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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)
[1]
Christiansen ME, Detti L. Clinically relevant female genital tract anomalies[J]. Clin Obstet Gynecol, 2017, 60(1): 18-26. DOI: 10.1097/GRF.0000000000000258.
[2]
Passos IMPE, Britto RL. Diagnosis and treatment of müllerian malformations[J]. Taiwan J Obstet Gynecol, 2020, 59(2): 183-188. DOI: 10.1016/j.tjog.2020.01.003.
[3]
Turocy JM, Rackow BW. Uterine factor in recurrent pregnancy loss[J]. Semin Perinatol, 2019, 43(2): 74-79. DOI: 10.1053/j.semperi.2018.12.003.
[4]
Cahen-Peretz A, Sheiner E, Friger M, et al. The association between Müllerian anomalies and perinatal outcome[J]. J Matern Fetal Neonatal Med, 2019, 32(1): 51-57. DOI: 10.1080/14767058.2017.1370703.
[5]
Fox NS, Roman AS, Stern EM, et al. Type of congenital uterine anomaly and adverse pregnancy outcomes[J]. J Matern Fetal Neonatal Med, 2014, 27(9): 949-953. DOI: 10.3109/14767058.2013.847082.
[6]
Letterie GS. Management of congenital uterine abnormalities[J]. Reprod Biomed Online, 2011, 23(1): 40-52. DOI: 10.1016/j.rbmo.2011.02.008.
[7]
Prior M, Richardson A, Asif S, et al. Outcome of assisted reproduction in women with congenital uterine anomalies: a prospective observational study[J]. Ultrasound Obstet Gynecol, 2018, 51(1): 110-117. DOI: 10.1002/uog.18935.
[8]
Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies[J]. Hum Reprod, 2016, 31(1): 2-7. DOI: 10.1093/humrep/dev264.
[9]
中华医学会妇产科学分会. 女性生殖器官畸形诊治的中国专家共识[J]. 中华妇产科杂志， 2015, 50(10): 729-733. DOI: 10.3760/cma.j.issn.0529-567x.2015.10.002.
[10]
Knez J, Saridogan E, Van Den Bosch T, et al. ESHRE/ESGE female genital tract anomalies classification system-the potential impact of discarding arcuate uterus on clinical practice[J]. Hum Reprod, 2018, 33(4): 600-606. DOI: 10.1093/humrep/dey043.
[11]
Makrigiannakis A. Implantation in women with uterine congenital malformations[M]// Grimbizis GF, Campo R, Tarlatzis BC, et al. Female genital tract congenital malformations: classification, diagnosis and management. London: Springer, 2015: 29-34. DOI: 10.1007/978-1-4471-5146-3.
[12]
Cahen-Peretz A, Walfisch A, Friger M, et a1. Maternal müllerian anomalies and future health of the offspring[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 212: 20-24. DOI: 10.1016/j.ejogrb.2017.02.010.
[13]
曹泽毅. 中华妇产科学[M]. 2版. 北京： 人民卫生出版社， 2004: 706-708.
[14]
Chan YY, Jayaprakasan K, Zamora J, et al. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review[J]. Hum Reprod Update, 2011, 17(6): 761-771. DOI: 10.1093/humupd/dmr028.
[15]
Olpin JD, Moeni A, Willmore RJ, et a1. MR imaging of Müllerian fusion anomalies[J]. Magn Reson Imaging Clin N Am, 2017, 25(3): 563-575. DOI: 10.1016/j.mric.2017.03.008.
[16]
Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies[J]. Gynecol Surg, 2016, 13: 1-16. DOI: 10.1007/s10397-015-0909-1.
[17]
王姝， 邓姗， 朱兰， 等. 应用3D打印技术手术前诊断女性生殖道畸形附一例报告[J]. 中华妇产科杂志， 2017, 52(10): 708-710. DOI: 10.3760/cma.j.issn.0529-567x.2017.10.013.
[18]
Pan HX, Liu P, Duan H, et al. Using 3D MRI can potentially enhance the ability of trained surgeons to more precisely diagnose Mullerian duct anomalies compared to MR alone[J]. Eur J Obstet Gynecol Reprod Biol, 2018, 228: 313-318. DOI: 10.1016/j.ejogrb.2018.07.007.
[19]
El Hachem H, Crepaux V, May-Panloup P, et al. Recurrent pregnancy loss: current perspectives[J]. Int J Womens Health, 2017, 9: 331-345. DOI: 10.2147/IJWH.S100817.
[20]
Saravelos SH, Cocksedge KA, Li TC. The pattern of pregnancy loss in women with congenital uterine anomalies and recurrent miscarriage[J]. Reprod Biomed Online, 2010, 20(3): 416-422. DOI: 10.1016/j.rbmo.2009.11.021.
[21]
Zhou H, Liu Y, Liu L, et al. Maternal pre-pregnancy risk factors for miscarriage from a prevention perspective: a cohort study in China[J]. Eur J Obstet Gynecol Reprod Biol, 2016, 206: 57-63. DOI: 10.1016/j.ejogrb.2016.07.514.
[22]
Jones RK, Jerman J. Population group abortion rates and lifetime incidence of abortion: United States, 2008-2014[J]. Am J Public Health, 2017, 107(12): 1904-1909. DOI: 10.2105/AJPH.2017.304042.
[23]
Hiersch L, Yeoshoua E, Miremberg H, et al. The association between Mullerian anomalies and short-term pregnancy outcome[J]. J Matern Fetal Neonatal Med, 2016, 29(16): 2573-2578. DOI: 10.3109/14767058.2015.1098613.
[24]
Takami M, Aoki S, Kurasawa K, et al. A classification of congenital uterine anomalies predicting pregnancy outcomes[J]. Acta Obstet Gynecol Scand, 2014, 93(7): 691-697. DOI: 10.1111/aogs.12400.
[25]
Venetis CA, Papadopoulos SP, Campo R, et al. Clinical implications of congenital uterine anomalies: a Meta-analysis of comparative studies[J]. Reprod Biomed Online, 2014, 29(6): 665-683. DOI: 10.1016/j.rbmo.2014.09.006.
[26]
Karami M, Jenabi E. The association between Mullerian anomalies and IUGR: a Meta-analysis[J]. J Matern Fetal Neonatal Med, 2019, 32(14): 2408-2411. DOI: 10.1080/14767058.2018.1432588.
[27]
Khazaei S, Jenabi E, Veisani Y. The association of Mullerian anomalies and placenta abruption: a Meta-analysis[J]. J Matern Fetal Neonatal Med, 2019, 32(3): 512-516. DOI: 10.1080/14767058.2017.1379072.
[28]
Kroener L, Wang ET, Pisarska MD. Predisposing factors to abnormal first trimester placentation and the impact on fetal outcomes[J]. Semin Reprod Med, 2016, 34(1): 27-35. DOI: 10.1055/s-0035-1570029.
[29]
Shim S, Hur YM, Kim DH, et al. Evidence for no significant impact of Müllerian anomalies on reproductive outcomes of twin pregnancy in Korean women[J]. Twin Res Hum Genet, 2016, 19(2): 146-153. DOI: 10.1017/thg.2016.4.
[30]
DI Spiezio Sardo A, Spinelli M, DA Cunha Vieira M, et a1. Hysteroscopic treatment of Müllerian duct anomalies[J]. Minerva Ginecol, 2016, 68(2): 175-185.
[31]
Budden A, Abbott JA. The diagnosis and surgical approach of uterine septa[J]. J Minim Invasive Gynecol, 2018, 25(2): 209-217. DOI: 10.1016/j.jmig.2017.07.017.
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