Skip to main content
Erschienen in: Archives of Gynecology and Obstetrics 4/2018

01.02.2018 | Maternal-Fetal Medicine

Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study

verfasst von: Salvatore Andrea Mastrolia, Yael Baumfeld, Reli Hershkovitz, David Yohay, Giuseppe Trojano, Adi Y. Weintraub

Erschienen in: Archives of Gynecology and Obstetrics | Ausgabe 4/2018

Einloggen, um Zugang zu erhalten

Abstract

Objective

The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with uterine malformations.

Study design

This was a retrospective population-based cohort study including women with a diagnosis of uterine malformation arised from workup for infertility or recurrent pregnancy loss, was accidental during pregnancy, or was noticed at the time of cesarean delivery.

Results

A total of 280,721 pregnancies met the inclusion criteria and were divided into two study groups: (1) pregnancies in women with uterine malformations (n = 1099); and (2) controls (n = 279,662). The rate of women presenting uterine malformations was 0.39%. The prevalence of cervical os insufficiency was significantly higher in women with a uterine malformation than in the control group (3.6 vs. 0.4%, p < 0.001). A multivariate analysis, performed to evaluate risk factors for cervical insufficiency in women with uterine malformations. Mullerian anomalies (OR 6.19, 95% CI 4.41–8.70, p < 0.001), maternal age (OR 1.05, 95% CI 1.04–1.06, p < 0.001), recurrent abortions (OR 12.93, 95% CI 11.43–14.62, p < 0.001), and ethnicity (OR 2.86, 95% CI 2.454–3.34, p < 0.001) were found to be independently associated with the development of cervical insufficiency.

Conclusion

Uterine anomalies have a strong association with cervical insufficiency. Women with uterine anomalies have an increased risk to develop pregnancy complications that arise from a loss in cervical function during the midtrimester or early third trimester.
Literatur
1.
Zurück zum Zitat Iams JD, Johnson FF, Sonek J et al (1995) Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol 172(4 Pt 1):1097–1103 Discussion 1104–1096 CrossRefPubMed Iams JD, Johnson FF, Sonek J et al (1995) Cervical competence as a continuum: a study of ultrasonographic cervical length and obstetric performance. Am J Obstet Gynecol 172(4 Pt 1):1097–1103 Discussion 1104–1096 CrossRefPubMed
2.
Zurück zum Zitat Rafaeli-Yehudai T, Kessous R, Aricha-Tamir B et al (2014) The effect of cervical cerclage on pregnancy outcomes in women following conization. J Matern Fetal Neonatal Med 27(15):1594–1597CrossRefPubMed Rafaeli-Yehudai T, Kessous R, Aricha-Tamir B et al (2014) The effect of cervical cerclage on pregnancy outcomes in women following conization. J Matern Fetal Neonatal Med 27(15):1594–1597CrossRefPubMed
3.
Zurück zum Zitat Romero R, Espinoza J, Kusanovic JP et al (2006) The preterm parturition syndrome. BJOG 113(Suppl 3):17–42CrossRefPubMed Romero R, Espinoza J, Kusanovic JP et al (2006) The preterm parturition syndrome. BJOG 113(Suppl 3):17–42CrossRefPubMed
4.
Zurück zum Zitat Reichman D, Laufer MR, Robinson BK (2009) Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 91(5):1886–1894CrossRefPubMed Reichman D, Laufer MR, Robinson BK (2009) Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 91(5):1886–1894CrossRefPubMed
5.
Zurück zum Zitat Mastrolia SA, Baumfeld Y, Hershkovitz R, et al. (2016) Bicornuate uterus is an independent risk factor for cervical os insufficiency: a retrospective population based cohort study. J Matern Fetal Neonatal Med 30(22):2705–2710CrossRefPubMed Mastrolia SA, Baumfeld Y, Hershkovitz R, et al. (2016) Bicornuate uterus is an independent risk factor for cervical os insufficiency: a retrospective population based cohort study. J Matern Fetal Neonatal Med 30(22):2705–2710CrossRefPubMed
6.
Zurück zum Zitat Raga F, Bauset C, Remohi J et al (1997) Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12(10):2277–2281CrossRefPubMed Raga F, Bauset C, Remohi J et al (1997) Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12(10):2277–2281CrossRefPubMed
7.
Zurück zum Zitat Sadek SM, Ahmad RA, Soliman BS (2015) Three dimensional color Doppler transvaginal ultrasound morphologic features of uterine septum and residual cavity in women with reproductive failure. Middle East Fertility Soc J 20:21–26CrossRef Sadek SM, Ahmad RA, Soliman BS (2015) Three dimensional color Doppler transvaginal ultrasound morphologic features of uterine septum and residual cavity in women with reproductive failure. Middle East Fertility Soc J 20:21–26CrossRef
8.
Zurück zum Zitat Rock JA, Schlaff WD (1985) The obstetric consequences of uterovaginal anomalies. Fertil Steril 43(5):681–692CrossRefPubMed Rock JA, Schlaff WD (1985) The obstetric consequences of uterovaginal anomalies. Fertil Steril 43(5):681–692CrossRefPubMed
9.
Zurück zum Zitat Stray-Pedersen B, Stray-Pedersen S (1984) Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 148(2):140–146CrossRefPubMed Stray-Pedersen B, Stray-Pedersen S (1984) Etiologic factors and subsequent reproductive performance in 195 couples with a prior history of habitual abortion. Am J Obstet Gynecol 148(2):140–146CrossRefPubMed
10.
Zurück zum Zitat Sanfilippo JS, Wakim NG, Schikler KN, Yussman MA (1986) Endometriosis in association with uterine anomaly. Am J Obstet Gynecol 154(1):39–43CrossRefPubMed Sanfilippo JS, Wakim NG, Schikler KN, Yussman MA (1986) Endometriosis in association with uterine anomaly. Am J Obstet Gynecol 154(1):39–43CrossRefPubMed
11.
Zurück zum Zitat Green LK, Harris RE (1976) Uterine anomalies. Frequency of diagnosis and associated obstetric complications. Obstet Gynecol 47(4):427–429PubMed Green LK, Harris RE (1976) Uterine anomalies. Frequency of diagnosis and associated obstetric complications. Obstet Gynecol 47(4):427–429PubMed
12.
Zurück zum Zitat Acién P (1993) Reproductive performance of women with uterine malformations. Hum Reprod 8(1):122–126CrossRefPubMed Acién P (1993) Reproductive performance of women with uterine malformations. Hum Reprod 8(1):122–126CrossRefPubMed
13.
Zurück zum Zitat Acién P (1997) Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 12(7):1372–1376CrossRefPubMed Acién P (1997) Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 12(7):1372–1376CrossRefPubMed
14.
Zurück zum Zitat Strassmann EO (1966) Fertility and unification of double uterus. Fertil Steril 17(2):165–176CrossRefPubMed Strassmann EO (1966) Fertility and unification of double uterus. Fertil Steril 17(2):165–176CrossRefPubMed
15.
Zurück zum Zitat Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST (2002) Female genital anomalies affecting reproduction. Fertil Steril 78(5):899–915CrossRefPubMed Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST (2002) Female genital anomalies affecting reproduction. Fertil Steril 78(5):899–915CrossRefPubMed
16.
Zurück zum Zitat Lin PC (2004) Reproductive outcomes in women with uterine anomalies. J Womens Health (Larchmt) 13(1):33–39CrossRef Lin PC (2004) Reproductive outcomes in women with uterine anomalies. J Womens Health (Larchmt) 13(1):33–39CrossRef
17.
Zurück zum Zitat Propst AM, Hill JA (2000) Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 18(4):341–350CrossRefPubMed Propst AM, Hill JA (2000) Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 18(4):341–350CrossRefPubMed
18.
Zurück zum Zitat Jurkovic D, Geipel A, Gruboeck K et al (1995) Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol 5(4):233–237CrossRefPubMed Jurkovic D, Geipel A, Gruboeck K et al (1995) Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol 5(4):233–237CrossRefPubMed
19.
Zurück zum Zitat Saravelos SH, Cocksedge KA, Li TC (2008) Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update 14(5):415–429CrossRefPubMed Saravelos SH, Cocksedge KA, Li TC (2008) Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Hum Reprod Update 14(5):415–429CrossRefPubMed
21.
Zurück zum Zitat ACOG practice bulletin (2002) Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 99(1):159–167 ACOG practice bulletin (2002) Diagnosis and management of preeclampsia and eclampsia. Number 33, January 2002. Obstet Gynecol 99(1):159–167
23.
Zurück zum Zitat Leiberman JR, Fraser D, Weitzman S, Glezerman M (1993) Birthweight curves in southern Israel populations. Isr J Med Sci 29(4):198–203PubMed Leiberman JR, Fraser D, Weitzman S, Glezerman M (1993) Birthweight curves in southern Israel populations. Isr J Med Sci 29(4):198–203PubMed
24.
Zurück zum Zitat The American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 49(6):944–955CrossRef The American Fertility Society (1988) The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 49(6):944–955CrossRef
25.
Zurück zum Zitat Gynecologists ACoOa (2009) ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 14(1):192–202 Gynecologists ACoOa (2009) ACOG Practice Bulletin No. 106: Intrapartum fetal heart rate monitoring: nomenclature, interpretation, and general management principles. Obstet Gynecol 14(1):192–202
26.
Zurück zum Zitat The American College of Obstetricians and Gynecologists. Task Force on Neonatal Encephalopathy and Cerebral Palsy, the American Academy of Pediatrics. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and physiopathology. Washington (DC): American College of Obstetricians and Gynecologists; 2003: 1–85 The American College of Obstetricians and Gynecologists. Task Force on Neonatal Encephalopathy and Cerebral Palsy, the American Academy of Pediatrics. Neonatal encephalopathy and cerebral palsy: defining the pathogenesis and physiopathology. Washington (DC): American College of Obstetricians and Gynecologists; 2003: 1–85
27.
Zurück zum Zitat Romero R, Gonzalez R, Sepulveda W et al (1992) Infection and labor. VIII. Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance. Am J Obstet Gynecol 167(4 Pt 1):1086–1091CrossRefPubMed Romero R, Gonzalez R, Sepulveda W et al (1992) Infection and labor. VIII. Microbial invasion of the amniotic cavity in patients with suspected cervical incompetence: prevalence and clinical significance. Am J Obstet Gynecol 167(4 Pt 1):1086–1091CrossRefPubMed
28.
Zurück zum Zitat Leible S, Muñoz H, Walton R et al (1998) Uterine artery blood flow velocity waveforms in pregnant women with müllerian duct anomaly: a biologic model for uteroplacental insufficiency. Am J Obstet Gynecol 178(5):1048–1053CrossRefPubMed Leible S, Muñoz H, Walton R et al (1998) Uterine artery blood flow velocity waveforms in pregnant women with müllerian duct anomaly: a biologic model for uteroplacental insufficiency. Am J Obstet Gynecol 178(5):1048–1053CrossRefPubMed
29.
Zurück zum Zitat Akar ME, Bayar D, Yildiz S, Ozel M, Yilmaz Z (2005) Reproductive outcome of women with unicornuate uterus. Aust N Z J Obstet Gynaecol 45(2):148–150CrossRefPubMed Akar ME, Bayar D, Yildiz S, Ozel M, Yilmaz Z (2005) Reproductive outcome of women with unicornuate uterus. Aust N Z J Obstet Gynaecol 45(2):148–150CrossRefPubMed
30.
Zurück zum Zitat Golan A, Langer R, Wexler S et al (1990) Cervical cerclage–its role in the pregnant anomalous uterus. Int J Fertil 35(3):164–170PubMed Golan A, Langer R, Wexler S et al (1990) Cervical cerclage–its role in the pregnant anomalous uterus. Int J Fertil 35(3):164–170PubMed
31.
Zurück zum Zitat Żyła MM, Wilczyński J, Nowakowska-Głąb A, Maniecka-Bryła I, Nowakowska D (2015) Pregnancy and delivery in women with uterine malformations. Adv Clin Exp Med 24(5):873–879CrossRefPubMed Żyła MM, Wilczyński J, Nowakowska-Głąb A, Maniecka-Bryła I, Nowakowska D (2015) Pregnancy and delivery in women with uterine malformations. Adv Clin Exp Med 24(5):873–879CrossRefPubMed
32.
Zurück zum Zitat Tulandi T, Arronet GH, McInnes RA (1980) Arcuate and bicornuate uterine anomalies and infertility. Fertil Steril 34(4):362–364CrossRefPubMed Tulandi T, Arronet GH, McInnes RA (1980) Arcuate and bicornuate uterine anomalies and infertility. Fertil Steril 34(4):362–364CrossRefPubMed
33.
Zurück zum Zitat Rackow BW, Arici A (2007) Reproductive performance of women with müllerian anomalies. Curr Opin Obstet Gynecol 19(3):229–237CrossRefPubMed Rackow BW, Arici A (2007) Reproductive performance of women with müllerian anomalies. Curr Opin Obstet Gynecol 19(3):229–237CrossRefPubMed
34.
Zurück zum Zitat Tomazevic T, Ban-Frangez H, Ribic-Pucelj M, Premru-Srsen T, Verdenik I (2007) Small uterine septum is an important risk variable for preterm birth. Eur J Obstet Gynecol Reprod Biol 135(2):154–157CrossRefPubMed Tomazevic T, Ban-Frangez H, Ribic-Pucelj M, Premru-Srsen T, Verdenik I (2007) Small uterine septum is an important risk variable for preterm birth. Eur J Obstet Gynecol Reprod Biol 135(2):154–157CrossRefPubMed
35.
Zurück zum Zitat Chan YY, Jayaprakasan K, Tan A et al (2011) Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol 38(4):371–382CrossRefPubMed Chan YY, Jayaprakasan K, Tan A et al (2011) Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol 38(4):371–382CrossRefPubMed
36.
Zurück zum Zitat Hua M, Odibo AO, Longman RE et al (2011) Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 205(6):558.e1–558.e5CrossRef Hua M, Odibo AO, Longman RE et al (2011) Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 205(6):558.e1–558.e5CrossRef
37.
Zurück zum Zitat Stein AL, March CM (1990) Pregnancy outcome in women with müllerian duct anomalies. J Reprod Med 35(4):411–414PubMed Stein AL, March CM (1990) Pregnancy outcome in women with müllerian duct anomalies. J Reprod Med 35(4):411–414PubMed
38.
Zurück zum Zitat Craig CJ (1973) Congenital abnormalities of the uterus and foetal wastage. S Afr Med J 47(42):2000–2005PubMed Craig CJ (1973) Congenital abnormalities of the uterus and foetal wastage. S Afr Med J 47(42):2000–2005PubMed
39.
Zurück zum Zitat Zupi E, Solima E, Marconi D, Valli E, Romanini C (1996) Uterine anomalies prevalence and reproductive outcome in women undergoing diagnostic hysteroscopy. Gynaecol Endosc 5:147–150 Zupi E, Solima E, Marconi D, Valli E, Romanini C (1996) Uterine anomalies prevalence and reproductive outcome in women undergoing diagnostic hysteroscopy. Gynaecol Endosc 5:147–150
40.
Zurück zum Zitat Zlopasa G, Skrablin S, Kalafatić D, Banović V, Lesin J (2007) Uterine anomalies and pregnancy outcome following resectoscope metroplasty. Int J Gynaecol Obstet 98(2):129–133CrossRefPubMed Zlopasa G, Skrablin S, Kalafatić D, Banović V, Lesin J (2007) Uterine anomalies and pregnancy outcome following resectoscope metroplasty. Int J Gynaecol Obstet 98(2):129–133CrossRefPubMed
41.
Zurück zum Zitat Zhang Y, Zhao YY, Qiao J (2010) Obstetric outcome of women with uterine anomalies in China. Chin Med J (Engl) 123(4):418–422 Zhang Y, Zhao YY, Qiao J (2010) Obstetric outcome of women with uterine anomalies in China. Chin Med J (Engl) 123(4):418–422
42.
Zurück zum Zitat Shuiqing M, Xuming B, Jinghe L (2002) Pregnancy and its outcome in women with malformed uterus. Chin Med Sci J 17(4):242–245PubMed Shuiqing M, Xuming B, Jinghe L (2002) Pregnancy and its outcome in women with malformed uterus. Chin Med Sci J 17(4):242–245PubMed
43.
Zurück zum Zitat Fox NS, Roman AS, Stern EM et al (2014) Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 27(9):949–953CrossRefPubMed Fox NS, Roman AS, Stern EM et al (2014) Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 27(9):949–953CrossRefPubMed
44.
Zurück zum Zitat Jayaprakasan K, Chan YY, Sur S et al (2011) Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment. Ultrasound Obstet Gynecol 37(6):727–732CrossRefPubMed Jayaprakasan K, Chan YY, Sur S et al (2011) Prevalence of uterine anomalies and their impact on early pregnancy in women conceiving after assisted reproduction treatment. Ultrasound Obstet Gynecol 37(6):727–732CrossRefPubMed
45.
Zurück zum Zitat Maneschi F, Zupi E, Marconi D et al (1995) Hysteroscopically detected asymptomatic müllerian anomalies. Prevalence and reproductive implications. J Reprod Med 40(10):684–688PubMed Maneschi F, Zupi E, Marconi D et al (1995) Hysteroscopically detected asymptomatic müllerian anomalies. Prevalence and reproductive implications. J Reprod Med 40(10):684–688PubMed
46.
Zurück zum Zitat Sørensen SS, Trauelsen AG (1987) Obstetric implications of minor müllerian anomalies in oligomenorrheic women. Am J Obstet Gynecol 156(5):1112–1118CrossRefPubMed Sørensen SS, Trauelsen AG (1987) Obstetric implications of minor müllerian anomalies in oligomenorrheic women. Am J Obstet Gynecol 156(5):1112–1118CrossRefPubMed
Metadaten
Titel
Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study
verfasst von
Salvatore Andrea Mastrolia
Yael Baumfeld
Reli Hershkovitz
David Yohay
Giuseppe Trojano
Adi Y. Weintraub
Publikationsdatum
01.02.2018
Verlag
Springer Berlin Heidelberg
Erschienen in
Archives of Gynecology and Obstetrics / Ausgabe 4/2018
Print ISSN: 0932-0067
Elektronische ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-018-4663-2

Weitere Artikel der Ausgabe 4/2018

Archives of Gynecology and Obstetrics 4/2018 Zur Ausgabe

Update Gynäkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert – ganz bequem per eMail.