Journal of the European Society for Gynaecological Endoscopy


Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis

M. Caballero Campo1,2, F. Pérez Milán1,2,3, M. Carrera Roig4, E. Moratalla Bartolomé5, J. A. Domínguez Arroyo6,7, J. L. Alcázar Zambrano8,9, L. Alonso Pacheco10, J. Carugno11

On behalf of Spanish Fertility Society Special Interest Group on Reproductive Organic Disorders

1 Reproductive Medicine Unit, Obstetrics & Gynecology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
2 Gregorio Marañón Institute for Health Research, Madrid, Spain
3 Universidad Complutense, Madrid, Spain
4 Reproductive Medicine Unit, Obstetrics & Gynecology Department, Hospital Universitario Doce de Octubre, Madrid, Spain
5 Gynecological Surgery and Endoscopy Unit, Hospital Universitario Ramón y Cajal, Madrid, Spain
6 Centro Extremeño de Reproducción Asistida, Badajoz, Spain
7 Universidad de Extremadura, Badajoz, Spain
8 Clínica Universidad de Navarra, Pamplona, Spain
9 Universidad de Navarra, Pamplona Spain
10 Gynecological Endoscopy Unit, Gutenberg Center, Xanit International Hospital, Málaga, Spain
11 Miller School of Medicine, Department of Obstetrics and Gynecology, University of Miami, Miami, FL, USA


Congenital uterine anomalies, Müllerian anomalies, pregnancy outcome, obstetric complications, labour complications, neonatal outcome

Published online: Mar 28 2024


Background: Congenital uterine anomalies (CUA) can be associated with impairments of early and late pregnancy events.

Objective: To assess the impact of CUA on reproductive outcomes in pregnancies conceived spontaneously or after assisted reproduction.

Material and Methods: Systematic review and meta-analysis of cohort studies comparing patients with CUA versus women with normal uterus. A structured literature search was performed in leading scientific databases to identify prospective and retrospective studies. The Newcastle-Ottawa scale, adapted to AHRQ standards, was used to assess the risk of bias. Pooled odds ratios (OR) were calculated. Publication bias and statistical heterogeneity were assessed, and meta-regression was used to analyse the heterogeneity.

Main outcome measures: Miscarriage, ectopic pregnancy, placental abruption, term, and premature rupture of membranes (PROM), malpresentation at delivery, preterm delivery prior to 37, 34 and 32 weeks, caesarean delivery, intrauterine growth restriction/small for gestational age, foetal mortality and perinatal mortality.

Results: 32 studies were included. CUAs increased significantly the risk of first/second trimester miscarriage (OR:1.54;95%CI:1.14-2.07), placental abruption (OR:5.04;3.60-7.04), PROM (OR:1.71;1.34-2.18), foetal malpresentation at delivery (OR:21.04;10.95-40.44), preterm birth (adjusted OR:4.34;3.59-5.21), a caesarean delivery (adjusted OR:7.69;4.17-14.29), intrauterine growth restriction/small for gestational age (adjusted OR:50;6.11-424), foetal mortality (OR:2.07;1.56-2.73) and perinatal mortality (OR:3.28;2.01-5.36).

Conclusions: CUA increases the risk of complications during pregnancy, delivery, and postpartum. Complications most frequent in CUA patients were preterm delivery, foetal malpresentation, and caesarean delivery.

What is new? Bicornuate uterus was associated with the highest number of adverse outcomes, followed by didelphys, subseptate and septate uterus.

Supplementary files