Abstract
Aims: To critically evaluate the hypothesis that cervical weakness could be another risk factor in patients with uterine anomalies for the adverse pregnancy outcome related with their presence. Brief description of the reviewed data: The prevalence of congenital uterine anomalies (CUA) has been variably reported, as there is no universally agreed classification system. Moreover cervical weakness is a difficult entity to diagnose with certainty. However, despite the heterogeneity in definitions and study populations, there is evidence that women with CUA are at increased risk of spontaneous mid-trimester losses and preterm delivery. Since the latter are inversely related to cervical length and ensuing cervical weakness, there does appear to be a correlation between CUA and cervical weakness. Furthermore, adverse pregnancy outcomes may be obviated with interventions such as cerclage. Clinical implications: Patients who have a history of mid-trimester loss or preterm delivery should be thoroughly evaluated to exclude the presence of CUA based on a well-defined classification. Tests to assess underlying cervical weakness should also be conducted. Open issues for further research: Consensus on CUA classification will yield a framework for the comparison of future studies. Robust, well-designed studies are required to delineate a more definitive association between cervical weakness and CUA.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Amesse LS, Pfaff-Amesse T. Congenital anomalies of the reproductive tract. In: Falcone T, Hurd WW, editors. Clinical reproductive medicine and surgery. 1st ed. New York: Mosby; 2007. p. 171–90.
Chan YY, Jayaprakasan K, Tan A, Thornton JG, Coomarasamy A, Raine-Fenning NJ. Reproductive outcomes in women with congenital uterine anomalies: a systematic review. Ultrasound Obstet Gynecol. 2011;38:371–82.
Grigoris F, Grimbizis SG, Sardo ADS, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Gynecol Surg. 2013;10(3):199–212.
Jurkovic D, Geipel A, Gruboeck K, et al. Three-dimensional ultrasound for the assessment of uterine anatomy and detection of congenital anomalies: a comparison with hysterosalpingography and two-dimensional sonography. Ultrasound Obstet Gynecol. 1995;5(4):233–7.
Raga F, Bonilla-Musoles F, Blanes J, et al. Congenital Mullerian anomalies; diagnostic accuracy of three-dimensional ultrasound. Fertil Steril. 1996;65:523–8.
Berry CW, Brambati B, Eskes TKAB, et al. The Euro-Team Early Pregnancy (ETEM) protocol for recurrent miscarriage. Hum Reprod. 1995;10(6):1516–20.
Rust OA, Atlas RO, Jones KJ, Benham BN, Balducci J. A randomised trial of cerclage versus no cerclage among patients with ultrasonographically detected second trimester preterm dilatation of the internal os. Am J Obstet Gynecol. 2000;183:830–5.
Althuisius SM, Dekker GA, van Geijn HP, Bekedam DJ, Hummel P. Cervical Incompetence prevention randomized cerclage trial (CIPRACT): study design and preliminary results. Am J Obstet Gynecol. 2001;183:823–9.
Raga F, Bauset C, Remohi J, et al. Reproductive impact of congenital Mullerian anomalies. Hum Reprod. 1997;12(10):2277–81.
Salim R, Regan L, Woelfer B, et al. A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage. Hum Reprod. 2003;18(1):162–6.
Chan Y, Jayaprakasan K, Zamora J, et al. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17:761–71.
Royal College of Obstetricians and Gynaecologists (RCOG). Guideline 17: the management of recurrent miscarriage. London: RCOG Press; 1998.
Saravelos S, Cocksedge K, Li T. The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage. Reprod Biomed Online. 2010;20(3):416–22.
Woelfer B, Salim R, Banerjee S, Elson J, Regan L, Jurkovic D. Reproductive outcomes in women with congenital uterine anomalies detected by three-dimensional ultrasound screening. Obstet Gynecol. 2001;98:1099–103.
Acien P. Reproductive performance in women with uterine malformation. Hum Reprod. 1993;8:122–6.
Sorensen SS, Trauelsen AGH. Obstetric implications of minor mullerian anomalies in oligomenorrheic women. Am J Obstet Gynecol. 1987;156:1112–8.
Zhang Y, Zhao YY, Qiao J. Obstetric outcomes in women with uterine anomalies in China. Chin Med J. 2010;123:418–22.
Shuiqing M, Xuming B, Jinghe L. Pregnancy and its outcome in women with malformed uterus. Chin Med Sci J. 2002;17:242–5.
Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril. 2009;91(5):1886–94.
Fakhhrolmolouk Y, Mostafee L. The role of cervical cerclage in pregnancy outcome in women with uterine anomaly. J Reprod Infert. 2011;12(4):277–9.
Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol. 2011;206(6):558–61.
Fox NS, Roman AS, Stern EM, Gerber RS, Saltzman DH, Rebarber A. Type of congenital uterine anomaly and adverse pregnancy outcomes. J Mat Fetal Neo Med. 2014;27:949–53.
Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73(1):1–14.
Christiansen OB, Nybo-Andersen AM, Bosch E, et al. Evidence-based investigations and treatments of recurrent pregnancy loss. Fertil Steril. 2005;83(4):821–39.
Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol. 2013;20(1):22–42.
TRUST trial, NTR 1676. The randomised uterine septum transection trial. www.studies-obsgyn.nl/TRUST.
Owen J, Yost N, Berghella V, et al. Mid-trimester endo-vaginal sonography in women at risk for spontaneous preterm birth. JAMA. 2001;286:1340–8.
Berghella V, Tolosa JE, Kuhlman KA, et al. Cervical Ultrasonography compared to manual examination as a predictor of preterm delivery. Am J Obstet Gynecol. 1997;177:723–30.
Vidaeff AC, Ramin SM. Management strategies for the prevention of preterm birth: part II- update on cervical cerclage. Curr Opin Obstet Gynecol. 2009;21:480–4.
Grimes-Dennis J, Berghella V. Cervical length and prediction of preterm delivery. Curr Opin Obstet Gynecol. 2007;19:191–5.
To MS, Skentou C, Liao AW, et al. Cervical length and funnelling at 23 weeks gestation in the prediction of spontaneous early preterm delivery. Ultrasound Obstet Gynecol. 2001;8:200–3.
Abbott D, To M, Shennan A. Cervical cerclage: a review of current evidence. Aust N Z J Obstet Gynaecol. 2012;52:220–3.
Berghella V, Odibo AO, To MS, et al. Cerclage for short cervix on ultrasonography: meta-analysis of trials using individual patient-level data. Obstet Gynecol. 2005;106:181–9.
Shirodkar VN. A new method of operative treatment for habitual abortion in the second trimester. Antiseptic. 1955;52:299–300.
McDonald IA. Suture of the cervix for inevitable miscarriage. J Obstet Gynecol Brit Emp. 1957;64:346–50.
Odibo AO, Berghella V, To MS, et al. Shirodkar versus McDonald cerclage for the prevention of preterm birth in women with a short cervical length. Am J Perinatol. 2007;24:55–60.
MRC/RCOG Working Party on Cervical Cerclage. Final report of the Medical Research Council/Royal College of Obstetricians and Gynaecologists multicentre randomized trial of cervical cerclage. Br J Obstet Gynaecol. 1993;100:516–23.
To MS, Alfirevic Z, Alfirevic VCF, et al. Cervical cerclage for prevention of preterm delivery in women with short cervix: randomized controlled trial. Lancet. 2004;363:1849–53.
Benson RC, Durfee RB. Transabdominal cervico-uterine cerclage during pregnancy for the treatment of cervical incompetence. Obstet Gynecol. 1965;25:145–55.
Zaveri V, Aghajafari F, Amankwah K, et al. Abdominal versus vaginal cerclage after a failed transvaginal cerclage: a systematic review. Am J Obstet Gynecol. 2002;187:868–72.
Davis G, Berghella V, Talucci M, et al. Patients with a prior failed transvaginal cerclage: a comparison of obstetric outcomes with either transabdominal or transvaginal cerclage. Am J Obstet Gynecol. 2000;183:836–9.
Witt MU, Joy SD, Clark J, Herring A, Bowes WA, Thorp JM. Cervicoisthmic cerclage: transabdominal vs transvaginal approach. Am J Obstet Gynecol. 2009;201:105–9.
Burger NB, Brolmann HAM, Einarsson JI, Langebrekke A, Hulme JAF. Effectiveness of abdominal cerclage placed via laparotomy or laparoscopy: systematic review. J Minim Invasive Gynecol. 2011;13:696–704.
Lotgering FK, Gaugler-Senden IP, Lotgering SF, Wallenburg HC. Outcome after transabdominal cervicoisthmic cerclage. Obstet Gynecol. 2006;107:779–84.
Foster TL, Moore ES, Sumners JE. Operative complications and fetal morbidity encountered in 300 prophylactic transabdominal cervical cerclage procedures by one obstetric surgeon. J Obstet Gynaecol. 2011;31:713–7.
Burger NB, Einarsson JI, Brolmann HA, Vree FE, Mc Elrath TF. Preconceptual laparoscopic abdominal cerclage: a multicentre cohort study. Am J Obstet Gynecol. 2012;207(4):273.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2015 Springer-Verlag London
About this chapter
Cite this chapter
Dawood, F., Farquharson, R. (2015). Cervical Weakness in Women Who Have Uterine Anomalies: Impact on Pregnancy Outcome. In: Grimbizis, G., Campo, R., Tarlatzis, B., Gordts, S. (eds) Female Genital Tract Congenital Malformations. Springer, London. https://doi.org/10.1007/978-1-4471-5146-3_15
Download citation
DOI: https://doi.org/10.1007/978-1-4471-5146-3_15
Published:
Publisher Name: Springer, London
Print ISBN: 978-1-4471-5145-6
Online ISBN: 978-1-4471-5146-3
eBook Packages: MedicineMedicine (R0)