Congenital uterine anomalies diagnosed at EPAS or dating ultrasound: a guideline for ongoing management

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Congenital uterine anomalies (CUA) are malformations of the uterus which occur during development in-utero. These malformations are therefore present from birth and many women have no symptoms-some may experience heavy periods. The implications of CUA, depending on the type and severity, can range from an increased risk of 1st/2nd Trimester miscarriage(s), intra-uterine growth restriction (IUGR), fetal malpresentation, pre-eclampsia and pre-term birth (PTB). There can be an association with anomalies of the genital tract, bladder and kidneys. Consideration should therefore be given to ultrasound imaging of the renal tract if indicated.

Types

  • Bicornuate uterus (heart-shaped womb)
  • Unicornuate uterus
  • Didelphic (double womb)
  • Septate/sub-septate uterus
  • Arcuate womb

Women who have had resection of a uterine septum remain at risk of PTB

Implications

Women with bicornuate and unicornuate uteri have an increased risk of first trimester miscarriage (OR 3.4; 95% CI 1.18–9.76 and OR 2.15; 95% CI 1.03–4.47 respectively), preterm birth (OR 2.55; 95% CI 1.57–4.17 and OR 3.47; 95% CI 1.94–6.22 respectively) and fetal malpresentation (OR 5.38; 95% CI 3.15–9.19 and OR 2.74; 95% CI 1.3–5.77 respectively), while women with uterus didelphys appear to have an increased risk of preterm labour (OR 3.58; 95% CI 2.0–6.4) and fetal malpresentation (OR 3.7; 95% CI 2.04–6.7).

The presence of variations in uterine size and shape in expectant mothers is associated with a two to five-fold increase in the risk of spontaneous preterm birth compared to those with normal uterine anatomy.

Management

The UK Preterm Birth Clinical Network Guidance advises women with CUA are referred to consultant antenatal clinics to form a plan of care for the remainder of pregnancy. 

Within GG&C we suggest that women found to have a CUA on an EPAS or dating ultrasound should have a Critical Alert-Woman generated on Badger by the sonographer and an appointment arranged with the patient’s named consultant at 16 weeks gestation in order to discuss this further.

Critical Alert-Woman

To enter a Critical Alert-Woman please search under the ‘Enter new note tab’ (See Picture 1) Complete the boxes (See Picture 2) detailing the details of the alert e.g. Bicornate uterus at EPAS scan. 

Picture 1

Picture 2

Suggested management includes 3rd trimester growth scans to monitor for IUGR and to confirm fetal presentation by 36 weeks gestation. Women with CUA are advised with signs and symptoms of PTB to contact MAU 24/7 for further assessment. If PTB at <30 weeks gestation is confirmed the PreTerm Labour guideline should be followed remembering to include; corticosteroids, Magnesium Sulphate and anti-biotic cover.

References

Reproductive Implications and Management of Congenital Uterine Anomalies MA Akhtar, SH Saravelos, TC Li, K Jayaprakasan, on behalf of the Royal College of Obstetricians and Gynaecologists

UK Preterm Clinical Network. Reducing preterm birth. Guidelines for commissioners and providers. 2019 [www.tommys.org/our-orga nisation/our-research/premature-birth-research/reducingpretermbirth-rates]

https://www.tommys.org/pregnancy-information/pregnancy-complications/uterine-abnormalityproblems-womb

Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies. Reprod Biomed Online2014; 29(6): 665 – 8

Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Cahill AG. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol 2011; 205(6): 558 e1 –5

Last reviewed: 30 November 2021

Next review: 30 November 2026

Author(s): Lynne Thomson

Version: 1

Approved By: Gynaecology Clinical Governance Group

Internal URL: 951