European Journal of Cardiovascular Medicine

Congenital uterine anomalies are rare malformations of the female reproductive system that can result in a variety of complications during pregnancy and delivery1. These anomalies, which include septate, arcuate, unicornuate, and bicornuate uteri, are often associated with adverse reproductive outcomes such as recurrent miscarriages, preterm labor, malpresentation, and intrauterine growth restriction (IUGR)2,3. While the prevalence of uterine anomalies in the general population is low, their impact on pregnancy outcomes can be significant, particularly in cases where the anomaly is undiagnosed until delivery4.

The diagnosis of uterine anomalies is typically made through imaging techniques such as 3D ultrasound, sonohysterography, or magnetic resonance imaging5 (MRI). However, many cases remain undetected until labor, particularly in women who undergo cesarean section for unrelated reasons. In the absence of early diagnostic testing, the anomaly is often discovered during the surgical procedure, as was the case for the patients included in this study6. Early recognition of uterine anomalies can enable timely interventions that may improve pregnancy outcomes and guide clinical decision-making during delivery.

This case series aims to assess the incidence and perinatal outcomes of congenital uterine anomalies in women undergoing cesarean section at KIMS & RF, Amalapuram, between February 2023 and January 2024. By reviewing the incidence of various uterine anomalies and their associated fetal presentations and neonatal outcomes, this study seeks to contribute to the understanding of the clinical significance of uterine malformations in obstetric practice and improve the management of pregnancies complicated by these anomalies.

Study Design:

This study was a retrospective case series conducted at KIMS & RF, Amalapuram, analyzing cesarean section patients over a period of one year, from February 2023 to January 2024. The primary aim was to investigate the incidence, fetal presentations, and perinatal outcomes in women diagnosed with congenital uterine anomalies during cesarean section.

Study Population:

The study included 460 women who underwent cesarean section at KIMS & RF during the specified time frame. Among these patients, 14 were diagnosed with congenital uterine anomalies, which were identified intraoperatively. These anomalies were not diagnosed prenatally as the patients did not undergo advanced imaging techniques such as 3D ultrasound or sonohysterography.

Inclusion Criteria:

Women undergoing cesarean section during the study period.

Women who were diagnosed with congenital uterine anomalies during cesarean delivery.

Exclusion Criteria:

Women who did not undergo cesarean section.

Women with known uterine anomalies diagnosed prior to surgery.

Data Collection:

Data were collected from medical records and operation notes, including:

Patient Demographics: Age, parity, and gestational age at delivery.

Uterine Anomalies: Type of uterine defect identified (septate, arcuate, unicornuate, or bicornuate uterus).

Fetal Presentation: Recorded as cephalic, podalic, transverse lie, or oblique lie.

Perinatal Outcomes: Including low birth weight (LBW), preterm delivery, intrauterine growth restriction (IUGR), and malpresentation.

Apgar Scores: Recorded at 1 and 5 minutes after birth to assess neonatal well-being.

Data Analysis:

Descriptive statistics were used to summarize the demographic characteristics, types of uterine anomalies, fetal presentations, and perinatal outcomes. The incidence of uterine anomalies was calculated as a percentage of the total cesarean section cases. The distribution of fetal presentations and perinatal outcomes was analyzed, and Apgar scores were categorized into excellent (10-8), average (7-5), and poor (4-0) scores. Statistical analysis was performed using standard statistical software to determine the proportions and distribution of the variables.

Ethical Considerations:

The study was conducted with ethical approval from the Institutional Ethics Committee of KIMS & RF, Amalapuram. Informed consent was obtained from all participants for the use of their medical data for research purposes. Confidentiality was maintained throughout the study.

Out of a total of 460 cesarean section patients, 14 (3.04%) were diagnosed with congenital uterine anomalies during the procedure. The distribution of these anomalies is outlined in Table 1, where the most common defect was septate uterus, accounting for 35% (5 cases) of the affected patients. Other anomalies included arcuate uterus (28%, 4 cases), unicornuate uterus (21%, 3 cases), and bicornuate uterus (14%, 2 cases).

Table 1: Distribution of Müllerian Anomalies

Figure No:1.Distribution of Mullerian Anomalies

Figure No:2.Arcuate Uterus

Figure No:3. Septate Uterus

Figure No:4. Unicornuate uterus

Figure No:5. Bicornuate uterus

The fetal presentation in these cases varied, with the majority of the pregnancies presenting in the cephalic position (42%). Podalic presentation was observed in 28% of cases, while transverse lie and oblique lie were each reported in 14% of cases, as shown in Table 2.

Table 2: Fetal Presentation in Cases with Uterine Anomalies

Figure No:6.Fetal Presentation in Cases with Uterine Anomalies

Perinatal outcomes associated with these uterine anomalies revealed a high rate of low birth weight (LBW) and preterm deliveries. As depicted in Table 3, 60% of the neonates born to mothers with septate uterus had LBW, and 60% were preterm. Similar patterns were observed in arcuate uterus (50% LBW, 25% preterm) and unicornuate uterus (100% LBW and preterm). Furthermore, intrauterine growth restriction (IUGR) was observed in 35% of the cases, with the highest rate in unicornuate uterus, where 67% of babies were diagnosed with IUGR.

Table 3: Perinatal Outcomes Associated with Anomalies

Figure No:7. Perinatal Outcomes Associated with Anomalies

Regarding neonatal health, Apgar scores were mostly favorable. Table 4 summarizes that 72% of neonates achieved excellent Apgar scores (10-8), while 28% had average scores (7-5). No neonates had poor Apgar scores (4-0). These findings suggest that while neonatal outcomes were generally positive, there was a notable incidence of LBW, preterm births, and IUGR among the study group, highlighting the challenges posed by uterine anomalies in pregnancy.

Table 4: Apgar Scores of Newborns with Uterine Anomalies

This study aimed to explore the incidence, fetal presentation, and perinatal outcomes associated with congenital uterine anomalies in cesarean section patients at KIMS & RF, Amalapuram. The results revealed that 3.04% of cesarean section patients were diagnosed with uterine anomalies during surgery, which aligns with previous studies reporting a low but significant prevalence of these anomalies in the general obstetric population. The most common uterine anomalies in our cohort were septate uterus (35%), arcuate uterus (28%), and unicornuate uterus (21%), with a smaller proportion of cases having a bicornuate uterus (14%). These findings are consistent with those of other studies^7,8, where septate and arcuate uteri are the most commonly identified anomalies, both of which are associated with higher rates of obstetric complications.

The fetal presentations in this study revealed a notable incidence of malpresentation, with 28% of the cases presenting in the podalic position and 14% in transverse and oblique lie. Previous research has shown that uterine anomalies, particularly septate and unicornuate uteri, can contribute to abnormal fetal positioning, potentially leading to obstructed labor and the need for cesarean delivery. Malpresentation in cases with uterine anomalies is a well-documented concern, as the altered shape and space of the uterine cavity can restrict fetal movement, increasing the likelihood of non-cephalic presentations^9,10.

Regarding perinatal outcomes, this study demonstrated a high prevalence of low birth weight (71%) and preterm delivery (64%) among neonates born to mothers with uterine anomalies. The higher incidence of low birth weight and preterm births in our cohort aligns with findings from previous studies, where uterine anomalies, particularly unicornuate and bicornuate uteri, have been associated with adverse pregnancy outcomes, including increased risk of premature birth and intrauterine growth restriction (IUGR). The association of IUGR (35%) with uterine anomalies observed in this study further supports the idea that these structural defects may impair the placental blood flow and fetal development^11,12.

Apgar scores were generally favorable in this cohort, with 72% of neonates achieving excellent scores (10-8) and 28% scoring average (7-5). No neonates had poor Apgar scores (4-0), suggesting that, despite the complications associated with uterine anomalies, the majority of newborns had good neonatal health¹³. This is consistent with findings in the literature, where neonatal outcomes in terms of Apgar scores have not been severely impacted by uterine anomalies, although some studies report an increased risk of neonatal complications such as respiratory distress and asphyxia, especially in preterm infants¹⁴.

One limitation of this study is the lack of advanced imaging modalities, such as 3D ultrasound or magnetic resonance imaging (MRI), to diagnose uterine anomalies prior to cesarean section. As a result, many of the anomalies were discovered only during surgery, which may have led to underreporting of cases and a potential delay in managing complications. Additionally, the study’s retrospective design limits the ability to establish causality or explore the long-term effects of uterine anomalies on reproductive health.

congenital uterine anomalies are associated with a higher risk of obstetric complications, including malpresentation, low birth weight, preterm delivery, and IUGR. Despite these challenges, neonatal outcomes, as measured by Apgar scores, were generally positive. Early detection and management of uterine anomalies, particularly through advanced imaging techniques, may help mitigate these risks and improve pregnancy outcomes. Further prospective studies with larger sample sizes and advanced diagnostic tools are needed to confirm these findings and provide more detailed insights into the long-term impact of uterine anomalies on maternal and neonatal health.

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