Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

In This Article

Bicornuate Uterus

The incidence of bicornuate uterus has historically been the most frequent, although, as stated before, uterine septi and arcuate uteri appear to be the most common.[2] Again, the current literature is limited on the reproductive outcome of bicornuate uterus. One observational study with 56 pregnancies in 26 subjects was found. Preterm deliveries and miscarriage rates are slightly elevated compared with historical controls, 25% and 25%, respectively ( Table 1 ). This is likely directly correlated with the severity of the fundal indentation of the bicornuate uterus.[2] No studies have looked at the impact of such an anomaly on infertility. However, in a subpopulation of infertile subjects (n = 1024), the incidence of bicornuate uterus was not different from that in fertile controls (n = 1289), 0.5% vs. 0.4%, respectively.[2] This suggests that the bicornuate uterus probably does not affect infertility unless recurrent miscarriages are diagnosed or other infertility factors cannot be ruled out.

Surgical reconstruction for the bicornuate uterus can be considered for patients with recurrent miscarriages and no other obvious etiologies although data on improved pregnancy maintenance are limited. In general, live birth rates improve in a selected population from 2%–21% to 60%–86%. The largest retrospective cohort study looked at 21 subjects.[18] In 8 subjects, there were improved live birth rate from 0% to 80% and a decreased miscarriage rate from 64% to 20% after surgical correction. In the same study, it is interesting to note that the 13 subjects who did not undergo surgical correction had a respectable 30% miscarriage rate and a 57% live birth rate. Another small observational study in 14 subjects found an improved live birth rate from 21% prior to metroplasty to 82% after metroplasty.[19] Based on these poor data, surgical correction of a bicornuate uterus to improve pregnancy maintenance is not recommended.

Nevertheless, if surgical correction of a bicornuate uterus for pregnancy maintenance is elected, a Strassman metroplasty is performed.[20] This technique involves a transverse fundal incision into the separated uterine cavity and subsequent reconstruction in a layered closure of a vertical incision similar to the closure of a classic incision during a cesarean section. No data exist advocating surgical correction for infertility indications, and this is not recommended.


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