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中华妇幼临床医学杂志(电子版)

Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition) ›› 2022, Vol. 18 ›› Issue (01): 87 -93. doi: 10.3877/cma.j.issn.1673-5250.2022.01.012

Original Article

Analysis of perinatal outcomes of pregnant women with congenital anomaly of genital organ

Si Wang, Qing Hu, Hua Liao, Xiaodong Wang, Haiyan Yu†()   

  • Received:2021-07-07 Revised:2022-01-08 Published:2022-02-01
  • Corresponding author: Haiyan Yu
  • Supported by:
    Sichuan Academic and Technical Leaders Training Support Fund(Office of Human Resources and Social Security of Sichuan 〔2017〕919-25)
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Objective

To investigate perinatal outcomes of pregnant women with congenital anomalies of genital organ.

Methods

From January 2009 to December 2019, a total of 99 779 cases of single pregnancy women who delivered live births in West China Second University Hospital, Sichuan University, were selected as research subjects. According to whether combined with congenital anomalies of genital organ or not, they were divided into observation group (n=324, combined) and control group (n=99 455, uncombined). Clinical data of two groups were retrospectively analyzed, and perinatal outcome of pregnant women in observation group were summarized. The incidence of complications during pregnancy, cesarean section rate and neonatal birth weight were statistically compared between two groups by chi-square test and independent-samples t test. The procedures followed in this study were in accordance with the World Medical Association Declaration of Helsinki revised in 2013.

Results

① In observation group, top three most common congenital anomalies of genital organ of pregnant women were septate uterus, unicornuate/rudimentary horn uterus and arcuate uterus, accounting for 35.2%(114/324), 26.2%(85/324) and 13.9%(45/324), respectively. The pregnant women in observation group had a total of 571 pregnancies including previous pregnancies, the rates of spontaneous abortion of pregnant women with arcuate uterus and septate uterus were the top two, which were 38.5% (35/91) and 28.6% (61/213), respectively. The full term birth rate of pregnant women with vaginal anomalies (70.0%) was higher than that of pregnant women with uterine anomalies (52.8%), and the difference was statistically significant (χ2=4.432, P=0.035). ② The preterm birth rate, incidence of premature rupture of membranes, malpresentation, placental abruption, fetal growth restriction (FGR), placenta adhesions/accreta and uterine rupture, and cesarean section rate of pregnant women in observation group were 29.6%, 29.3%, 36.1%, 5.9%, 2.5%, 21.0%, 3.4%, 78.7%, respectively, which were statistically higher than those of 9.8%, 22.3%, 5.7%, 1.2%, 1.0%, 11.5%, 1.5%, 62.0% in control group, while the rate of oligohydramnios and neonatal birth weight were 0.9% and (2 913±652) g, which were significantly lower than those of 2.9% and (3 254±445) g in control group, and all the differences above were statistically significant (all P<0.05). There were no significant differences in rate of placenta previa, hypertensive disorder complicating pregnancy (HDCP) and postpartum hemorrhage (PPH), and hysterectomy rate between two groups (P>0.05).

Conclusions

Pregnant women with congenital anomalies of genital organ are at high risk of maternal and fetal perinatal complications. The pre-pregnancy and early pregnancy diagnosis rate of congenital anomalies of genital organ should be improved in pregnant women, and strengthening perinatal care and perinatal management can improve perinatal outcomes.

Key words: Genitalia, female, Congenital abnormalities, Pregnancy, Pregnancy complications, Pregnancy outcome, Pregnant women
表1 不同类型先天性生殖器官异常孕妇围生结局及分娩方式比较[例数(%)]
畸形类型 例数 早产 胎膜早破 胎位异常 前置胎盘 胎盘早剥 羊水过少 FGR
纵隔子宫 114 39(34.2) 36(31.6) 54(47.4) 5(4.4) 10(8.9) 3(2.6) 2(1.8)
单角/残角子宫 85 26(30.6) 26(30.6) 31(36.5) 6(7.1) 1(1.2) 0(0) 3(3.5)
双角子宫 14 2(14.3) 4(28.6) 3(21.4) 0(0) 0(0) 0(0) 2(14.3)
弓形子宫 45 12(26.7) 12(26.7) 15(33.3) 2(4.4) 6(13.3) 0(0) 0(0)
双子宫 23 5(21.7) 5(21.7) 10(43.5) 2(8.7) 1(4.3) 0(0) 1(4.3)
阴道纵隔 26 6(23.1) 7(26.9) 1(3.8) 2(7.7) 0(0) 0(0) 0(0)
阴道横隔 3 0(0) 0(0) 0(0) 0(0) 0(0) 0(0) 0(0)
复杂畸形 14 6(42.8) 5(35.7) 3(21.4) 1(7.1) 1(7.1) 0(0) 0(0)
畸形类型 例数 HDCP 胎盘黏连/植入 子宫破裂 PPH 子宫切除 剖宫产
纵隔子宫 114 3(2.6) 28(24.6) 5(4.4) 3(2.6) 0(0) 88(77.2)
单角/残角子宫 85 4(4.7) 17(20.0) 5(5.9) 4(4.7) 0(0) 72(84.5)
双角子宫 14 0(0) 5(35.7) 0(0) 0(0) 0(0) 12(85.7)
弓形子宫 45 0(0) 9(20.0) 0(0) 1(2.2) 0(0) 40(88.9)
双子宫 23 2(8.7) 5(21.7) 1(4.3) 1(4.3) 0(0) 18(78.3)
阴道纵隔 26 1(3.8) 0(0) 0(0) 2(7.7) 0(0) 13(50.0)
阴道横隔 3 0(0) 0(0) 0(0) 0(0) 0(0) 1(33.3)
复杂畸形 14 1(7.1) 3(21.4) 0(0) 1(7.1) 1(7.1) 11(78.6)
表2 2组孕妇围生结局及剖宫产率比较[例数(%)]
组别 例数 早产 胎膜早破 胎位异常 前置胎盘 胎盘早剥 羊水过少 FGR
观察组 324 96(29.6) 95(29.3) 117(36.1) 18(5.6) 19(5.9) 3(0.9) 8(2.5)
对照组 99 455 9 790(9.8) 22 198(22.3) 5 636(5.7) 6 863(6.9) 1 163(1.2) 2 848(2.9) 968(1.0)
χ2值   141.638 9.124 550.907 0.910 56.865 4.368 5.996
P值   <0.001 0.003 <0.001 0.340 <0.001 0.037 0.014
组别 例数 HDCP 胎盘黏连/植入 子宫破裂 PPH 子宫切除 剖宫产
观察组 324 10(3.1) 68(21.0) 11(3.4) 12(3.7) 1(0.3) 255(78.7)
对照组 99 455 5 048(5.1) 11 424(11.5) 1 518(1.5) 4 079(4.1) 261(0.3) 61 660(62.0)
χ2值   2.656 28.606 6.287 0.130 —a 38.276
P值   0.103 <0.001 0.012 0.719 0.574 <0.001
表3 观察组孕妇妊娠情况比较[次数(%)]
先天性生殖器官异常类型 妊娠次数(次) 自然流产 早产 足月产
子宫畸形 506 138(27.3) 101(19.9) 267(52.8)
  纵隔子宫 213 61(28.6) 40(18.8) 112(52.6)
  单角/残角子宫 144 32(22.2) 33(22.9) 79(54.9)
  双角子宫 21 3(14.3) 4(19.0) 14(66.7)
  弓形子宫 91 35(38.5) 17(18.7) 39(42.8)
  双子宫 37 7(18.9) 7(18.9) 23(62.2)
阴道畸形 40 5(12.5) 7(17.5) 28(70.0)
  阴道纵隔 37 5(13.5) 6(16.2) 26(70.3)
  阴道横隔 3 0(0) 1(33.3) 2(66.7)
复杂畸形 25 1(4.0) 10(40.0) 14(56.0)
合计 571 144(25.2) 118(20.7) 309(54.1)
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