Advertisement

Archives of Gynecology and Obstetrics

, Volume 299, Issue 5, pp 1321–1330 | Cite as

Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship

  • Xiao-qing Li
  • Hui-jun Qian
  • Xu-yin Zhang
  • Yuan He
  • Shao-Fen Zhang
  • Ke-Qin HuaEmail author
  • Jing-Xin DingEmail author
General Gynecology
  • 82 Downloads

Abstract

Purpose

To evaluate the relationship between the uterine size measured by pelvic magnetic resonance and reproductive outcome in women with a unicornuate uterus.

Methods

This was a retrospective study including 140 patients affiliated with unicornuate uterus diagnosed by the pelvic MR prior to their first pregnancy in the Obstetrics and Gynecology Hospital of Fudan University from April 2010 to December 2017. All the length of the unicornuate uterus were re-measured and recorded by skilled radiologists during the study period. We divided all the 140 participants with complete pelvic MR imaging into four groups by the best reproductive outcomes, which refers to Group 1 (primary infertility, n = 21), Group 2 ( < 24 weeks’ gestation, n = 34), Group 3 (preterm delivery, 24–35 weeks’ gestation, n = 13), Group 4 ( ≥ 35 weeks’ gestation, n = 72), followed them up and then analyzed the data.

Results

Measurements of 140 patients with hemi-uteri were retrieved for analysis. The mean length of the uterine was 4.90  ± 0.56 cm. There were no significant differences in the uterine cavity length, cervical length, endometrial thickness and uterine wall thickness between the four groups while the uterine length (P = 0.001) was statistically significant. Women with uterine lengths  ≥  4.5 cm were more likely to experience full-term delivery compared with the other group (P = 0.001). Ordinal multiple logistic regression analysis showed that the uterine length [OR = 9.03 (95% CI: 2.90–28.13)] and uterine cavity length [OR = 0.32 (95% CI: 0.06–2.04)] were independent protective factors for better obstetric outcomes

Conclusion

The uterine length is a reliable prognostic factor for the gestational week of delivery and an appropriate antenatal surveillance factor of women with unicornuate uterus.

Keywords

Unicornuate uterus Hemi-uterus Reproductive outcome Obstetric outcomes Uterine size Uterine length 

Notes

Acknowledgements

The authors thank the Obstetrics and Gynecology Hospital of Fudan University for supporting in statistical analyses. The authors are grateful to Yuan He for her advice on the data analysis. The authors thank DXJ and KHQ for carefully reviewing the article.

Author contributions

XQL: project development, data management, data analysis, and manuscript writing. HJQ: project development and data management. XYZ: data collection. SFZ: project development. YH: data analysis. KQH: data management. JXD: manuscript revise and project development. All authors read and approved the final manuscript.

Funding

This study was supported by the Chinese National Nature Sciences Foundation [grant number 81471416 and 81771524].

Compliance with ethical standards

Conflict of interest

All the authors declare that they have no competing interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. This study was approved by the Ethics Committee of the Department of Gynecology, the Obstetrics and Gynecology Hospital of Fudan University [2018–18] and informed consent was obtained from each individual.

Informed consent

Informed consent was obtained from all individual participants included in the study.

References

  1. 1.
    White-Walker S (2000) Before we are born: essentials of embroyology and birth defects. J Midwifery Women's Health 45(2):192.  https://doi.org/10.1016/S1526-9523(99)00025-2 CrossRefGoogle Scholar
  2. 2.
    Sawada M, Kakigano A, Matsuzaki S, Takiuchi T, Mimura K, Kumasawa K, Endo M, Ueda Y, Yoshino K, Kimura T (2018) Obstetric outcome in patients with a unicornuate uterus after laparoscopic resection of a rudimentary horn. J Obstet Gynaecol Res.  https://doi.org/10.1111/jog.13622 Google Scholar
  3. 3.
    Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A (2011) The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update 17(6):761–771.  https://doi.org/10.1093/humupd/dmr028 CrossRefGoogle Scholar
  4. 4.
    The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions (1988). Fertil Steril 49 (6):944-955. doi:10.1016/s0015-0282(16)59942-7Google Scholar
  5. 5.
    Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brolmann H, Gianaroli L, Campo R (2013) The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 28(8):2032–2044.  https://doi.org/10.1093/humrep/det098 CrossRefGoogle Scholar
  6. 6.
    Zyla MM, Wilczynski J, Nowakowska-Glab A, Maniecka-Bryla I, Nowakowska D (2015) Pregnancy and delivery in women with uterine malformations. Adv Clin Exp Med 24(5):873–879.  https://doi.org/10.17219/acem/23171 CrossRefGoogle Scholar
  7. 7.
    Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF (2014) Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online 29(6):665–683.  https://doi.org/10.1016/j.rbmo.2014.09.006 CrossRefGoogle Scholar
  8. 8.
    Reichman D, Laufer MR, Robinson BK (2009) Pregnancy outcomes in unicornuate uteri: a review. Fertil Steril 91(5):1886–1894.  https://doi.org/10.1016/j.fertnstert.2008.02.163 CrossRefGoogle Scholar
  9. 9.
    Reichman DE, Laufer MR (2010) Congenital uterine anomalies affecting reproduction. Best Pract Res Clin Obstet Gynaecol 24(2):193–208.  https://doi.org/10.1016/j.bpobgyn.2009.09.006 CrossRefGoogle Scholar
  10. 10.
    Francisco Raga CB, Remohi Jose, Bonilla-Musoles F, Simo ́n C, Pellicer A (1997) Reproductive impact of congenital Mu ̈llerian anomalies. Hum Reprod 12(10):2277–2281CrossRefGoogle Scholar
  11. 11.
    Egbase PE, Al-Sharhan M, Grudzinskas JG (2000) Influence of position and length of uterus on implantation and clinical pregnancy rates in IVF and embryo transfer treatment cycles. Hum Reprod 15(9):1943–1946CrossRefGoogle Scholar
  12. 12.
    Hawkins LK, Correia KF, Srouji SS, Hornstein MD, Missmer SA (2013) Uterine length and fertility outcomes: a cohort study in the IVF population. Hum Reprod 28(11):3000–3006.  https://doi.org/10.1093/humrep/det344 CrossRefGoogle Scholar
  13. 13.
    Cenksoy PO, Ficicioglu C, Yesiladali M, Akcin OA, Kaspar C (2014) The importance of the length of uterine cavity, the position of the tip of the inner catheter and the distance between the fundal endometrial surface and the air bubbles as determinants of the pregnancy rate in IVF cycles. Eur J Obstet Gynecol Reprod Biol 172:46–50.  https://doi.org/10.1016/j.ejogrb.2013.09.023 CrossRefGoogle Scholar
  14. 14.
    Chun SS, Chung MJ, Chong GO, Park KS, Lee TH (2010) Relationship between the length of the uterine cavity and clinical pregnancy rates after in vitro fertilization or intracytoplasmic sperm injection. Fertil Steril 93(2):663–665.  https://doi.org/10.1016/j.fertnstert.2009.08.067 CrossRefGoogle Scholar
  15. 15.
    Grimbizis GF, Di Spiezio SA, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D, Bermejo C, Amso NN, Nargund G, Timmerman D, Athanasiadis A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Tarlatzis B, Farquharson R, Gianaroli L, Campo R (2016) The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod 31(1):2–7.  https://doi.org/10.1093/humrep/dev264 CrossRefGoogle Scholar
  16. 16.
    Sheth SS, Hajari AR, Lulla CP, Kshirsagar D (2017) Sonographic evaluation of uterine volume and its clinical importance. J Obstet Gynaecol Res 43(1):185–189.  https://doi.org/10.1111/jog.13189 CrossRefGoogle Scholar
  17. 17.
    Mastrolia SA, Baumfeld Y, Hershkovitz R, Yohay D, Trojano G, Weintraub AY (2018) Independent association between uterine malformations and cervical insufficiency: a retrospective population-based cohort study. Arch Gynecol Obstet 297(4):919–926.  https://doi.org/10.1007/s00404-018-4663-2 CrossRefGoogle Scholar
  18. 18.
    Kaveh M, Mehdizadeh Kashi A, Sadegi K, Forghani F (2018) Pregnancy in non-communicating rudimentary horn of a unicornuate uterus. Int J Fertil Steril 11(4):318–320.  https://doi.org/10.22074/ijfs.2018.5022 Google Scholar
  19. 19.
    Kanno Y, Suzuki T, Nakamura E, Goya K, Nishijima Y, Shinoda M, Hayashi M, Izumi S (2014) Successful term delivery after laparoscopic resection of a non-communicating rudimentary horn in a patient with a unicornuate uterus: a case report. Tokai J Exp Clin Med 39(2):59–63Google Scholar
  20. 20.
    Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST (2002) Female genital anomalies affecting reproduction. Fertil Steril 78(5):899–915CrossRefGoogle Scholar
  21. 21.
    Jayasinghe Y, Rane A, Stalewski H, Grover S (2005) The presentation and early diagnosis of the rudimentary uterine horn. Obstet Gynecol 105(6):1456–1467.  https://doi.org/10.1097/01.AOG.0000161321.94364.56 CrossRefGoogle Scholar
  22. 22.
    Pados G, Tsolakidis D, Athanatos D, Almaloglou K, Nikolaidis N, Tarlatzis B (2014) Reproductive and obstetric outcome after laparoscopic excision of functional, non-communicating broadly attached rudimentary horn: a case series. Eur J Obstet Gynecol Reprod Biol 182:33–37.  https://doi.org/10.1016/j.ejogrb.2014.08.023 CrossRefGoogle Scholar
  23. 23.
    Fox NS, Roman AS, Stern EM, Gerber RS, Saltzman DH, Rebarber A (2014) Type of congenital uterine anomaly and adverse pregnancy outcomes. J Matern Fetal Neonatal Med 27(9):949–953.  https://doi.org/10.3109/14767058.2013.847082 CrossRefGoogle Scholar
  24. 24.
    Liu J, Wu Y, Xu S, Su D, Han Y, Wu X (2017) Retrospective evaluation of pregnancy outcomes and clinical implications of 34 Han Chinese women with unicornuate uterus who received IVF-ET or ICSI-ET treatment. J Obstet Gynaecol 37(8):1020–1024.  https://doi.org/10.1080/01443615.2017.1318266 CrossRefGoogle Scholar
  25. 25.
    Li X, Ouyang Y, Yi Y, Lin G, Lu G, Gong F (2017) Pregnancy outcomes of women with a congenital unicornuate uterus after IVF-embryo transfer. Reprod Biomed Online 35(5):583–591.  https://doi.org/10.1016/j.rbmo.2017.07.015 CrossRefGoogle Scholar
  26. 26.
    Akar ME, Bayar D, Yildiz S, Ozel M, Yilmaz Z (2005) Reproductive outcome of women with unicornuate uterus. Aust N Z J Obstet Gynaecol 45(2):148–150.  https://doi.org/10.1111/j.1479-828X.2005.00346.x CrossRefGoogle Scholar
  27. 27.
    Hawkins LK, Missmer SA, Correia KF, Hornstein MD (2014) Assessment of pregnancy-associated, within-woman change in uterine length. J Matern-Fetal Neo M 27(10):989–993.  https://doi.org/10.3109/14767058.2013.853732 CrossRefGoogle Scholar
  28. 28.
    Donderwinkel PF, Dorr JP, Willemsen WN (1992) The unicornuate uterus: clinical implications. Eur J Obstet Gynecol Reprod Biol 47(2):135–139.  https://doi.org/10.1016/0028-2243(92)90043-X CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Xiao-qing Li
    • 1
    • 2
  • Hui-jun Qian
    • 3
  • Xu-yin Zhang
    • 1
    • 2
  • Yuan He
    • 4
  • Shao-Fen Zhang
    • 1
    • 2
  • Ke-Qin Hua
    • 1
    • 2
    Email author
  • Jing-Xin Ding
    • 1
    • 2
    Email author
  1. 1.Department of Gynecology, Obstetrics and Gynecology HospitalFudan UniversityShanghaiChina
  2. 2.Shanghai Key Laboratory of Female Reproductive Endocrine Related DiseasesShanghaiChina
  3. 3.Department of Radiology, Obstetrics and Gynecology HospitalFudan UniversityShanghaiChina
  4. 4.Public Health School of Fudan UniversityShanghaiChina

Personalised recommendations