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