Obstetric outcomes of women with congenital uterine anomalies in the United States.

Autor: Mandelbaum RS; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Anderson ZS; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Masjedi AD; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Violette CJ; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., McGough AM; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Doody KA; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Guner JZ; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Quinn MM; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Paulson RJ; Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Mandelbaum, Anderson, Masjedi, Violette, McGough, Doody, Guner, Quinn, and Paulson)., Ouzounian JG; Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Ouzounian)., Matsuo K; Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California Keck School of Medicine, Los Angeles, CA (Matsuo); Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA (Matsuo). Electronic address: koji.matsuo@med.usc.edu.
Jazyk: angličtina
Zdroj: American journal of obstetrics & gynecology MFM [Am J Obstet Gynecol MFM] 2024 Aug; Vol. 6 (8), pp. 101396. Date of Electronic Publication: 2024 Jun 10.
DOI: 10.1016/j.ajogmf.2024.101396
Abstrakt: Background: Due to the rarity, congenital uterine anomaly type-specific evaluation of pregnant women has been relatively understudied.
Objective: To describe national-level obstetric outcomes in women with congenital uterine anomalies.
Study Design: This cross-sectional study queried the Healthcare Cost and Utilization Project's Nationwide Inpatient Sample. Pregnant women with diagnosis of congenital uterine anomalies who had hospital delivery between 2016 and 2019 were examined. The World Health Organization's International Classification of Disease, 10th revision coding was used to delineate type of congenital uterine anomaly, diagnoses, and procedures performed during the index admission. Primary outcomes included pregnancy outcome, which was classified as full-term live birth, preterm live birth, abortion/stillbirth, or ectopic pregnancy. Secondary outcomes included obstetric comorbidities and severe maternal morbidity, which were compared between different subtypes of congenital uterine anomalies with multivariable logistic regression model.
Results: A total of 50,180 pregnant women with congenital uterine anomalies were identified. Bicornuate was the most common subtype (73.5%), followed by arcuate (13.5%) and unicornuate (10.0%). 70.6% of women with congenital uterine anomalies had a full-term live birth, 26.8% had a preterm live birth, 2.1% had an abortion or stillbirth, and 0.4% had an ectopic pregnancy. 61.8% of preterm births occurred between 33 and 36 weeks, 16.9% between 30 and 32 weeks, and 21.3% at <30 weeks. There were 1,440 (2.9%) periviable births. The preterm (34.5%) and periviable (6.9%) birth rates were highest in the uterine didelphys group. Overall, two-thirds (65.7%) of patients with congenital uterine anomalies were delivered via cesarean section. When compared to arcuate uterus, risk of severe maternal morbidity in septate uterus (4.8% vs 2.6%, adjusted-odds ratio [aOR] 2.60, 95% confidence interval [CI] 1.49-4.52) was increased, including hemorrhage (14.5% vs 7.7%, aOR 2.16, 95% CI 1.51-3.07). This was followed by uterine didelphys (4.2% vs 2.6%, aOR 1.75, 95% CI 1.24-2.47), unicornuate uterus (3.8% vs 2.6%, aOR 1.61, 95% CI 1.29-2.01), and bicornuate uterus (3.0% vs 2.6%, aOR 1.23, 95% CI 1.04-1.47).
Conclusion: While the majority of patients with congenital uterine anomalies result in full-term viable deliveries, each subtype of congenital uterine anomalies confers different obstetric risks. Uterine didelphys was associated with the highest risk of preterm birth, while septate uterus was associated with the highest risk of severe maternal morbidity. While this hospital delivery dataset likely overrepresents bicornuate uteri, this populational data may help inform patients with congenital anomalies considering pregnancy. El resumen está disponible en Español al final del artículo.
(Copyright © 2024 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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