Reproductive Outcomes in Women With Uterine Anomalies

Paul C. Lin, M.D.

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In This Article

Unicornuate Uterus

The incidence of the unicornuate uterus was 6.3%.[2] Combining the current literature, tubal pregnancy rates were elevated at 4.3%, pregnancies in the remnant horn occurred in 2% of pregnancies, the miscarriage rate was 34.4%, the preterm delivery rate was 43.3%, and the live birth rate was 54.2%.[3,22,23] The unicornuate uterus has significant problems with reproductive outcome secondary to abnormal uterine vasculature and decreased muscle mass ( Table 1 ).

Increased cesarean section rates are a result of fetal malpresentation and uterine contractility irregularities during labor. Ectopic rates are probably higher because of two factors: abnormal vasculature with a relatively more receptive blood supply for the embryo in the fallopian tube than the uterus and greater chance of transmigration of sperm or ova to the contralateral side.

Sometimes, a unicornuate uterus has a rudimentary, noncommunicating horn. Transmigration of sperm or ovum or both can occur, and pregnancy can occur in this embryological remnant.[24] This can cause uterine rupture and can be difficult to diagnose.

In summary, the reproductive outcomes of a unicornuate uterus are clearly the poorest.[25]

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