What types of uterine anomalies, if any, cause more pregnancy
complications, compared to the other anomalies? An evaluation of a large
population database.
Abstract
Objective: to compare pregnancy risks between different congenital
uterine anomalies utilizing other congenital anomalies as a control
group in a large population database. Design, setting, and sample: A
retrospective population-based cohort study from the
Healthcare-Cost-Utilization
Project-Nationwide-Inpatient-Sample(HCUP-NIS) included-3,846,342
births(2010-2014). Of them 6195 deliveries were to women with bicornuate
uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with
unicornuate uteri and 1404 with septate uteri. Main Outcome Measures and
Results: After adjustent for confounders, women with bicornuate uteri
were more likely to deliver vaginally(aOR 1.4, 95%CI: 1.1-1.9),
P=0.01), less likely to deliver by cesarean(CD) and had lower risk of
SGA(aOR 0.8, 95%CI: 0.7-0.9, P=0.03) when compared to the other
anomalies (aOR 0.6, 95%CI: 0.5-0.6), P=0.0001). Pregnant women with
arcuate uterus had lower risks of preterm delivery((aOR 0.6, 95%CI:
0.5-0.8), P=0.0001), less chance of operative vaginal delivery(aOR 0.5,
95%CI: 0.2-0.9), P=0.04), and higher risk for CD(aOR 1.6, 95%CI:
1.4-2, P=0.0001). Pregnant women with didelphys uteri had higher risk of
PPROM(aOR 1.6, 95%CI: 1.3-1.9), P=0.0001), preterm delivery(aOR 1.5,
95%CI: 1.3-1.6), P=0.0001), CD(aOR 1.4, 95%CI: 1.2-1.5, P=0.0001) and
wound complications (aOR 1.6, 95%CI: 1.1-2.4), P=0.02). Pregnant
unicornuate uteri had increased risks of preterm delivery(aOR 1.4,
95%CI: 1.1-1.6), P=0.0001), CD(aOR 2, 95%CI: 1.6-2.5), P=0.0001) and
of SGA(aOR 1.8, 95%CI: 1.4-2.3, P=0.0001). Pregnant septate uteri had
higher risk of chorioamnionitis(aOR 1.5, 95%CI: 1.1-2.1), P=0.048) and
CD(aOR 1.4, 95%CI: 1.2-1.6), P=0.0001). Conclusion: We demonstrated
that there are different risks for certain adverse pregnancy and
neonatal outcomes in diverse uterine anomalies as compared to the other
anomalies