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Clinical Obstetrics

Poster Session 1

(325) Adverse Pregnancy Outcomes in Patients with Congenital Uterine Anomalies: Evaluation of a Large Population Database

Tuesday, February 13, 2024
10:30 AM – 12:00 PM  
Location: Prince George's Exhibit Hall CDE, Lower Atrium Level

    Primary & Presenting Author(s)

  • Zoe O. Silsby, BS (she/her/hers)

    Medical Student
    Case Western Reserve University School of Medicine
    Cleveland, OH, United States

    • Coauthor(s)

  • SR

    Stephen Rhodes, PhD

    University Hospitals
    Cleveland, OH, United States

  • DK

    David C. Kaelber, MD, MPH, PhD

    Center for Clinical Informatics Research and Education, The MetroHealth System
    Cleveland, OH, United States

  • DS

    David Sheyn, MD

    University Hospitals
    Cleveland, OH, United States

  • Justin R. Lappen, MD

    Division Director - Maternal Fetal Medicine Associate Professor - Obstetrics/Gynecology and Reproductive Biology Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
    Cleveland Clinic Foundation
    Cleveland, OH, United States

Objective:

Published literature has established an increased risk of some adverse pregnancy outcomes in patients with congenital uterine anomalies (CUA); however, prior studies are limited by small sample sizes. Our aim was to better characterize the risk of adverse pregnancy outcomes among patients with CUA. 

Study Design:

We performed a retrospective cohort study of female patients aged 10-55 with a documented pregnancy outcome in the TriNetX Analytics Research Network. Congenital uterine anomalies were identified using ICD-10 codes Q51.x and O34.0. Patients with multiple conflicting diagnosis codes were excluded from analysis. We assessed the risk of adverse pregnancy outcomes in patients with and without an encounter diagnosis of CUA. Outcomes of interest included pregnancy outcome (i.e. abortion, ectopic pregnancy, live birth, stillbirth) and Severe Maternal Morbidity (SMM), using ICD-10 indicator codes selected by the Centers for Disease Control and Prevention (CDC). Descriptive statistics and chi-squared tests were used to analyze differences between groups.

Results: 2,217,222 patients met inclusion criteria, 16,413 of whom had a one or more encounter diagnoses codes for CUA. Baseline differences between groups are shown in Table 1. Compared to patients with no encounter diagnoses for CUA, patients with CUA had higher rates of spontaneous abortion (14% vs 6.8%, p< 0.001) and stillbirth (1.2% vs 0.45%, p< 0.001). SMM was also increased in patients with CUA. Specifically, these patients had statistically significantly higher rates of blood products transfusion (1% vs 0.79%) hysterectomy (0.21% vs 0.10%), and DIC (0.46% vs 0.26%, all p< 0.001) within 30 days of delivery.

Conclusion: Patients with CUA are at higher risk of adverse pregnancy outcomes compared to patients with normal uterine anatomy, including for SMM and severe hemorrhage. Patients with CUA should be counseled about these pregnancy-associated risks, and CUA should be incorporated into risk-stratification and prevention strategies.