Pregnancy outcome in women with uterine anomalies

Aims: To review the impact of female genital malformations as well as their different types on pregnancy outcome.Methods: Pertinent studies were identified through a computer Medline, Embase and Cochrane Library search. Uterine defects were grouped into five classes, according to the new ESHRE/ESGE Classification of Female Genital Malformations. Only data on untreated congenital uterine anomalies, apart for metroplasty in bicornuate uterus, were taken into account in accordance to the objective of the issue.Clinical implications: Those uterine malformations that cannot be surgically treated (Hemi-uterus and Bicorporeal uterus with double cervix AFS Unicornuate and Didelphys uteri) are associated with poor reproductive performances, increased abortion rates and lower live birth rates, eventhough a successful pregnancy is possible. On the opposite, septate uterus, hypoplastic uterus (AFS “T-shaped”) and partial unification defects (AFS bicornuate uterus) are associated to the worst reproductive outcomes when untreated and to the higher reproductive performances after surgery.Open issue: The hypoplastic uterus (T-shaped/Uterus Infantilis) is an old/new congenital pathology to be taken into account, both for its increasing incidence and damage of reproductive outcome and for the promising results of hysteroscopic surgery in those patients.Further researches concerning new clinical and diagnostic parameters are also advisable, in order to individuate those subpopulations of patients with uterine congenital anomalies, i.e. women with septate uterus, that will benefit of surgical procedure.Finally, focusing again on septate uterus, further controlled trials are needed in order to get to a definite conclusion on the issue of the length of the septum into the uterine cavity and the impairment of pregnancy. © Springer-Verlag London 2015.