A Study of Pregnancy Outcomes in Women with Mullerian Uterine Malformations

Abstract Background: Müllerian duct anomalies result from defective embryological development, fusion, or canalization of the ducts. These structural abnormalities are associated with adverse reproductive outcomes including miscarriage, preterm birth, fetal growth restriction (FGR), and malpresentation. Objective: To assess pregnancy outcomes in women diagnosed intraoperatively with Müllerian uterine malformations. Methods: This retrospective study analyzed 10 pregnant women diagnosed with Müllerian uterine anomalies during caesarean section or exploratory laparotomy between January 2023 and March 2025. Cases with prior surgical correction were excluded. Data on pregnancy outcomes—including miscarriage, malpresentation, preterm delivery, fetal growth restriction, and low birth weight—were analyzed. Results: Among 10 cases, bicornuate uterus was most common (40%), followed by partial septate (30%), unicornuate (20%), and arcuate uterus (10%). Malpresentation occurred in 50% of cases, predominantly breech. Preterm delivery occurred in 20% (very preterm 10%, late preterm 10%). The incidence of FGR was 60%, and low birth weight 70%. Miscarriages occurred in 20%, with one case of recurrent first-trimester loss (up to 9 miscarriages) in a unicornuate uterus. Caesarean section rate was 90%. Conclusion: Pregnancy in women with Müllerian uterine malformations is associated with increased risks of miscarriage, preterm delivery, FGR, and low birth weight. Intraoperative recognition of such anomalies should prompt evaluation of both renal fossae and the uterine cavity to prevent future complications. Early diagnosis through safe imaging modalities like 3D ultrasound or MRI enables timely surgical correction and improved obstetric outcomes.