Preliminary Study On The Pregnancy Outcomes Of Women With Uterine Malformation

Background: Uterine malformation is the most common abnormality of female reproductive system,including uterus septus,uterus duplex,bicornuate uterus,arcuate uterus,unicornuate uterus and so on.There is often no clinical symptom in the non-pregnant,but due to the abnormal morphology of the uterine cavity and maldevelopment of endometrium,it might result in abortion,premature birth,premature rupture of membranes,abnormal presentation,fetal growth restriction and other adverse pregnancy outcomes,while cesarean section rate also increases.The cause of different types of uterine malformation is not alike,so the effects on pregnancy outcomes are not entirely the same.Among the various types of uterine malformation,uterus septus has the highest incidence rate,and it is reported that it is more likely to cause recurrent miscarriage.While unicornuate uterus is more likely to lead to abnormal presentation,along with relatively high cesarean section rate.Due to the different sample size and statistical methods,so far there is no uniform conclusion about the influence of different types of uterine malformation on the pregnancy outcomes.When patients with uterine malformation become pregnant,the cesarean section rate is as high as 70%,mainly because of abnormal presentation.Considering the increased risk of bleeding,there is no definite conclusion about whether to do plastic surgery of uterus during cesarean section(mainly involving uterus septus and unicornute uterus accompany with rudimentary uterine horn).Purpose:1.To discuss the realationship between uterine malformation and pregnancy outcomes.2.To study the effects of different types of uterine malformation on pregnancy outcomes.3.To evaluate the safety of uterine malformation orthopedy in cesarean section.Method: From 2011 to 2015,375 cases of uterine malformation who had children in Beijing Obstetrics and Gynecology Hospital of Capital Medical University are selected as the research object,and 375 cases of normal uterine pregnancy of the same period are randomly selected as controls.Criteria for admission: age of 18-34 years,singleton pregnancy,primiparas,no uterine leiomyoma or adenomyosis,no medical and surgery complications,no myomectomy and plastic surgery of uterus.Collecting general information of patients: age,type and diagnosis of uterine malformation,gravida;prenatal situations: the history of spontaneous abortion,missed abortion,artificial abortion,intrauterine death,premature rupture of membranes,placental abruption,placenta previa,fetal distress,abnormal presentation;intrapartum and postpartum situations: whether umbilical cord around the neck,delivery mode(vaginal delivery,cesarean section),cesarean section indication,premature birth,term delivery,gestational weeks,postpartum hemorrhage,placenta adherence/retention;neonatal situations: birth weight,1 min Apgar score.The data is analyzed using SPSS17.0 statistical software.The measurement data is described using the mean and standard deviation.The t test and analysis of variance are used to analyze and compare;enumeration data is described by constituent ratio,compared with Chi-squared test,correction for continuity or Fisher exact probability test.It is statistically significant when P<0.05.Result:1.The gravida of malformation group is higher than the control group(1.64±0.91 VS 1.51±0.77,P=0.035);Premature rupture of membranes(29.9% VS 22.1%,P=0.016),postpartum hemorrhage(3.2% VS 1.1%,P=0.043),umbilical cord around the neck(31.5% VS 17.1%,P=0.000),abnormal presentation(46.9% VS 5.3%,P=0.000),preterm birth(16.0% VS 4.0%,P=0.000),cesarean section rate(72.5% VS18.4%,P=0.000)of malformation group are significantly higher than those in normal uterus group;while gestational age(37.78 ± 1.96 VS 39.21 ± 1.26,P=0.000),birth weight(3069.67 ± 548.84 VS 3384.99 ± 402.52,P=0.000),the incidence of macrosomia(1.3% VS 4.8%,P=0.006)are significantly lower than those of normal uterus group.2.In the malformation group,the incidence of abnormal presentation and birth weight are statistically significant among different types of uterine malformation difference(P<0.05).Unicornuate uterus has the highest incidence rate of abnormal presentation(70.1%),and the uterus duplex has the lowest neonatal birth weight.3.In this study,22 cases of uterus septus and 12 cases of unicornute uterus accompany with rudimentary uterine horn are treated with resection of the septum and the rudimentary uterine horn during cesarean section.As a result that bleeding occurres in 1 cases of uterus septus(4.5%)and 1 cases of the unicornute uterus accompany with rudimentary(8.3%).Whether treated with resection of the septum or not,the patients' postpartum hemorrhage rate(4.5% VS 2.8%,P=0.534)and the amount of postpartum hemorrhage(442.27±160.77 VS 385.47±153.55,P=0.120)in two groups have no statistically significance.The patients treated with resection of rudimentary uterine horn have higher amount of postpartum hemorrhage(599.17±461.74 VS 365.77±149.17,P=0.003)than those without rudimentary uterine horn resection,but refers to the postpartum hemorrhage rate,there is no statistically significance(8.3% VS 3.8%,P=0.470).Conclusion: When patients with uterine malformation get pregnant,the risk of premature rupture of membranes,abnormal presentation,postpartum hemorrhage,premature birth and other adverse pregnancy outcomes increases,so as the rate of cesarean section;Unicornuate uterus has the highest rate of abnormal presentation;it is suggested that all the patients with rudimentary uterine horn should be treated with resection of rudimentary uterine horn and ipsilateral fallopian tube.The clinical diagnosis and treatment of patients with uterine malformation should be as early as possible,in order to strengthen the health care of pregnant women and provide individualized treatment,thus reducing the incidence of perinatal complications.