Pregnancy Complications in Uterine Anomalies—A Pilot Study
by
, and
Claudiu Voic
1,
Melinda Ildiko Mitranovici
2,*
,
Septimiu Voidazan
3,
Cezara Maria Mureşan
4,5,6 and
Elena Silvia Bernad
4,5,6,7
1
Doctoral School, Victor Babes University of Medicine and Pharmacy from Timișoara, 300041 Timisoara, Romania
2
Department of Obstetrics and Gynecology, Emergency County Hospital Hunedoara, 14 Victoriei Street, 331057 Hunedoara, Romania
3
Department of Epidemiology, “George Emil Palade” University of Medicine, Pharmacy, Sciences and Technology, 540142 Targu Mures, Romania
4
Department of Obstetrics and Gynecology, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
5
Center for Laparoscopy, Laparoscopic Surgery and In Vitro Fertilization, Faculty of Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
6
Clinic of Obstetrics and Gynecology, Laparoscopy, In Vitro Fertilization and Embryotransfer Research Center, Pius Brinzeu County Clinical Emergency Hospital, 300723 Timisoara, Romania
7
Center for Neuropsychology and Behavioral Medicine, Victor Babes University of Medicine and Pharmacy, 300041 Timisoara, Romania
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2026, 15(8), 2827; https://doi.org/10.3390/jcm15082827
Submission received: 4 March 2026
/
Revised: 2 April 2026
/
Accepted: 5 April 2026
/
Published: 8 April 2026
(This article belongs to the Special Issue Pregnancy and Delivery Complications: Bridging Research and Clinical Practice)
Abstract
Uterine malformation represents a rare disease with a prevalence of up to 7% of the general population. Background/Objectives: Higher pregnancy complication rates have been reported in the literature; thus, in our study, we aimed to examine not only the obstetric complications encountered but also the psychological interventions and multidisciplinary approaches for parental counseling in our department in the context of preterm birth at the limit of viability. Methods: A retrospective pilot study was conducted on all the women in our department between 2010 and 2017 with congenital uterine malformations associated with infertility or pregnancy. In the study group, we included women with AUCs (n = 26), while the control group included pregnant women with normal uteri (n = 25) (total: n = 51), and then pregnancy complications were investigated. Results: Highly significant pregnancy complications were observed in the study group, the most important being preterm birth (p = 0.003) in comparison with the control group. Out of 26 patients with AUCs, only 14 gave birth to a live fetus compared to 22 out of the 25 with normal pregnancies, meaning that failure to give birth to a live newborn statistically significantly increased among the former group (p = 0.004). In terms of birth weight (p = 0.0001), Apgar score (p = 0.029) and intensive care unit admission (p = 0.0001), we observed significant differences between the newborns in the study group versus controls, with an impact on mental state that required psychological support. Conclusions: A clear correlation was observed in our study between uterine congenital malformations and pregnancy complications. The most common pregnancy outcome was premature delivery, with statistical significance. In addition, higher neonate admissions to the intensive care unit associated with lower Apgar scores were encountered compared with normal pregnancies. Appropriate parental counseling by obstetricians, neonatologists and psychologists could enhance pregnancy outcomes.
1. Introduction
The uterine malformation prevalence is 7% of the general population [1,2,3,4], including pathologies that may be affected by inaccurate diagnostic techniques [5]. Higher associated rates of pregnancy complications have been reported in the literature, such as miscarriage, preterm delivery, miscarriage, fetal death, ectopic pregnancy, malpresentation, intrauterine growth restriction or other obstetric complications [4,5,6,7,8,9,10]. High-risk pregnancy is associated with emotional stress, and thus professional support contributes to these pregnant women’s emotional well-being [11].
Many classifications have been proposed for uterine malformations, with the most accurate being that of the American Society of Reproductive Medicine [1,12]. In addition, the European Society of Human Reproduction and Embryology/European Society for Gynecological Endoscopy (ESHRE/ESGE) classification is relevant and has increased clinical impact [2]. Five main classes are included in this classification system: dysmorphic T-shaped uteri; septate uteri; uterus didelphys and bicornuate uteri; unicorporeal or unicornuate uteri; and aplastic uteri. In this classification, unclassified is class 6, while normal uteri are class 0 [2,13].
Different techniques are used to diagnose congenital uterine anomalies (CUAs): the most prominent is ultrasound, including 3D ultrasound (3D US), followed by hysterosalpingography (HSG), magnetic resonance imaging (MRI), hysteroscopy, and laparoscopy [2]. According to most studies, uterine malformations are associated with poor obstetric outcomes [4]. Surgical strategies have been employed to improve reproductive outcomes, but their effectiveness has not yet been demonstrated [1,8].
CUAs have been relatively understudied due to their rarity [5,6], meaning that their association with heavy mental pressure is poorly evaluated. Parental stress related to female infertility, poor obstetric outcomes, and premature infant hospitalization is a significant concern [14]. Approximately 64% of parents are affected by the inability to achieve spontaneous conception [14,15], a situation that also affects their quality of life, with adverse social consequences such as marriage breakdown. Targeted psychological interventions are required to improve their quality of life [16].
In this context, through our study, we aim to examine not only the obstetric complications encountered but also the psychological interventions and multidisciplinary approaches for parental counseling in our department. Our intention is to raise awareness of the importance of uterine malformation and the necessity of psychological interventions among both professionals and patients. Further studies are needed in order to find new and effective methods to improve fertility and pregnancy outcomes.
2. Materials and Methods
We conducted a retrospective pilot study on all women with congenital uterine malformations in our department between 2010 and 2017. The inclusion criteria were women with uterine abnormalities such as Müllerian agenesia, bicornuate uterus, unicornuate uterus, uterus didelphys, and septate uterus, determined according to the American College of Obstetricians and Gynecologists (ACOG) classification [1,12] as being associated with infertility or pregnancy. Infertility was defined according to the World Health Organization (WHO) criteria: patients with difficulty achieving a pregnancy after 12 months [12]. Exclusion criteria were as follows: genital malformations encountered outside of the context of infertility or pregnancy, multiple pregnancies, or pregnancies with fetal anomalies; complex malformations were also excluded. In the study group, we included women with CUAs (n = 26). Pregnancies in case of normal uteri were included in the reference group (n = 25). We included a total of 51 women in our study. We recorded data about maternal obstetric and demographic characteristics.
The description of the malformations was obtained based on the ACOG recommendation [1,12] using 3D transvaginal ultrasonography, hysteroscopy and laparoscopy. Surgical procedures were the treatment tool used for this specific purpose, and also to confirm the diagnosis suggested by ultrasound. We evaluated the maternal evolution, as well as the short-term neonatal outcomes, such as birth weight, sex, Apgar score and intensive care unit admission, and then we compared the two groups.
Signed informed consent was obtained from all patients upon admission to our department. The Ethics Committee of the Clinical Studies of Emergency County Hospital Al Simionescu Hunedoara approved the research protocol and the publication of the articles (ethical approval number: 16552/04.11.2024).
Statistical Analysis
The normality distribution of numerical variables was assessed using the Kolmogorov–Smirnov test. Numerical data are expressed as means (standard deviation) or as medians (interquartile range) for normally and non-normally distributed data, respectively.
The Chi-squared test was used to compare categorical variables with the overall p-values provided in the tables. The level of statistical significance was set at p < 0.05, and all statistical tests were performed with SPSS, version 23.0.0 (SPSS Inc., Chicago, IL, USA).
3. Results
We have divided this section into several subsections based on the different factors analyzed.
3.1. Demographic Data and Diagnostic Tools
Comparing the study group of patients with uterine malformations in the context of pregnancy (n = 26) and the control group of women with normal pregnancies (n = 25), demographic data show non-statistically significant differences.
We present the types of malformations and diagnostic methods in the table below; 3D transvaginal ultrasound was the main technique, and we applied the Chi-squared test. Hysteroscopy and laparoscopy were, until recently, the gold standard in diagnostic procedures for AUCs. Even if these techniques are invasive, they allow for concurrent surgical correction. While a normal uterus does not require additional diagnostic methods, besides ultrasound, in case of AUCs, we sometimes need other investigations. In some of our cases, a combination of these techniques was applied (Table 1).
3.2. Types of Pregnancy-Related Complications Encountered
The most common pregnancy-related complication found in women with CUAs is preterm birth. We identified seven miscarriages, three infertility cases and eight premature births among the twenty-six women in our study group. These complications have a significantly severe impact on women with uterine anomalies (p = 0.003) (Table 2).
Then, we analyzed the relation between the types of malformations and pregnancy complications encountered and observed that the most frequent malformation was a subseptate uterus (11 from 26), associated with miscarriage in three cases, preterm birth, and placenta praevia in three cases. Mullerian agenesis led to infertility in 100% of instances. A miscarriage with serious bleeding was obtained in a septate uterus (Table 3).
The results in the statistics were included separately, but since in some cases two or three concurrent results were encountered, due to a potential causal relationship, we chose to display them this way precisely for clearer evidence; otherwise, the total number of outcomes is greater precisely through cumulation.
Significantly poorer pregnancy outcomes were obtained in the malformation group compared to the control group, as shown in Table 2 (p = 0.003). The most severe outcomes, such as infertility, were encountered in Müllerian agenesia or a bicornuate uterus. In addition, ectopic pregnancy followed by hysterectomy was encountered in the case of a unicornuate uterus with a rudimentary horn, while pregnancies in cases of a subseptate uterus and uterus didelphys were associated with the best outcomes in our study.
3.3. Types of Deliveries and Interventions
Out of 26 patients with CUAs, only 14 gave birth to a live fetus, compared to 22 out of 25 of those with normal pregnancies, meaning that the failure to give birth to a live newborn was statistically significantly increased (p = 0.004). The difference between groups regarding cesarean section and vaginal delivery was not significantly affected (Table 4).
Regarding types of surgical interventions used in this study, the most common procedure was cerclage in seven cases (26.9%); in 50% of CUAs, no procedure was applied (Table 5).
In our study, infertility was encountered in Müllerian agenesia along with bicornuate and septate uteri. Miscarriages were also associated with a bicornuate and septate uterus. Metroplasty was not successful in cases of a bicornuate uterus, while hysteroscopic septum resection was successful in only one case of a subseptate uterus, followed by premature birth. In one situation, a hysterectomy was used in the case of an ectopic pregnancy in the rudimentary uterine horn.
3.4. Neonatal Outcomes
Significant differences were encountered in the neonate outcomes in the two groups. We applied the Student test to compare the birth weight of newborns in the two groups, which was statistically significantly lower in patients with uterine anomalies (Table 6).
Apgar scores recorded at 1 min were also compared, with low scores reported in four cases in the study group, reaching statistical significance (p = 0.029) (Table 7).
Neonatal Intensive Care Unit (NICU) admission only occurred in the malformation group, and this difference was statistically significant (p = 0.001). The NICU admission was reported in cases of uterus didelphys, uterus bicornuate and uterus subseptate (Table 8).
3.5. Multidisciplinary Approach to Prenatal Parental Counseling
Considering the pregnancy complications associated with uterine anomalies, a multidisciplinary approach was necessary in a statistically significant proportion of cases (p = 0.002) (Table 9). The impact on mental state necessitated psychological support, especially in cases of infertility and premature infants born at the limit of viability. Prenatal counseling was chosen with the inclusion of a neonatologist to provide an accurate explanation of the infant’s evolution. In normal pregnancies, only an obstetrician or an obstetrician and neonatologist were necessary. Parental inclusion in therapeutic decision-making, however, was not statistically significant (Table 10).
4. Discussion
Uterine malformations are rare diseases associated with poor pregnancy outcomes [1,2,3,4]. As we have structured the results, in the discussions we focus on the aspects pursued: pregnancy outcomes in AUCS compared with normal uterus, diagnostic tools used in our study compared with the literature, surgical procedures, multidisciplinary approach and ethical concerns.
In our research, we observed the poorest obstetric outcomes in the case of Müllerian agenesia (infertility), followed by bicornuate uteri (infertility and miscarriage) (p = 0.003). Similar results were obtained by Pedro [4], wherein the bicornuate uterus groups were associated with pregnancy complications. This situation is linked with the underdiagnosis of congenital uterine anomalies (CUAs) [17]. According to Kang et al. (2024) [18], CUAs are associated with poor obstetrical outcomes such as higher early miscarriage rates and lower live birth rates [18]. However, women with CUAs have a significantly higher risk of developing pregnancy complications, including infertility, compared to women with a normal uterus [13]. Lin et al. (2004) [19] found in their research that the poorest reproductive outcomes were obtained in women with unicornuate uteri, while an arcuate uterus, which is a variant of a normal uterus, is not associated with pregnancy complications. In case of a septate uterus, an increased miscarriage rate was detected [19]. Our findings are similar to the literature. Analyzing the relation between malformation types and pregnancy outcomes, the most frequent malformation encountered was a subseptate uterus (11 of 26), associated with miscarriage in three cases, and placenta praevia, associated with preterm birth in three cases. In one case of a unicornuate uterus with a rudimentary horn, ectopic pregnancy was followed by hysterectomy. Only 14 out of 26 patients with CUAs gave birth to a live fetus compared to 22 out of 25 of those with normal pregnancies, meaning that the failure to give birth to a live newborn was statistically significantly increased (p = 0.004). However, any anatomical defects can lead to complications, while successful embryo implantation depends on a proper endometrial cavity [5]. The best outcomes were therefore obtained in pregnancies associated with a subseptate uterus and uterus didelphys, followed by preterm birth. Preterm birth was observed in uteri didelphys, unicornuate uteri, and subseptate uteri. Preterm birth was associated with other complications, for example, placenta praevia, breech presentation, or bleeding and also occurred alone. Unicornuate and didelphys uteri were also followed by miscarriages. However, according to De Angelis (2015), a successful pregnancy is possible [20], but didelphys uteri have a higher risk of preterm delivery [21] and IUGR [22]. In our study, the most important complication encountered in women with CUAs was premature delivery, even after proper management of such pregnancies, which is similar to data in the literature [21,22,23,24,25].
Uterine malformations remained underdiagnosed in our study, even if ultrasound demonstrated its efficacy. Confusion still exists in diagnosing such cases, especially between arcuate and subseptate uteri. Also, an ectopic pregnancy developed in the rudimentary horn of a woman with a unicornuate uterus was diagnosed only through laparotomy. This was corroborated by Li et al. (2019), who described a rupture of an ectopic first-trimester pregnancy developed in the rudimentary horn [26]. Mistakes occur when investigating women with CUAs, which may lead to pregnancy mismanagement [27]. CUME definitions for these conditions could help in diagnosing uterine malformations [17].
The successful diagnostic tool used in our study was 3D transvaginal ultrasonography; however, other techniques were used, such as hysteroscopy, hysterography, and laparoscopy. Surgical interventions were considered for treatment, with cerclage being the most common surgical procedure used successfully in our study, reaching statistical significance (p = 0.005). Cervical incompetence was not associated with any of these cases. Based on the findings in the literature, this procedure can be used most of the time with remarkable results [4,28]. However, the gold standard in AUCs diagnosis remains MRI [29,30]
Related to surgical interventions, in our study, the uterine cavity obtained after metroplasty was insufficient for the development of a normal pregnancy, and was followed by miscarriage. According to the literature, the rate of pregnancy can not be increased after metroplasty [4], and according to Wang et al. (2019), the metroplasty was followed by infertility, a procedure also used in a case of a complete uterine septum [31]. On the contrary, Ganti et al. (2024) suggested that hysteroscopic metroplasty can significantly improve pregnancy outcomes [29], while Shokeir (2004) performed hysteroscopic septoplasty in women with unexplained infertility [32]. In our research, hysteroscopic septum resection was successful in only one case of a subseptate uterus, followed by premature birth. Afterward, a high proportion of the affected women can conceive spontaneously [31]. According to Akhtar et al. (2020), surgical procedures used as treatment for CUAs are not recommended because of the high risk they pose compared to their potential benefits [30].
In our study, a rudimentary uterine horn was complicated by an ectopic pregnancy that ended with a hysterectomy. This was successfully diagnosed through ultrasound and confirmed after the surgical procedure.
Additionally, we analyzed neonatal outcomes in the pregnancies of women with CUAs compared with those in women with normal uteri. We encountered a low Apgar score (p = 0.029) and high NICU admissions of neonates delivered by pregnant women with CUAs, which were significantly higher than in the control group (p = 0.001). Birth weight was also statistically significantly lower in patients with uterine anomalies (p = 0.0001). Our findings are similar to those obtained in a case report by Vaz et al. (2017) [33]. Furthermore, Abe et al. reported severe cerebral palsy, a long-term neuro-developmental disorder, in a neonate after a pregnancy associated with a bicornuate uterus [34]. Müllerian defects could be considered a risk factor for poor pregnancy outcomes, associated with placental abruption, intrauterine growth restriction, preeclampsia, and preterm delivery with high perinatal mortality [29,33]. Abnormal placental cord insertion was another complication reported in cases of pregnancies complicated by a CUA, which is associated with poor pregnancy outcomes [30,35].
Proper management of these conditions depends on a universally accepted classification system, which is needed in order to find appropriate prevention strategies [28,36]. In the future, different diagnostic modalities will be necessary for precise classification [24,37], but until then, CUAs can be easily misdiagnosed. According to Akkus et al. (2024), over one year, anomalies did not receive prior diagnosis, being discovered during cesarean section in a tertiary center [38].
A multidisciplinary approach was necessary in a statistically significant proportion (p = 0.002) of patients in our research. Abhinaya et al. conducted a study (2024), finding that those with CUAs require proper counseling in the antenatal period and proper monitoring during labor [24,39]. According to Hendy, three-quarters of parents experienced high overall stress levels [14], while in our study, we identified an increased need for psychological support in association with a multidisciplinary approach, with a neonatologist being involved along with obstetricians. In cases of prematurity at the limit of viability, prenatal counseling should be introduced in clinical practice and adjusted to parental needs. Heterogeneity has been found among practitioners and trainees, and system-based hospital variation has been found [40].
Gestational age limits regarding fetal viability have been gradually reduced because of advances in neonatal care. In decision-making processes, obstetricians should employ neonatologists and psychologists in guiding families. Parents will face challenges because of the high chances of severe sequelae of premature infants [41,42]. However, a study was conducted to identify the preferences of adults with children born prematurely because of the ethical considerations regarding the future of these infants. The author emphasized that these adults prefer a periviability guideline that takes into consideration multiple prognostic factors [43]; the FIGO guideline explores the ethical complexities of this issue [44]. Other studies were employed to analyze who should make decisions on lifesaving treatment for extremely premature infants born at the limits of viability, including considering parents’ and healthcare professionals’ involvement [45]. A multidisciplinary approach to psychological support for parents confronting such dilemmas was also analyzed, and according to Hendy et al., even marital status and mental health were affected [14]. In our research, marital status was not affected by CUAs and pregnancy complications related to these pathologies.
The strength of our study lies in the possibility of appropriate diagnosis and surgical management in cases of pregnancy associated with a uterine malformation. This was a quick, inexpensive retrospective study that identified gaps in the current knowledge and helped us to design a future appropriate management strategy. Women with uterine malformations should benefit from a multidisciplinary approach and psychological counseling, and should be informed about the CUA’s impact on fertility and obstetric outcomes; however, we observed a lack of awareness of the problems associated with CUAs in both patients and gynecologists.
A major limitation of our study is that it is an observational retrospective study. It was conducted in a single center. However, we used 3D transvaginal ultrasound, which is currently the most effective method along with MRI, the achieved accuracies exceeding 90–97% [46]. The small sample size is another important limitation, but it is consistent with those in the literature, with malformations being rare in the general population according to ASRM [47]. Further studies are needed in a multicentric study using additional diagnostic tools. A genetic perspective should be useful.
5. Conclusions
In our research, we observed a clear correlation between uterine congenital malformations and pregnancy complications. The most common pregnancy outcome was premature delivery, reaching statistical significance. Lower Apgar scores and higher neonate admissions to the intensive care unit were also encountered compared with normal pregnancies. Optimal management should incorporate multidisciplinary approaches, with appropriate parental counseling conducted by obstetricians, neonatologists and psychologists. Accurate information based on good practice and valid classification systems, and an increased awareness of these pathologies, could increase the chances of therapy being adapted to the situation for future pregnant women. This pilot study opens new fields for further research.
Author Contributions
Conceptualization, C.V.; methodology, M.I.M.; software, S.V.; validation, M.I.M.; formal analysis, S.V.; investigation, C.M.M.; resources, C.V. and C.M.M.; data curation, C.M.M. and S.V.; writing—original draft preparation, C.V.; writing—review and editing, M.I.M.; visualization, E.S.B.; supervision, E.S.B.; project administration, C.V. and M.I.M.; funding acquisition, C.M.M. All authors have read and agreed to the published version of the manuscript.
Funding
We would like to acknowledge Victor Babes University of Medicine and Pharmacy Timisoara, Romania, for their support in covering the costs of publication for this research paper.
Institutional Review Board Statement
This study was conducted in accordance with the Declaration of Helsinki and approved by the Institutional Review Board of the Clinical Studies of Emergency County Hospital Al Simionescu Hunedoara (ethical approval number: 16552/4 November 2024).
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Data Availability Statement
Raw data are available in the Al Simionescu County Hospital registers.
Conflicts of Interest
The authors declare no conflicts of interest.
Abbreviations
The following abbreviations are used in this manuscript:
| ESHRE | European Society of Human Reproduction and Embryology |
| ESGE | European Society for Gynecological Endoscopy |
| CUA | congenital uterine anomaly |
| HSG | hysterosalpingography |
| MRI | magnetic resonance imaging |
| ACOG | American College of Obstetricians and Gynecologists |
| WHO | World Health Organization |
| NICU | Neonatal Intensive Care Unit |
| IUGR | intrauterine growth restriction |
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Table 1.
Diagnostic technique uterine malformation crosstabulation.
| p = 0.0001 | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| diagnosis | hysteroscopy | Count | 0 | 1 | 1 |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| hysteroscopy and ultrasound | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| hysterography/hysteroscopy | Count | 0 | 3 | 3 | |
| % within Malformation | 0.0% | 11.5% | 5.9% | ||
| hysteroscopy | Count | 0 | 2 | 2 | |
| % within Malformation | 0.0% | 7.7% | 3.9% | ||
| laparoscopy | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| laparotomy | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| 3D transvaginal ultrasound (3D-TVUS) | Count | 25 | 7 | 32 | |
| % within Malformation | 100.0% | 26.9% | 62.7% | ||
| 3D-TVUS/hysterography | Count | 0 | 4 | 4 | |
| % within Malformation | 0.0% | 15.4% | 7.8% | ||
| 3D-TVUS/hysterography/hysteroscopy | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| 3D-TVUS/laparoscopy | Count | 0 | 3 | 3 | |
| % within Malformation | 0.0% | 11.5% | 5.9% | ||
| 3D-TVUS/MRI | Count | 0 | 2 | 2 | |
| % within Malformation | 0.0% | 7.7% | 3.9% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
3D-TVUS = three-dimensional transvaginal ultrasound, MRI magnetic resonance imaging.
Table 2.
Comparison between pregnancy complications in the study group with malformations and those with normal pregnancies.
Table 2.
Comparison between pregnancy complications in the study group with malformations and those with normal pregnancies.
| p = 0.003 Significance | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| pregnancy complications | breech presentation | Count | 1 | 1 | 2 |
| % within Malformation | 4.0% | 3.8% | 3.9% | ||
| breech presentation and placenta praevia | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| breech presentation, and preterm birth | Count | 0 | 2 | 2 | |
| % within Malformation | 0.0% | 7.7% | 3.9% | ||
| placental abruption | Count | 1 | 0 | 1 | |
| % within Malformation | 4.0% | 0.0% | 2.0% | ||
| dystocic pelvis | Count | 1 | 0 | 1 | |
| % within Malformation | 4.0% | 0.0% | 2.0% | ||
| ectopic pregnancy in a rudimentary horn | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| infertility | Count | 0 | 3 | 3 | |
| % within Malformation | 0.0% | 11.5% | 5.9% | ||
| IUGR | Count | 1 | 0 | 1 | |
| % within Malformation | 4.0% | 0.0% | 2.0% | ||
| miscarriage | Count | 3 | 6 | 9 | |
| % within Malformation | 12.0% | 23.1% | 17.6% | ||
| miscarriage with important bleeding | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| no | Count | 13 | 3 | 16 | |
| % within Malformation | 52.0% | 11.5% | 31.4% | ||
| oligoamnios | Count | 1 | 0 | 1 | |
| % within Malformation | 4.0% | 0.0% | 2.0% | ||
| preeclampsia | Count | 2 | 0 | 2 | |
| % within Malformation | 8.0% | 0.0% | 3.9% | ||
| preterm birth | Count | 1 | 5 | 6 | |
| % within Malformation | 4.0% | 19.2% | 11.8% | ||
| preterm birth and placenta praevia | Count | 1 | 3 | 4 | |
| % within Malformation | 4.0% | 11.5% | 7.8% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
We applied the Chi-squared test, and it had a statistically significant association of p < 0.05.
Table 3.
Pregnancy complications and genital uterine malformations.
| p = 0.12 | Genit. Malf. | Total | |||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|
| Mullerian Agenesia | n | Septate Uterus | Subseptate Uterus | Unicornuate Uterus | Unicornuate Uterus with Rudimentary Horn | Uterus Didelphys | Uterus Bicornuate | ||||
| pregnancy complications | breech presentation | Count | 0 | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 2 |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 9.1% | 0.0% | 0.0% | 0.0% | 0.0% | 3.9% | ||
| breech presentation and placenta praevia | Count | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 0.0% | 0.0% | 0.0% | 25.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| breech presentation and preterm birth | Count | 0 | 0 | 0 | 0 | 1 | 0 | 1 | 0 | 2 | |
| % within genit. malf. | 0.0% | 0.0% | 0.0% | 0.0% | 25.0% | 0.0% | 50.0% | 0.0% | 3.9% | ||
| Placental abruption | Count | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| dystocic pelvis | Count | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| ectopic pregnancy in a rudimentary horn | Count | 0 | 0 | 0 | 0 | 0 | 1 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 50.0% | 0.0% | 0.0% | 2.0% | ||
| infertility | Count | 1 | 0 | 1 | 0 | 0 | 0 | 0 | 1 | 3 | |
| % within genit. malf. | 100.0% | 0.0% | 33.3% | 0.0% | 0.0% | 0.0% | 0.0% | 33.3% | 5.9% | ||
| Intrauterine growth restriction | Count | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| miscarriage | Count | 0 | 3 | 1 | 3 | 0 | 1 | 0 | 1 | 9 | |
| % within genit. malf. | 0.0% | 12.0% | 33.3% | 27.3% | 0.0% | 50.0% | 0.0% | 33.3% | 17.6% | ||
| miscarriage with important bleeding | Count | 0 | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 0.0% | 33.3% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| no | Count | 0 | 13 | 0 | 2 | 1 | 0 | 0 | 0 | 16 | |
| % within genit. malf. | 0.0% | 52.0% | 0.0% | 18.2% | 25.0% | 0.0% | 0.0% | 0.0% | 31.4% | ||
| oligoamnios | Count | 0 | 1 | 0 | 0 | 0 | 0 | 0 | 0 | 1 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 2.0% | ||
| preeclampsia | Count | 0 | 2 | 0 | 0 | 0 | 0 | 0 | 0 | 2 | |
| % within genit. malf. | 0.0% | 8.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 0.0% | 3.9% | ||
| preterm birth | Count | 0 | 1 | 0 | 2 | 1 | 0 | 1 | 1 | 6 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 18.2% | 25.0% | 0.0% | 50.0% | 33.3% | 11.8% | ||
| preterm birth and placenta praevia | Count | 0 | 1 | 0 | 3 | 0 | 0 | 0 | 0 | 4 | |
| % within genit. malf. | 0.0% | 4.0% | 0.0% | 27.3% | 0.0% | 0.0% | 0.0% | 0.0% | 7.8% | ||
| Total | Count | 1 | 25 | 3 | 11 | 4 | 2 | 2 | 3 | 51 | |
| % within genit. malf. | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | ||
Table 4.
Comparison: failure to deliver a live newborn with cesarean versus vaginal birth.
| p = 0.004 | Genit. Malf. | Total | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Mullerian Agenesia | n | Septate Uterus | Subseptate Uterus | Unicornuate Uterus | Unicornuate Uterus with Rudimentary Horn | Uterus Didelphys | Uterus Bicornuate | |||
| Failure to give birth to a live newborn | Count | 1 | 3 | 3 | 3 | 1 | 2 | 0 | 2 | 15 |
| % within genit. malf. | 100.0% | 12.0% | 100.0% | 27.3% | 25.0% | 100.0% | 0.0% | 66.7% | 29.4% | |
| C | Count | 0 | 8 | 0 | 5 | 2 | 0 | 2 | 1 | 18 |
| % within genit. malf. | 0.0% | 32.0% | 0.0% | 45.5% | 50.0% | 0.0% | 100.0% | 33.3% | 35.3% | |
| V | Count | 0 | 14 | 0 | 3 | 1 | 0 | 0 | 0 | 18 |
| % within genit. malf. | 0.0% | 56.0% | 0.0% | 27.3% | 25.0% | 0.0% | 0.0% | 0.0% | 35.3% | |
| Total | Count | 1 | 25 | 3 | 11 | 4 | 2 | 2 | 3 | 51 |
| % within genit. malf. | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | 100.0% | |
C = cesarean section; V = vaginal delivery.
Table 5.
Surgical interventions required.
| p = 0.005 Significance | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| intervention | a. Necessary intervention for failed pregnancy: curettage | Count | 0 | 1 | 1 |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| a. Necessary intervention for failed pregnancy: hysterectomy | Count | 0 | 2 | 2 | |
| % within Malformation | 0.0% | 7.6% | 4.0% | ||
| b. Intervention to improve fertility: hysteroscopic resection | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| b. Intervention to improve fertility: hysteroscopic resection followed by cerclage | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| b. Intervention to improve fertility: metroplasty | Count | 0 | 1 | 1 | |
| % within Malformation | 0.0% | 3.8% | 2.0% | ||
| c. Intervention during pregnancy to improve outcome: cerclage | Count | 1 | 7 | 8 | |
| % within Malformation | 4.0% | 26.9% | 15.7% | ||
| d. no intervention | Count | 24 | 13 | 37 | |
| % within Malformation | 96.0% | 50.0% | 72.5% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
Table 6.
Differences between the birth weights of newborns in the malformation group and the normal uterus group.
Table 6.
Differences between the birth weights of newborns in the malformation group and the normal uterus group.
| Malformations | Normal Uterus | Mean | Std. Deviation | p-Value | |
|---|---|---|---|---|---|
| birth weight | yes | 14 | 2243.57 | 540.322 | 0.0001 |
| no | 22 | 2975.91 | 460.752 |
The student’s test was used; the mean birth weight and standard deviation were reported.
Table 7.
APGAR scores recorded at 1 min in newborns from pregnancies with malformation versus the normal uterus groups.
Table 7.
APGAR scores recorded at 1 min in newborns from pregnancies with malformation versus the normal uterus groups.
| p = 0.029 Significance | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| APGAR score at 1 min | 5 | Count | 0 | 2 | 2 |
| % within Malformation | 0.0% | 14.3% | 5.6% | ||
| 6 | Count | 1 | 2 | 3 | |
| % within Malformation | 4.5% | 14.3% | 8.3% | ||
| 7 | Count | 1 | 0 | 1 | |
| % within Malformation | 4.5% | 0.0% | 2.8% | ||
| 8 | Count | 3 | 2 | 5 | |
| % within Malformation | 13.6% | 14.3% | 13.9% | ||
| 9 | Count | 8 | 8 | 16 | |
| % within Malformation | 36.4% | 57.1% | 44.4% | ||
| 10 | Count | 9 | 0 | 9 | |
| % within Malformation | 40.9% | 0.0% | 25.0% | ||
| Total | Count | 22 | 14 | 36 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
Table 8.
NICU admission in the malformation group compared to the control group.
| p = 0.0001 Significance | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| NICU | Count | 3 | 12 | 15 | |
| % within Malformation | 12.0% | 46.2% | 29.4% | ||
| no | Count | 22 | 11 | 33 | |
| % within Malformation | 88.0% | 42.3% | 64.7% | ||
| yes | Count | 0 | 3 | 3 | |
| % within Malformation | 0.0% | 11.5% | 5.9% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
Table 9.
Multidisciplinary approach involving obstetrician/neonatologist/psychologist.
| p = 0.002 | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| multidisciplinary approach: O/N/P | no | Count | 19 | 9 | 28 |
| % within Malformation | 76.0% | 34.6% | 54.9% | ||
| O, N | Count | 5 | 6 | 11 | |
| % within Malformation | 20.0% | 23.1% | 21.6% | ||
| O, N, P | Count | 1 | 5 | 6 | |
| % within Malformation | 4.0% | 19.2% | 11.8% | ||
| O, P | Count | 0 | 6 | 6 | |
| % within Malformation | 0.0% | 23.1% | 11.8% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
O = obstetrician; N = neonatologist; P = psychologist.
Table 10.
Parents’ involvement in treatment decision-making.
| p = 0.75 Significance | Malformation | Total | |||
|---|---|---|---|---|---|
| No | Yes | ||||
| Parents’ involvement | no | Count | 3 | 4 | 7 |
| % within Malformation | 12.0% | 15.4% | 13.7% | ||
| yes | Count | 22 | 22 | 44 | |
| % within Malformation | 88.0% | 84.6% | 86.3% | ||
| Total | Count | 25 | 26 | 51 | |
| % within Malformation | 100.0% | 100.0% | 100.0% | ||
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MDPI and ACS Style
Voic, C.; Mitranovici, M.I.; Voidazan, S.; Mureşan, C.M.; Bernad, E.S. Pregnancy Complications in Uterine Anomalies—A Pilot Study. J. Clin. Med. 2026, 15, 2827. https://doi.org/10.3390/jcm15082827
AMA Style
Voic C, Mitranovici MI, Voidazan S, Mureşan CM, Bernad ES. Pregnancy Complications in Uterine Anomalies—A Pilot Study. Journal of Clinical Medicine. 2026; 15(8):2827. https://doi.org/10.3390/jcm15082827
Chicago/Turabian StyleVoic, Claudiu, Melinda Ildiko Mitranovici, Septimiu Voidazan, Cezara Maria Mureşan, and Elena Silvia Bernad. 2026. "Pregnancy Complications in Uterine Anomalies—A Pilot Study" Journal of Clinical Medicine 15, no. 8: 2827. https://doi.org/10.3390/jcm15082827
APA StyleVoic, C., Mitranovici, M. I., Voidazan, S., Mureşan, C. M., & Bernad, E. S. (2026). Pregnancy Complications in Uterine Anomalies—A Pilot Study. Journal of Clinical Medicine, 15(8), 2827. https://doi.org/10.3390/jcm15082827
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