Download PDF
Semin Reprod Med 2011; 29(6): 514-521
DOI: 10.1055/s-0031-1293205
© Thieme Medical Publishers

Uterine Anomaly and Recurrent Pregnancy Loss

Mayumi Sugiura-Ogasawara1 , Yasuhiko Ozaki1 , Kinue Katano1 , Nobuhiro Suzumori1 , Eita Mizutani1
  • 1Department of Obstetrics and Gynecology, Nagoya City University, Graduate School of Medical Sciences, Nagoya, Japan
Further Information

Publication History

Publication Date:
08 December 2011 (online)

    Permissions and Reprints

ABSTRACT

Women with recurrent pregnancy loss have a 3.2 to 6.9% likelihood of having a major uterine anomaly and a 1.0 to 16.9% chance of having an arcuate uterus. Bicornuate and septate uterine have a negative impact on reproductive outcomes and are associated with subsequent euploid miscarriage. The impact of an arcuate uterus on pregnancy outcome remains unclear. There are no definitive criteria to distinguish among the arcuate, septate, and bicornuate uteri. The American Fertility Society classification of Müllerian anomalies is the most common standardized classification of uterine anomalies. According to estimates, 65 to 85% of patients with bicornuate or septate uteri have a successful pregnancy outcome after metroplasty. However, 59.5% of the patients with such anomalies have a successful subsequent pregnancy without surgery, with a cumulative live birthrate of 78.0%. There is no case-control study to compare live birthrates in women who had surgery compared with those who did not. Strict criteria to distinguish between the bicornuate and septate uterus should be established. Further study is needed to confirm the benefits of metroplasty.

KEYWORDS

Bicornuate uterus - congenital uterine anomaly - recurrent pregnancy loss - septate uterus

REFERENCES

  • 1 Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, Pellicer A. Reproductive impact of congenital Müllerian anomalies.  Hum Reprod. 1997;  12 (10) 2277-2281
    Google Scholar
  • 2 Makino T, Umeuchi M, Nakada K, Nozawa S, Iizuka R. Incidence of congenital uterine anomalies in repeated reproductive wastage and prognosis for pregnancy after metroplasty.  Int J Fertil. 1992;  37 (3) 167-170
    Google Scholar
  • 3 Sugiura-Ogasawara M, Ozaki Y, Kitaori T, Kumagai K, Suzuki S. Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases.  Fertil Steril. 2010;  93 (6) 1983-1988
    Google Scholar
  • 4 Clifford K, Rai R, Watson H, Regan L. An informative protocol for the investigation of recurrent miscarriage: preliminary experience of 500 consecutive cases.  Hum Reprod. 1994;  9 (7) 1328-1332
    Google Scholar
  • 5 Acién P. Incidence of Müllerian defects in fertile and infertile women.  Hum Reprod. 1997;  12 (7) 1372-1376
    Google Scholar
  • 6 Salim R, Regan L, Woelfer B, Backos M, Jurkovic D. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage.  Hum Reprod. 2003;  18 (1) 162-166
    Google Scholar
  • 7 The American Fertility Society . The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions.  Fertil Steril. 1988;  49 (6) 944-955
    Google Scholar
  • 8 Ruge P. Pregnancy in cases of uterus septus.  Ztschr f Geburtsh u Gynak. 1884;  10 141
    Google Scholar
  • 9 Strassmann P. Die operative vereinigung eines doppelten uterus.  Zentralbl Gynakol. 1907;  31 1322
    Google Scholar
  • 10 Jones Jr H W, Jones G E. Double uterus as an etiological factor in repeated abortion: indications for surgical repair.  Am J Obstet Gynecol. 1953;  65 (2) 325-339
    Google Scholar
  • 11 Candiani G B, Fedele L, Parazzini F, Zamberletti D. Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis.  Br J Obstet Gynaecol. 1990;  97 (7) 613-617
    Google Scholar
  • 12 Ayhan A, Yücel I, Tuncer Z S, Kişnişçi H A. Reproductive performance after conventional metroplasty: an evaluation of 102 cases.  Fertil Steril. 1992;  57 (6) 1194-1196
    Google Scholar
  • 13 Chervenak F A, Neuwirth R S. Hysteroscopic resection of the uterine septum.  Am J Obstet Gynecol. 1981;  141 (3) 351-353
    Google Scholar
  • 14 Goldenberg M, Sivan E, Sharabi Z, Mashiach S, Lipitz S, Seidman D S. Reproductive outcome following hysteroscopic management of intrauterine septum and adhesions.  Hum Reprod. 1995;  10 (10) 2663-2665
    Google Scholar
  • 15 DeCherney A H, Russell J B, Graebe R A, Polan M L. Resectoscopic management of müllerian fusion defects.  Fertil Steril. 1986;  45 (5) 726-728
    Google Scholar
  • 16 Daly D C, Maier D, Soto-Albors C. Hysteroscopic metroplasty: six years' experience.  Obstet Gynecol. 1989;  73 (2) 201-205
    Google Scholar
  • 17 Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P. Hysteroscopic septum resection in patients with recurrent abortions or infertility.  Hum Reprod. 1998;  13 (5) 1188-1193
    Google Scholar
  • 18 Hickok L R. Hysteroscopic treatment of the uterine septum: a clinician's experience.  Am J Obstet Gynecol. 2000;  182 (6) 1414-1420
    Google Scholar
  • 19 Patton P E, Novy M J, Lee D M, Hickok L R. The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum.  Am J Obstet Gynecol. 2004;  190 (6) 1669-1675; discussion 1675–1678
    Google Scholar
  • 20 Kormányos Z, Molnár B G, Pál A. Removal of a residual portion of a uterine septum in women of advanced reproductive age: obstetric outcome.  Hum Reprod. 2006;  21 (4) 1047-1051
    Google Scholar
  • 21 Letterie G S. Structural Abnormalities and Reproductive Failure: Effective Techniques of Diagnosis and Management. New York, NY: Blackwell Science; 1998
    Google Scholar
  • 22 Braun P, Grau F V, Pons R M, Enguix D P. Is hysterosalpingography able to diagnose all uterine malformations correctly? A retrospective study.  Eur J Radiol. 2005;  53 (2) 274-279
    Google Scholar
  • 23 Devi Wold A S, Pham N, Arici A. Anatomic factors in recurrent pregnancy loss.  Semin Reprod Med. 2006;  24 (1) 25-32
    Google Scholar
  • 24 Buttram Jr V C, Gibbons W E. Müllerian anomalies: a proposed classification. (An analysis of 144 cases).  Fertil Steril. 1979;  32 (1) 40-46
    Google Scholar
  • 25 Strassmann E O. Plastic unification of double uterus; a study of 123 collected and five personal cases.  Am J Obstet Gynecol. 1952;  64 (1) 25-37
    Google Scholar
  • 26 Troiano R N, McCarthy S M. Mullerian duct anomalies: imaging and clinical issues.  Radiology. 2004;  233 (1) 19-34
    Google Scholar
  • 27 Tompkins P. Comments on the bicornuate uterus and twinning.  Surg Clin North Am. 1962;  42 1049-1062
    Google Scholar
  • 28 Perrot N, Frey I, Bigot J M. Ultrasono-hysterography: techniques and indications. [in French].  J Radiol. 1996;  77 (9) 687-690
    Google Scholar
  • 29 Pellerito J S, McCarthy S M, Doyle M B, Glickman M G, DeCherney A H. Diagnosis of uterine anomalies: relative accuracy of MR imaging, endovaginal sonography, and hysterosalpingography.  Radiology. 1992;  183 (3) 795-800
    Google Scholar
  • 30 Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D. Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening.  Obstet Gynecol. 2001;  98 (6) 1099-1103
    Google Scholar
  • 31 Fedele L, Dorta M, Brioschi D, Massari C, Candiani G B. Magnetic resonance evaluation of double uteri.  Obstet Gynecol. 1989;  74 (6) 844-847
    Google Scholar
  • 32 Wu M H, Hsu C C, Huang K E. Detection of congenital müllerian duct anomalies using three-dimensional ultrasound.  J Clin Ultrasound. 1997;  25 (9) 487-492
    Google Scholar
  • 33 Homer H A, Li T C, Cooke I D. The septate uterus: a review of management and reproductive outcome.  Fertil Steril. 2000;  73 (1) 1-14
    Google Scholar
  • 34 Grimbizis G F, Camus M, Tarlatzis B C, Bontis J N, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results.  Hum Reprod Update. 2001;  7 (2) 161-174
    Google Scholar
  • 35 Taylor E, Gomel V. The uterus and fertility.  Fertil Steril. 2008;  89 (1) 1-16
    Google Scholar
  • 36 Saravelos S H, Cocksedge K A, Li T C. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal.  Hum Reprod Update. 2008;  14 (5) 415-429
    Google Scholar
  • 37 Acién P. Reproductive performance of women with uterine malformations.  Hum Reprod. 1993;  8 (1) 122-126
    Google Scholar
  • 38 Stirrat G M. Recurrent miscarriage.  Lancet. 1990;  336 (8716) 673-675
    Google Scholar
  • 39 Lin P C, Bhatnagar K P, Nettleton G S, Nakajima S T. Female genital anomalies affecting reproduction.  Fertil Steril. 2002;  78 (5) 899-915
    Google Scholar
  • 40 Fedele L, Bianchi S. Hysteroscopic metroplasty for septate uterus.  Obstet Gynecol Clin North Am. 1995;  22 (3) 473-489
    Google Scholar
  • 41 Buttram Jr V C. Müllerian anomalies and their management.  Fertil Steril. 1983;  40 (2) 159-163
    Google Scholar
  • 42 Fayez J A. Comparison between abdominal and hysteroscopic metroplasty.  Obstet Gynecol. 1986;  68 (3) 399-403
    Google Scholar
  • 43 Fedele L, Dorta M, Brioschi D, Giudici M N, Candiani G B. Pregnancies in septate uteri: outcome in relation to site of uterine implantation as determined by sonography.  AJR Am J Roentgenol. 1989;  152 (4) 781-784
    Google Scholar
  • 44 Dabirashrafi H, Bahadori M, Mohammad K et al.. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus.  Am J Obstet Gynecol. 1995;  172 (1 Pt 1) 105-107
    Google Scholar
  • 45 Raga F, Casañ E M, Bonilla-Musoles F. Expression of vascular endothelial growth factor receptors in the endometrium of septate uterus.  Fertil Steril. 2009;  92 (3) 1085-1090
    Google Scholar
  • 46 Edstom K. Intrauterine surgical procedures during hysteroscopy.  Endoscopy. 1974;  6 175-181
    Google Scholar
  • 47 Ogasawara M, Aoki K, Okada S, Suzumori K. Embryonic karyotype of abortuses in relation to the number of previous miscarriages.  Fertil Steril. 2000;  73 (2) 300-304
    Google Scholar
  • 48 Sugiura-Ogasawara M, Ozaki Y, Sato T, Suzumori N, Suzumori K. Poor prognosis of recurrent aborters with either maternal or paternal reciprocal translocations.  Fertil Steril. 2004;  81 (2) 367-373
    Google Scholar

Mayumi Sugiura-OgasawaraM.D. Ph.D. 

Nagoya City University, Graduate School of Medical Sciences

Mizuho-ku, Nagoya 4678601, Japan

Email: og.mym@med.nagoya-cu.ac.jp

      >