Congenital anomalies of the female reproductive system are defined as deviations from normal anatomy, and present a diagnostic challenge because of the variety of morphologic presentations. They are the result of abnormal development of the Müllerian ducts during embryogenesis. These anatomic disorders occur frequently and may result from genetic mutation, developmental arrest or acquired defects. Disorders range from congenital absence of the vagina and uterus, to defects in lateral or vertical fusion of the Müllerian ducts. A variety of anatomic defects may also be found in the urinary system. These anomalies are often asymptomatic and unrecognized. The true prevalence of uterine anomalies in the population is unknown. A recent major study indicated the prevalence of uterine anomalies (including minor anomalies, such as hypoplastic or arcuate uteri) about 7–8% in the normal fertile population and >25% in women with recurrent spontaneous abortions. Less than half, have clinical symptoms. Provided there is no obstruction to menstrual flow, these uterine anomalies present few problems in the absence of pregnancy. In the presence of pregnancy there is an increased incidence of miscarriage, poor fetal growth and malpresentation or placental adherence. The risk of spontaneous abortions in this group, during the first-trimester is 28–45%, while in the second-trimester is 5%. There are different uterine anomalies. A complete failure of fusion between the ducts results in a didelphic uterus. A partial failure results in an arcuate or bicornuate uterus. A failure of septal resorption results in variants ranging from a subseptate to a septate uterus. Atresia of one of the paramesonephric ducts results in a unicornuate uterus with a single tube. A differential diagnosis is very important, because of prognosis for reproduction and the choice of the most suitable surgical approach. Women with uterine anomalies are known to have a higher incidence of infertility, pelvic pain, recurrent pregnancy loss, preterm labor, fetal mortality, fetal growth restriction, preterm rupture of membranes, abnormal fetal presentation, retained placenta, and increased cesarean delivery rate. US is often the first imaging modality chosen because of its availability, short scan time, and low cost, several limitations are encountered during imaging. Transvaginal imaging, although superior to the transabdominal approach, may not always be possible, as in young girls or patients with vaginal septa. Detection of uterine anomalies by 3D ultrasound or MRI has really increased the accurate diagnosis of these anomalies. Several studies have examined pregnancy outcomes for each specific uterine anomaly. Women with an arcuate uterus have a similar reproductive outcome to women with a normal uterus. The unicornuate uterus has the poorest overall reproductive outcome, and the septate uterus has an increased miscarriage rate. The didelphic uterus, also has poor obstetrical outcomes. Didelphic, bicornuate, unicornuate, and septate uteri have also lower pregnancy rates in ART. Conclusion: Women with congenital uterine malformation usually have poorer reproductive outcomes and higher incidence of complications during pregnancy and delivery. Early diagnosis and treatment can improve obstetric outcomes.
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