Cervical weakness in women who have uterine anomalies: Impact on pregnancy outcome

Abstract

Aims: To critically evaluate the hypothesis that cervical weakness could be another risk factor in patients with uterine anomalies for the adverse pregnancy outcome related with their presence.Brief description of the reviewed data: The prevalence of congenital uterine anomalies (CUA) has been variably reported, as there is no universally agreed classification system. Moreover cervical weakness is a difficult entity to diagnose with certainty. However, despite the heterogeneity in definitions and study populations, there is evidence that women with CUA are at increased risk of spontaneous mid-trimester losses and preterm delivery. Since the latter are inversely related to cervical length and ensuing cervical weakness, there does appear to be a correlation between CUA and cervical weakness. Furthermore, adverse pregnancy outcomes may be obviated with interventions such as cerclage.Clinical implications: Patients who have a history of mid-trimester loss or preterm delivery should be thoroughly evaluated to exclude the presence of CUA based on a well-defined classification. Tests to assess underlying cervical weakness should also be conducted.Open issues for further research: Consensus on CUA classification will yield a framework for the comparison of future studies. Robust, well-designed studies are required to delineate a more definitive association between cervical weakness and CUA.