Frequency and Types of Uterine Anomalies during Caesarean Section for Abnormal Presentation

Author(s): Prathap T.1 , Neha M. Wali2 , Akshara Prasad3 , Ashwini R.4

BACKGROUND Abnormal fusion or canalisation of mullerian duct during embryonic life results in congenital uterine malformations. Prevalence of congenital uterine malformations is approximately 2 - 4% in reproductive age group and 5 - 25% in women with adverse pregnancy outcomes. Diagnosis of uterine anomalies has to be made precisely which requires diagnostic modalities like ultrasonography, magnetic resonance imaging, hysterosalpingogram, and hysterolaparoscopy. This observational study is conducted to determine the frequency and types of congenital uterine anomalies discovered during Caesarean section done for abnormal presentations. METHODS This is a retrospective observational study conducted in the Department of Obstetrics and Gynaecology of JSS Hospital, Mysuru. A total number of 108 cases were included in the study over a period of 2 years. Patients who underwent Caesarean section due to abnormal presentation were included in the study. After delivery of the foetus and the placenta, uterus was examined for the presence or absence of congenital malformations by digital palpation of the uterine cavity and inspection of fundus of uterus after exteriorisation. Demographic characteristics and the obstetric outcomes were noted. RESULTS During the study period of 2 years, 108 Caesarean sections were performed for abnormal presentation in the Department of OBG, JSS Hospital, Mysuru. Out of 108 patients, 15 (13.89%) patients were diagnosed with uterine anomalies and 93 (86.11%) patients had normal uterus. Majority of the patients with uterine anomalies who underwent caesarean section were primigravida (80%) and also majority of them belonged to the age group of 25 - 30 years (73.3%). The most commonly observed uterine anomaly during the study period was arcuate uterus. Though our study included cases only with abnormal presentation, 12 out of 15 (80%) had breech presentation and the rest 3 (20%) had transverse lie. History of miscarriage was found to be higher in patients with uterine anomalies. 53.3% patients with uterine anomaly had preterm delivery & the preterm delivery rate in patients with normal uterus was lesser i.e. 40.9%. CONCLUSIONS Congenital uterine anomalies can affect reproductive and obstetric outcomes and hence their accurate diagnosis can benefit several women from adverse outcomes. Caesarean section can be one of the diagnostic modalities for uterine malformations with no increase in the operative time or risk or cost for the patient.