Adverse Pregnancy Outcomes in Patients with Congenital Uterine Anomalies: Evaluation of a Population Dataset

ABSTRACT

Objective

This study aimed to characterize the risk of adverse pregnancy outcomes among patients with congenital uterine anomalies (CUA) using electronic health record data.

Study Design

Retrospective cohort study utilizing the TriNetX analytics research network, including female patients aged 10 to 55 with a documented singleton and intrauterine pregnancy.

Results

A total of 561,440 patients met inclusion criteria, of whom 3,381 (0.6%) had one or more International Classification of Diseases (ICD) encounter diagnosis codes for CUA. Compared with patients with no documented ICD encounter diagnosis of CUA, patients with CUA had lower rates of live birth (odds ratio [OR]: 0.36, 95% confidence interval [CI]: 0.33–0.38). CUA patients had higher rates of preterm labor (OR: 1.41, 95% CI: 1.20–1.65), fetal malpresentation (OR: 2.48, 95% CI: 2.16–2.85), and postpartum hemorrhage (OR: 1.54, 95% CI: 1.31–1.80). Severe maternal morbidity (SMM) was increased in patients with CUA, including for hysterectomy (OR: 3.41, 95% CI: 1.26–9.17) and acute renal failure (OR: 1.97, 95% CI: 1.08–3.57).

Conclusion

Patients with CUA are at higher risk of adverse pregnancy outcomes compared with patients with normal uterine anatomy, including for SMM and postpartum complications. These patients should be counseled about these possible risks, and CUA should be incorporated into risk-stratification and prevention strategies.

Key Points

• Adversary pregnancy outcomes are higher with CUAs.

• CUA patients have higher risk of preterm delivery.

• CUAs are linked to higher rates of fetal malpresentation.

• Markers of SMM increased in patients with CUA.

• Enhanced screening and high-risk delivery care are encouraged.

Keywords

congenital uterine anomalies - Mullerian anomalies - severe maternal morbidity - adverse pregnancy outcomes - spontaneous abortion - intrauterine fetal demise - malpresentation

Note

This study was presented as a poster presentation at the Society of Maternal Fetal Medicine Annual Pregnancy Meeting, February 10–14, 2024, National Harbor, MD.

Publication History

Received: 03 April 2025

Accepted: 13 August 2025

Article published online:
08 September 2025

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