Reproductive outcomes in women with congenital uterine anomalies: a systematic review
Y. Y. Chan,Kannamannadiar Jayaprakasan,A. Tan,Jim G Thornton,Arri Coomarasamy,Nick Raine-Fenning +5 more
TLDR
A systematic review of the association between different types of congenital uterine anomaly and various reproductive outcomes found that the effect on reproductive outcome is unclear.Abstract:
Objective
Congenital uterine anomalies are common but their effect on reproductive outcome is unclear. We conducted a systematic review to evaluate the association between different types of congenital uterine anomaly and various reproductive outcomes.
Methods
Searches were performed using MEDLINE, EMBASE, the Cochrane Library and Web of Science. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Uterine defects were grouped into arcuate uteri, canalization defects (septate and subseptate uteri) and unification defects (unicornuate, bicornuate and didelphys uteri). Pooled risk ratios (RR) with 95% confidence intervals (CI) were computed using random effects models.
Results
We identified nine studies comprising 3805 women. Meta-analysis showed that arcuate uteri were associated with increased rates of second-trimester miscarriage (RR, 2.39; 95% CI, 1.33–4.27, P = 0.003) and fetal malpresentation at delivery (RR, 2.53; 95% CI, 1.54–4.18; P < 0.001). Canalization defects were associated with reduced clinical pregnancy rates (RR, 0.86; 95% CI, 0.77–0.96; P = 0.009) and increased rates of first-trimester miscarriage (RR, 2.89; 95% CI; 2.02–4.14; P < 0.001), preterm birth (RR, 2.14; 95% CI, 1.48–3.11; P < 0.001) and fetal malpresentation (RR, 6.24; 95% CI, 4.05–9.62; P < 0.001). Unification defects were associated with increased rates of preterm birth (RR, 2.97; 95% CI, 2.08–4.23; P < 0.001) and fetal malpresentation (RR, 3.87; 95% CI, 2.42–6.18; P < 0.001).
Conclusions
Canalization defects reduce fertility and increase rates of miscarriage and preterm delivery. None of the unification defects reduces fertility but some are associated with miscarriage and preterm delivery. Arcuate uteri are specifically associated with second-trimester miscarriage. All uterine anomalies increase the chance of fetal malpresentation at delivery. Copyright © 2011 ISUOG. Published by John Wiley & Sons, Ltd.read more
Citations
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Journal ArticleDOI
The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies
Grigoris F. Grimbizis,Stephan Gordts,Attilio Di Spiezio Sardo,Sara Y. Brucker,Carlo De Angelis,Marco Gergolet,Tin-Chiu Li,Vasilios Tanos,Hans A.M. Brölmann,Luca Gianaroli,Rudi Campo +10 more
TL;DR: The new ESHRE/ESGE classification system of female genital anomalies seems to fulfill the expectations and the needs of the experts in the field, but its clinical value needs to be proved in everyday practice.
Journal ArticleDOI
ESHRE guideline: recurrent pregnancy loss.
Ruth Bender Atik,Ole Bjarne Christiansen,Janine Elson,Astrid Marie Kolte,Sheena E.M. Lewis,Saskia Middeldorp,Willianne L.D.M. Nelen,Braulio Peramo,Siobhan Quenby,Nathalie Vermeulen,Mariëtte Goddijn +10 more
TL;DR: The guideline provides clinicians with clear advice on best practice in RPL, based on the best evidence available, and is approved by the guideline group and the ESHRE Executive Committee.
Journal ArticleDOI
New insights into mechanisms behind miscarriage
TL;DR: Recent experimental evidence has led to the concept that the decidualized endometrium acts as biosensor of embryo quality, which if disrupted, may lead to implantation of embryos destined to miscarry.
Journal ArticleDOI
Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss
Siobhan Quenby,Siobhan Quenby,Ioannis D. Gallos,Rima K Dhillon-Smith,Marcelina Podesek,Mary D. Stephenson,Joanne D. Fisher,Jan J. Brosens,Jan J. Brosens,Jane Brewin,Rosanna Ramhorst,Emma S. Lucas,Emma S. Lucas,Rajiv C. McCoy,Robert Anderson,Shahd Daher,Lesley Regan,Maya Al-Memar,Tom Bourne,David A. MacIntyre,Raj Rai,Ole Bjarne Christiansen,Mayumi Sugiura-Ogasawara,Joshua Odendaal,Joshua Odendaal,Adam J. Devall,Phillip R. Bennett,Stavros Petrou,Arri Coomarasamy +28 more
TL;DR: In the UK, the pooled risk of miscarriage is 15·3% (95% CI 12·5-18·7%) of all recognized pregnancies, and three or more miscarriages is 0·7% (0·5 −0·8%) as discussed by the authors.
Journal ArticleDOI
Infertility and reproductive disorders: impact of hormonal and inflammatory mechanisms on pregnancy outcome
Silvia Vannuccini,Vicki L. Clifton,Ian S. Fraser,Hugh S. Taylor,Hilary O. D. Critchley,Linda C. Giudice,Felice Petraglia +6 more
TL;DR: There is a real need for development of evidence-based recommendations about clinical management and specific obstetric care pathways for the introduction of prompt preventative care measures.
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