Reproductive outcomes in women with congenital uterine anomalies: a systematic review
Open accessAbstract
OBJECTIVE: Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes. METHODS: Searches were performed using MEDLINE, EMBASE, the Cochrane Library and Web of Science. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate and subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using random effects models. RESULTS: We identified nine studies comprising 3805 women. Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33-4.27, P = 0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54-4.18; P < 0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77-0.96; P = 0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02-4.14; P < 0.001), preterm birth (RR, 2.14; 95% CI, 1.48-3.11; P < 0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05-9.62; P < 0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08-4.23; P < 0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42-6.18; P < 0.001). CONCLUSIONS: Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects reduces fertility but some are associated with miscarriage and preterm delivery. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery.
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Any association between caffeine and miscarriage is likely to be confounded by the fact that a healthy pregnancy is associated with nausea and vomiting, which in turn may reduce caffeine consumption.
“Furthermore, any association between caffeine and miscarriage is likely to be confounded by the fact that a healthy pregnancy is associated with nausea and vomiting (due to pregnancy hormones), which in turn may reduce caffeine consumption. 72”
From Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss (2021) · cites this paper as [72]
The First-trimester miscarriage and Discussion passages address miscarriage in relation to congenital uterine anomalies, not caffeine intake. Searches of our copy for caffeine consumption and nausea and vomiting found no passage addressing the proposed confounding mechanism. (LLM, conf=0.76)
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- Authors
- Chan, Y. Y., Jayaprakasan, K., Tan, A., Thornton, J. G., Coomarasamy, A., & Raine‐Fenning, N. J.
- Affiliations
- Nottingham University Hospitals NHS Trust (GB)
- University of Nottingham (GB)
- Birmingham Women's Hospital (GB)
- Corresponding author
- Chan, Y. Y.
- Venue
- Ultrasound in Obstetrics & Gynecology
- Publisher
- Wiley
- Published
- 2011-09-20
- Volume
- 38
- Issue
- 4
- Pages
- 371-382
- ISSN
- 0960-7692 (ISSN-L)
- 1469-0705
- OpenAlex
- W2147813481
- Cited by
- 564
- References
- 65
- Citations by year
- 2026: 22 · 2025: 35 · 2024: 46 · 2023: 53 · 2022: 41 · 2021: 65 · 2020: 70 · 2019: 31 · 2018: 29 · 2017: 46 · 2016: 40 · 2015: 26 · 2014: 32 · 2013: 19 · 2012: 5
- FWCI
- 3.25
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Ultrasound in Obstetrics and Gynecology (publishedVersion)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion)
- Topics
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Life Sciences › Immunology and Microbiology › Immunology › Reproductive System and Pregnancy
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Reproductive Health and Contraception
- Keywords
- congenital uterine anomalies, reproductive outcomes, arcuate uterus, septate uterus, subseptate uterus, unicornuate uterus, bicornuate uterus, uterus didelphys, miscarriage, preterm birth, fetal malpresentation, clinical pregnancy rate, fertility, reproductive endocrinology, infertility, pregnancy complications
- MeSH terms
- Abortion, Spontaneous, Female, Fertility, Humans, Labor Presentation, Pregnancy, Pregnancy Outcome, Risk Factors, Uterine Diseases, Uterus, Meta-Analysis as Topic, Premature Birth
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