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Congenital Uterine Anomalies in Pregnancy

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Abstract

Congenital uterine, renal, and urologic anomalies arise from abnormalities during embryologic development. Congenital uterine anomalies encompass a spectrum of anomalies ranging from uterovaginal hypoplasia to arcuate uterus. While many cases are asymptomatic, some are associated with adverse reproductive outcomes which may warrant surgical management. Unicornuate, bicornuate, didelphic, and septate uteri are associated with poor obstetrical outcomes such as recurrent pregnancy loss, intrauterine growth restriction, preterm delivery, fetal malpresentation, and rudimentary horn pregnancy with subsequent uterine rupture. While surgery has not been found to improve pregnancy outcomes in women with unicornuate and didelphic uteri, uterine reunification procedures can be effective for increasing rates of fetal survival in select anomalies. Hysteroscopic septum resection is the most popular intervention for septate uterus with favorable outcomes in the setting of infertility or recurrent pregnancy loss. Jones and Tompkins metroplasties are also acceptable techniques for septum resection but less commonly utilized. Surgery is primarily reserved for patients who are symptomatic or at risk for poor reproductive outcomes. Prior to surgery for non-obstetric indications, women with uterine anomalies should be evaluated for the presence of associated renal abnormalities, ovarian maldescent, and endometriosis, as clinically indicated to aid in surgical planning.

Congenital anomalies of the kidney and urinary tract (CAKUT) also encompass a spectrum of abnormalities in renal parenchymal development, renal migration, and the developing collecting system. Most of these anomalies are diagnosed in the antenatal or postnatal period, and if clinically significant they are often corrected during infancy. Even so, pregnant women with a history of CAKUT may have reduced renal function and altered anatomy secondary to anatomic abnormalities or adhesions from prior surgery. These factors must be taken into account prior to non-obstetric surgery in these patients.

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Author information

Authors and Affiliations

  1. Department of Obstetrics, Gynecology and Reproductive Sciences, Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA

    Angela L. Du & Joseph S. Sanfilippo

Authors
  1. Angela L. Du
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  2. Joseph S. Sanfilippo
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Corresponding author

Correspondence to Joseph S. Sanfilippo .

Editor information

Editors and Affiliations

  1. Nezhat Medical Center, Atlanta, GA, USA

    Ceana H. Nezhat

  2. Department of Surgery, Northeast Ohio Medical University, Youngstown, OH, USA

    Michael S. Kavic

  3. School of Dental Medicine, State University of New York at Buffalo, Buffalo, NY, USA

    Raymond J. Lanzafame

  4. Department of Gynecology and Obstetrics, Emory University, Atlanta, GA, USA

    Michael K. Lindsay

  5. Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA

    Travis M. Polk

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Du, A.L., Sanfilippo, J.S. (2019). Congenital Uterine Anomalies in Pregnancy. In: Nezhat, C., Kavic, M., Lanzafame, R., Lindsay, M., Polk, T. (eds) Non-Obstetric Surgery During Pregnancy. Springer, Cham. https://doi.org/10.1007/978-3-319-90752-9_29

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  • DOI: https://doi.org/10.1007/978-3-319-90752-9_29

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-90751-2

  • Online ISBN: 978-3-319-90752-9

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