The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage

Abstract

Congenital uterine anomalies (CUA) are a known cause of recurrent miscarriage (RM), but the pattern of pregnancy loss that different CUA produce remains unknown. This study included 665 women with RM who were screened for CUA using a combined two-dimensional ultrasound (2D-US) and hysterosalpingography (HSG) approach. All suspected CUA were definitively diagnosed and classified via a combined hysteroscopy/laparoscopy procedure. Pregnancy outcomes were evaluated and compared for each type of CUA versus a control group of women with no identifiable cause of RM (unexplained RM). Fifty-six women with CUA and 107 women with unexplained RM were identified. In total, 881 pregnancies were analysed. Analysis showed that women with a septate or bicornuate uterus suffered from significantly increased second-trimester miscarriages compared with controls (13.2% and 13.8% versus 1.0%; P<0.001 and P<0.05, respectively). Women with an arcuate, septate or bicornuate uterus showed significantly reduced rates of biochemical pregnancy losses compared with controls (9.5%, 11.1% and 11.1% versus 30.4%; P<0.01, P<0.01 and P<0.05, respectively). Pregnancies of women with RM and CUA are not associated with early implantation failure and are compromised at a more advanced gestational age.

The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review

“…However, most studies did not provide clear data as to whether miscarriage occurred during the first or second trimester, and the studies differ in the pattern of miscarriage, including consecutive and non-consecutive miscarriage, and in the number of previous miscarriages. It is important to note that most of the studies included in this current review investigated women with two or more miscarriages (Raga et al ., 1997; Weiss et al ., 2005; Guimaraes Filho et al ., 2006a, b; Dendrinos et al ., 2008; Ghi et al ., 2009; Bohlmann et al ., 2010; Saravelos et al ., 2010) and the results are not, therefore, necessarily directly applicable to women with a single previous miscarriage or those with a previous live birth (a factor that could not be assessed as it was not reported as a separate group by any author). The prevalence of congenital uterine anomalies in women with two or more miscarriages appears to be similar to those with three or more miscarriages, regardless of the diagnostic test used.…”

Perinatal outcomes in singleton and twin ICSI pregnancies following hysteroscopic correction of partial intrauterine septa

“…From a previous study [21], we know that the majority of pregnancy losses in women who had intrauterine septa, and who suffered from recurrent miscarriage, occurred in the mid to late 1st trimester and early 2nd trimester of pregnancy. The data from our study corroborate these findings as the vast majority of losses appeared to occur between 7and 21 weeks The rates were calculated as per confirmed pregnancy or delivery, groups were statistically compared using calculated risk ratios, independent samples t test for means and Fisher's exact test and Chi square test for percentages, p<0.05 being significant *The number of patient cycles with a delivery after 20 gestation weeks 1 Preterm delivery was defined as a delivery of a live infant prior to 37 weeks and very preterm as a delivery prior to 32 weeks (86,8-87,5 %) in both the control and septum singleton pregnancies.…”

Diagnosis and Management of Congenital Uterine Anomalies in Pregnancy

“…[34][35][36] However, 2D ultrasound has a sensitivity of only 60% in identifying uterine anomalies. 37 Saline infusion sonohysterography is also a useful tool for evaluation of the uterine cavity, although less readily available than 2D ultrasound. One comparative study evaluated 83 women with a history of recurrent spontaneous abortion or infertility with an initial diagnosis of uterine anomaly, each of whom underwent SIS, HSG, and diagnostic hysteroscopy.…”