Congenital Uterine Anomalies: Diagnosis and Reproductive Outcomes

Congenital uterine anomalies arise from aberrant development, fusion or resorption of the Müllerian ducts during embryogenesis, leading to a spectrum of morphological variations in uterine shape and internal architecture. Common subtypes include the septate uterus, characterised by a fibrous or muscular septum dividing the uterine cavity; the bicornuate uterus, with an indented fundal contour; the unicornuate uterus, featuring a single horn often accompanied by a rudimentary structure; and uterine didelphys, a complete duplication of uterine bodies and cervices. Presentation may be silent or manifest as recurrent miscarriage, infertility, preterm birth or malpresentation. Diagnostic modalities have evolved from two-dimensional ultrasound and hysterosalpingography to three-dimensional ultrasound and magnetic resonance imaging, supported by standardised classification systems that aim to improve reproducibility and guide clinical decision-making. Hysteroscopic metroplasty of a septate uterus remains the most widely adopted surgical intervention to restore a unified cavity and improve reproductive chances, whereas management of other subtypes often requires individualised approaches. Meta-analyses have quantified increased risks of pregnancy loss, preterm delivery and obstetric complications across anomaly types, while registry data and cohort studies underscore the influence of anatomical severity, patient age and comorbid conditions on outcomes. Advances in imaging and minimally invasive surgery have enhanced early detection, refined subtype delineation and optimised treatment pathways, with the ultimate goal of improving live birth rates while minimising procedural morbidity.

Research from Nature Portfolio

Recent work evaluating minimally invasive correction techniques has demonstrated that a vaginoscopic incision of an oblique vaginal septum in adolescents with obstructed hemi-vagina and ipsilateral renal agenesis yields excellent short-term relief of symptoms and prevents septal reformation. Utilising a “no-touch” approach under direct visualisation, surgeons achieved complete drainage without intraoperative complications, minimal postoperative pain and preserved vaginal integrity. Follow-up vaginoscopy confirmed sustained patency of the vaginal canal, indicating that this technique offers a safe, effective alternative to conventional approaches and may accelerate recovery and reduce hospital stay.

Congenital Uterine Anomalies: Diagnosis and Reproductive Outcomes publication trend

The graph below shows the total number of articles in congenital uterine anomalies: diagnosis and reproductive outcomes across all publications each year (not limited to Nature Index journals).

Technical terms

Müllerian duct anomaly (MDA): A developmental defect in one or more of the paired embryonic ducts that form the female reproductive tract.

Septate uterus: A condition in which a fibromuscular septum divides the uterine cavity to a variable extent, increasing miscarriage risk.

Hysteroscopic metroplasty: A minimally invasive endoscopic procedure to resect a uterine septum and restore a single cavity.

Unicornuate uterus: A malformed uterus with a single horn and often a non-communicating rudimentary horn, linked to obstetric complications.

OHVIRA syndrome: Obstructed hemivagina and ipsilateral renal anomaly, a rare combination of Müllerian and urinary tract malformations requiring prompt drainage of haematocolpos.

References

1. Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty. Frontiers in Endocrinology (2023).
2. Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research. Journal of Clinical Medicine (2022).
3. Reproductive, Obstetric and Neonatal Outcomes in Women with Congenital Uterine Anomalies: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine (2021).
4. Vaginoscopic Incision of Oblique Vaginal Septum in Adolescents with OHVIRA Syndrome. Scientific Reports (2019).