The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review.
Level 3 - non-randomized controlled study
Systematic review and meta-analysis of observational studies
PubMed 21705770 · doi:10.1093/humupd/dmr028
What was done
A systematic review and meta-analysis searched MEDLINE, EMBASE, Web of Science, and the Cochrane register to determine the prevalence of congenital uterine anomalies across unselected women and specific clinical cohorts (infertility, IVF treatment, history of miscarriage, combined infertility and recurrent miscarriage, and preterm delivery). Two reviewers independently performed study selection and data extraction. Studies were categorized based on whether they used optimal or suboptimal diagnostic tests.
What was found
The review synthesized 94 observational studies comprising 89,861 women. When using optimal diagnostic tests, uterine anomaly prevalence was 5.5% (95% CI, 3.5–8.5) in the unselected population, 8.0% (95% CI, 5.3–12) in infertile women, 13.3% (95% CI, 8.9–20.0) in women with a history of miscarriage, and 24.5% (95% CI, 18.3–32.8) in women with both miscarriage and infertility. Arcuate uterus was the most frequent finding in the unselected population (3.9%; 95% CI, 2.1–7.1) and did not increase in high-risk groups, whereas septate uterus was the most common anomaly in high-risk cohorts.
Why it matters
It establishes benchmark prevalence rates across specific reproductive risk profiles, demonstrating that clinically significant structural defects like septate uterus are disproportionately concentrated in women with pregnancy loss and infertility.
Limits
All included data derive from observational studies susceptible to selection bias. Exact prevalence numbers for the IVF and preterm delivery subgroups were omitted from the abstract, and results depend heavily on the variable accuracy of diagnostic modalities categorized as optimal versus suboptimal.
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