uterine anomalies and reproductive outcomes

1. Uterine Anomalies and Reproductive
Outcomes
Walid Ayad
Assist.proff. Of obstetrics &gyn.
Al azhar university-damietta.

2. objective

3. introduction
Venetis etal.,2014

4. •Pelvic pain, AUB, miscarriage and PTL
Symptoms not related to reproductive system
Workup of infertility
Ludwin etal., 2018
introduction
Renal
20-30%
skeletal

5. AdaptedfromLangmanJ,MedicalEmbryology,4thed,Williams&Wilkins,Baltimore,
1981.p.253.
Embryological background
1-organogenesis

6. classification
ASRM
ESHRE-ESGE
Other (Aciens-Experts)
There is no universally accepted classification system for CUAs, which is
problematic because such a system would allow physicians to codify the
symptomatology, treatment, and outcome of affected patients and more accurately
compare their research data with that of others
Arleo etal.,2013

7. ASRM CLASSIFICATION

9. ESHRE ESGE classification
ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies.
Hum Reprod 2013

11. prevalence
An accurate prevalence of CUAs is difficult to
determine since many are never identified,
especially if they asymptomatic
. prevalence varies according population
studied
 CUAs in women with1ry infertility equal to
women with normal reproductive outcomes
Mark and Alan 2019

12. prevalence
•In a systematic review
•5.5% in general populotion
•8% in infertile
•14% in miscarriage
•5-10%in 1st trim. abortion
•25% in 2nd trim. and PTL
•24% inwomenwithhistory
miascariage &infertility
Mark and Alan., 2019.

13. Frequency of specific CUAs in
affected women
Bicorniat
25%
Septate
35%
Arcuate
15%
Unicor
niate
10%
Agenes
is
3%
Didelphis
5%

14. Potential sequences
Non pregnant
pregnant
●Hematometra (blood-filled uterine cavity)
●Hematocolpos(blood-filled vagina)
●Retromenstruationand developmentof endometriosis
●Pelvicpain, cyclicornoncyclic
●Abnormal uterinebleedingordischarge
●Genital tract infection

15. Potential sequences
●Spontaneous abortion
●Recurrent miscarriage
●Preterm delivery
●Intrauterine growth restriction
●Antepartum and postpartum bleeding
●Placental attachment abnormalities
●Cervical insufficiency
●Fetal malpresentation
●Pregnancy-associated hypertension
●Cesarean delivery
●Rupture of a rudimentary horn
Pregnant
Ludwinetal.,2018Venties etal., 2014Chanetal.,2011

17. 6How Do Congenital Uterine
Anomalies Affect Reproductive
Outcomes?
Robert W. Rebar, MD reviewing Venetis CA et al. Reprod Biomed Online 2014 Dec
Effects varied among different abnormalities; whether to remove uterine septa before pregnancy is
attempted remains controversial.

18. 25 study 3477 lady

19. Risk of 1st &2nd abortion
septate(RR2.8),bicorniate(2.4)and
unicorniate(2.1)
Risk of PTL all CUA(RR2.2)except arcuate
uterus

20. Risk of malpresentation with all CUA but
most markdly with septate &bicorniate
4.6)&(RR.4.3
Risk of fetal growth restriction and birth
weight less 2500gm were high with didelphs
bicorniate and unicorniate

21. Placental abruption in septate and arcuate
uterus but when all CUA no signf.
PROM no significant difference either by
specific type or as all

23. Gyun etal 2010

24. Grimbizis et al 2001

25. Hystrosalpingography
Us
90%2D 77%
2D SIS 95%
3D 98 100%
3D SIS 100%
MRI
Hystroscopy-laproscopy
DIAGNOSTIC TOOLS
Ludwin etal 2013

26. Imaging modalities
HSG
Intercorneal
angle
Fundal
contour
Intercorneal
distance
2DUS
3D
MRI

27. Diagnosis and clinical
impact of common CUAS
< 10 mm
< 50%
Arcuate
Normal variant
Prior etal2018

28. SEPTATE UTERUS
The commenest variant
The most correctable
No universal accepted definition
•ASRM septum guidlines2016

29. Does septum Contribute to
Pregnancy outcome
Descriptive
No RCT
Fair evidence
Infertility
•ASRM septum guidlines2016
risk of miscarriage26-90% & PTL9-33%
Malpresentation ,IUGR ,placental
abrubtio and perinatal mortality

30. Imaging of the septum
>1.5 mm
>50%

31. TTT

32. Does Septoplasty Improve
Outcomes
Fedele etal.,2006Aisha nd fathi 2017

33. AJOGMFM 2019

34. Bicorniate
•Better reproductive outcome than septate
Live birth rate
70%
Ptl20%Miscariage25-35%
>10mm

35. Commonly associated with infertility
Worest obstetric outcome?
Miscariage 50% PTL30% ectopic 5%
•
•Decrease clinical pregnancy rate and live birth rate
after ICSI
•
Yanron etal2018

36. Uterine didelphs
PTL 40%
Live birth
rate 50%
Abortion
40%
HWW
.syndrome

37. DYSMORPHIC UTERUS

38. Acquired uterine anomalies
Submucous fibroid
Intra uterine
synechia

39. Uterine synechia

41. Submucous fibroids

42. Hystroscopy is the key

44. finally
CUAS. are apparently related to an
impaired reproductive outcome, while
their exact clinical impact, as well as
the effectiveness of their treatment,
is still considered controversial