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

Zoe O. Silsby; Jessica Abou Zeki; Anna Swensen; Stephen Rhodes; David C. Kaelber; David Sheyn; Justin R. Lappen

doi:10.1055/a-2682-6137

American Journal of Perinatology, Table of Contents

Am J Perinatol
DOI: 10.1055/a-2682-6137

Original Article

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

Authors

Zoe O. Silsby

¹Case Western Reserve University School of Medicine, Cleveland, Ohio, United States

²Department of Obstetrics and Gynecology, Inova Fairfax Hospital, Fairfax, Virginia, United States
Jessica Abou Zeki

³Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
Anna Swensen

¹Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
Stephen Rhodes

³Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
David C. Kaelber

⁴Departments of Internal Medicine, Pediatrics, and Population and Quantitative Health Sciences, Case Western Reserve University, Cleveland, Ohio, United States

⁵The Center for Clinical Informatics Research and Education, The MetroHealth System, Cleveland, Ohio, United States
David Sheyn

³Department of Urology, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
Justin R. Lappen

⁶Division of Maternal and Fetal Medicine, OB/GYN and Women's Health Institute, Cleveland Clinic, Cleveland, Ohio, United States

Abstract

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

Full Text

References

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