control group.
The proportion of women who experienced a preterm delivery < 37 weeks was three times higher in the study group compared to the control group, and women with a unicornuate uterus were significantly more likely to require delivery by Caesarean section.
RELEVANCE TO CLINICAL PRACTICE
This study demonstrates that the unicornuate uterus is associated with an increased risk of adverse pregnancy outcomes requiring close monitoring for the duration of the pregnancy. The risk of ectopic pregnancies is increased in all women with unicornuate uteri and ultrasound examinations of pregnant women with a unicornuate uterus should be arranged early in pregnancy. A detailed and systematic examination of uterine morphology should be standard routine in clinical practice to detect unicornuate uteri and expansion of the ultrasound examination to include the urinary tract should be performed when a unicornuate uterus is suspected.
