Anatomic factors associated with recurrent pregnancy loss

Anatomic uterine defects appear to predispose women to reproductive difficu lties, including first- and second-trimester pregnancy losses, higher rates of preterm labor and birth, and abnormal fetal presentation. These anatomi c abnormalities can be classified as congenital, including mullerian and di ethylstilbestrol-related abnormalities, or acquired, such as intrauterine a dhesions or leiomyomata. In women with three or more consecutive spontaneou s abortions who underwent hysterosalpingography or hysteroscopic examinatio n of their uteri, mullerian anomalies have been found in 8 to 10%. Women wi th mullerian anomalies may be predisposed to recurrent pregnancy loss becau se of inadequate vascularity to the developing embryo and placenta, reduced intraluminal volume, or cervical incompetence. The reproductive history of most women with a mullerian anomaly is poor, especially for women with a u terine septum, the most common mullerian anomaly. Recurrent pregnancy losse s resulting from a uterine septum, bicornuate uterus, intrauterine adhesion s, and fibroids are amenable to surgical correction. Women with mullerian a nomaly and a history of second-trimester pregnancy losses may benefit from a prophylactic cervical cerclage.