Midline uterine defect size is correlated with miscarriage of euploid embryos in recurrent cases

Abstract

Objective: To compare subsequent pregnancy outcomes after two or more miscarriages in patients with and without congenital uterine anomalies.

Design: Case-control study.

Setting: Nagoya City University Hospital.

Patient(s): A total of 42 patients with a bicornuate or septate uterus and 1528 with normal uteri.

Intervention(s): No surgery.

Main outcome measure(s): The cumulative success rate for birth, abnormal chromosome karyotype rate in aborted concepti, and the predictive values of the height of the defect/length of the remaining uterine cavity ratio (D/C ratio).

Result(s): Of the total of 1676 patients, 54 (3.2%) had congenital uterine anomalies; 25 (59.5%) of the 42 patients with a bicornuate or septate uterus had a successful first pregnancy after examination, while this was the case for 1096 (71.7%) of the 1528 with normal uteri. There was no difference in the cumulative live-birth rate (78.0% and 85.5%) within the follow-up period. However, the rates for an abnormal chromosome karyotype in aborted concepti in cases with and without uterine anomalies were 15.4% (two of 13) and 57.5% (134 of 233), respectively, with the latter being significantly higher. The D/C ratio in the miscarriage group was also significantly greater than that for the live-birth group.

Conclusion(s): Congenital uterine anomalies have a negative impact on reproductive outcome in couples with recurrent miscarriage and are associated with further miscarriage with a normal embryonic karyotype. The D/C ratio was found to have a predictive value for further miscarriages in recurrent cases.