Association of a unicornuate uterus with adverse obstetric outcomes: A retrospective cohort study

Abstract

Objective: To estimate the association of unicornuate uterus (UU) with adverse obstetric outcomes. Methods: Using data from 26 737 singleton childbirths from a tertiary hospital from 1999 to 2019, we identified 44 births from women with a UU. A total of 367 births from women with a normal uterus were randomly selected as controls. The outcome measures were preterm birth (PTB), breech presentation, and cesarean delivery. The subdivisions of PTB and indications for cesarean delivery were described. Results: The presence of UU was associated with an increased risk of PTB (adjusted risk ratio [aRR], 2.3; 95% confidence interval [CI], 1.1-4.9), breech presentation (aRR, 6.2; 95% CI, 2.9-13.2), and cesarean delivery (aRR, 2.1; 95% CI, 1.8-2.7). For women with a UU, most PTBs (7/9) were moderate to late PTBs, and approximately half of the PTBs (4/9) were iatrogenic due to preeclampsia (PE). Breech presentation, PE, and prior surgery for rudimentary horn resection were UU-related indications for cesarean delivery. Conclusions: Women with a UU have a higher risk of PTB, breech presentation, and cesarean delivery. Understanding of the subdivisions of PTBs and indications for cesarean delivery might help clinicians when counseling women with pregnancy complicated by a UU.

Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis

“…Combined PROM-PPROM risk was increased in patients with CUA (OR:1.71; 95%CI:1.34-2.18; 9 studies; I2:65%) ( Table SIII ; Figure S5 ), specifically with bicornuate uterus (OR:1.79; 95%CI: 1.37- 2.33; 2 studies; I2: 0%). No effect was detected for unicornuate uterus (OR:0.46; 95%CI:0.18-1.21, 1 study) ( Lu et al, 2021 ) ( Table SIII ; Figure S6 ).…”

“…From these, 6461 were screened by title and 328 by title and abstract. A final subset of 78 studies were full-text evaluated ( Figure 1 ), of which 32 ( Ban-Frangez et al, 2009 ; Ben-Rafael et al, 1991 ; Cahen-Peretz et al, 2017 ; Cai et al, 2021 ; Cooney et al, 1998 ; Crane et al, 2012 ; Chen et al, 2018 ; Chen et al, 2019 ; Erez et al, 2007 ; Hiersch et al, 2016 ; Hua et al, 2011 ; Jayaprakasan et al, 2011 ; Kong et al, 2021 ; Leible et al, 1998 ; Li et al, 2017 ; Lu et al, 2021 ; Marianna et al, 2022 ; Mastrolia et al, 2017 ; Mastrolia et al, 2018 ; Ouyang et al, 2020 ; Ozgur et al, 2017 ; Pleş et al, 2018 ; Prior et al, 2018 ; Qiu et al, 2022 ; Saravelos et al, 2010 ; Sugiura-Ogasawara et al, 2010 ; Surrey et al, 2018 ; Takami et al, 2014 ; Tomaževič et al, 2010 ; Zambrotta et al, 2021 ; Zlopasa et al, 2007 ) fulfilled inclusion criteria ( Table SI ). Scores granted by Newcastle-Ottawa Score and quality assessment using AHRQ standards are presented in Appendix 2 .…”

“…Twelve of the studies selected by Kim et al ( 2021 ) were not included in our meta-analysis: one was published out of time limits ( Forde et al, 1978 ) while the other eleven did not achieve the minimum score on the AHRQ-adapted NOS scale ( Acién, 1993 ; Fox et al, 2014 ; Liang and Hu, 2010 ; Maneschi et al, 1995 ; Neal et al, 2019 ; Ravasia et al, 1999 ; Shuiqing et al, 2002 ; Sorensen and Trauelsen, 1987 ; Woelfer et al, 2001 ; Zhang et al, 2010 ; Zupi et al, 1996 ). Our meta-analysis includes seven studies not considered by Kim et al ( 2021 ) ( Cai et al, 2021 ; Crane et al, 2012 ; Chen et al, 2018 ; Lu et al, 2021 ; Marianna et al, 2022 ; Qiu et al, 2022 ; Surrey et al, 2018 ).…”