[引用][C] OC14. 04: The reproductive outcomes of women with congenital uterine anomalies: a systematic review
Y Chan, K Jayaprakasan, A Tan… - … in Obstetrics & …, 2011 - Wiley Online Library
Ultrasound in Obstetrics & Gynecology, 2011•Wiley Online Library
Objectives To evaluate the association between the different types of congenital uterine
anomaly and various reproductive outcomes. We hypothesised that uterine anomalies are
associated with suboptimal reproductive outcomes. Methods Searches were performed in
MEDLINE, EMBASE, and Cochrane Library. Two reviewers conducted study selection and
data extraction independently. The Newcastle-Ottawa Quality Assessment Scales were used
for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects …
anomaly and various reproductive outcomes. We hypothesised that uterine anomalies are
associated with suboptimal reproductive outcomes. Methods Searches were performed in
MEDLINE, EMBASE, and Cochrane Library. Two reviewers conducted study selection and
data extraction independently. The Newcastle-Ottawa Quality Assessment Scales were used
for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects …
Objectives
To evaluate the association between the different types of congenital uterine anomaly and various reproductive outcomes. We hypothesised that uterine anomalies are associated with suboptimal reproductive outcomes.
Methods
Searches were performed in MEDLINE, EMBASE, and Cochrane Library. Two reviewers conducted study selection and data extraction independently. The Newcastle-Ottawa Quality Assessment Scales were used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate or subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were estimated using random effects models.
Results
We identified 9 observational studies comprising 3805 patients. Meta-analysis showed that women with arcuate uteri are at an increased risk of second trimester miscarriage (RR 2.39; 95% CI, 1.33–4.27, P= 0.003) and fetal malpresentation (RR 2.53; 95% CI, 1.54–4.18, P= 0.0003). Canalization defects appear to reduce clinical pregnancy rates (RR 0.86; 95% CI, 0.77–0.96, P= 0.009) and increase rates of first trimester miscarriage (RR 2.89; 95% CI, 2.02–4.14, P< 0.00001), preterm birth (RR 2.14; 95% CI, 1.48–3.11, P< 0.0001) and malpresentation (RR 6.24; 95% CI, 4.05–9.62, P< 0.00001). Unification defects were also associated with decreased clinical pregnancy rates (RR 0.87; 95% CI, 0.76–0.99, P= 0.03) and increased rates of both first (RR 2.13; 95% CI, 1.24–3.65, P= 0.006) and second trimester miscarriage (RR 2.01; 95% CI, 1.11–3.64, P= 0.02), preterm birth (RR 3.29; 95% CI, 2.49–4.35, P< 0.00001), and malpresentation (RR 4.07; 95% CI, 2.86–5.77, P< 0.00001).
Conclusions
Congenital uterine anomalies are associated with poor reproductive outcome. Canalization and unification defects both reduce pregnancy rates and increase the risk of miscarriage, and preterm delivery. Arcuate uteri are associated with increased risk of second trimester miscarriage. All uterine anomalies appear to increase the chance of fetal malpresentation at birth.
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