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

ABSTRACT

Background: Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events. Objective: To assess the impact of CUA on reproductive outcomes in pregnancies conceived spontaneously or after assisted reproduction. Materials and Methods: Systematic review and meta-analysis of cohort studies comparing patients with CUA versus women with normal uterus. A structured literature search was performed in leading scientific databases to identify prospective and retrospective studies. The Newcastle-Ottawa scale, adapted to AHRQ standards, was used to assess the risk of bias. Pooled odds ratios (OR) were calculated. Publication bias and statistical heterogeneity were assessed, and meta-regression was used to analyse the heterogeneity. Main outcome measures: Miscarriage, ectopic pregnancy, placental abruption, term, and premature rupture of membranes (PROM), malpresentation at delivery, preterm delivery prior to 37, 34 and 32 weeks, caesarean delivery, intrauterine growth restriction/small for gestational age, foetal mortality and perinatal mortality. Results: 32 studies were included. CUAs increased significantly the risk of first/second trimester miscarriage (OR1.54;95%CI1.14-2.07), placental abruption (OR5.04;3.60-7.04), PROM (OR1.71;1.34-2.18), foetal malpresentation at delivery (OR21.04;10.95-40.44), preterm birth (adjusted OR4.34;3.59-5.21), a caesarean delivery (adjusted OR7.69;4.17-14.29), intrauterine growth restriction/small for gestational age (adjusted OR50;6.11-424), foetal mortality (OR2.07;1.56-2.73) and perinatal mortality (OR3.28;2.01-5.36). Conclusions: CUA increases the risk of complications during pregnancy, delivery, and postpartum. Complications most frequent in CUA patients were preterm delivery, foetal malpresentation, and caesarean delivery. What is new? Bicornuate uterus was associated with the highest number of adverse outcomes, followed by didelphys, subseptate and septate uterus.