Impact of Congenital Uterovaginal Anomalies on Maternal and Fetal Outcomes at a Tertiary Hospital in Punjab: A Prospective Observational Study

Background: Congenital uterovaginal anomalies result from abnormal formation, fusion, or resorption of the Müllerian ducts during embryogenesis.They may remain asymptomatic or present with abnormal uterine bleeding, dyspareunia, subfertility, recurrent pregnancy loss, preterm birth, or fetal malpresentation.This study evaluated maternal and fetal outcomes among pregnant women with congenital uterovaginal anomalies at a tertiary referral hospital.Materials and methods: This single-center prospective observational comparative study was conducted in the Department of Obstetrics and Gynecology, Government Medical College and its associated tertiary-care hospital, Amritsar, Punjab, India, from April 1, 2022 to March 31, 2025.Consecutive total-enumeration sampling included all eligible singleton pregnancies with a previously diagnosed anomaly or an anomaly identified during the index pregnancy, delivery, or cesarean section.Multiple pregnancies were excluded.All 32 eligible women were included; therefore, no a priori sample-size calculation was performed.Maternal and fetal outcomes were summarized descriptively and compared with contemporaneous aggregate hospital data for pregnant women without a documented uterovaginal anomaly.Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated, and categorical outcomes were assessed using Pearson's chisquare test or Fisher's exact test, as appropriate.A two-sided p-value <0.05 was considered statistically significant.Results: Among 5,407 pregnancies/deliveries recorded during the study period, 32 women had a congenital uterovaginal anomaly (hospital-detected prevalence, 0.59%).Most participants (78.13%) were aged 21-35 years.Arcuate uterus was the most frequent anomaly (28.13%), followed by bicornuate and septate uteri (21.88% each).A history of subfertility was present in 40.63% of women, and 43.75% had experienced a previous preterm birth.During the index pregnancy, three spontaneous abortions (9.38%) and two ectopic pregnancies (6.25%) occurred.Among the 27 pregnancies continuing beyond these early outcomes, 12 fetuses (44.44%) had a malpresentation, 15 births (55.56%) were preterm, and 19 neonates (70.37%) had a birth weight <2.5 kg.Aggregate hospital comparisons suggested higher odds of abortion, ectopic pregnancy, malpresentation, preterm birth, and low birth weight among women with anomalies; however, estimates were unadjusted and should be interpreted cautiously because the anomaly group was small and only aggregate comparator data were available.Conclusion: Congenital uterovaginal anomalies should be considered in women with unexplained subfertility, recurrent pregnancy loss, recurrent preterm birth, or fetal malpresentation.Early recognition permits individualized counselling, targeted antenatal surveillance, and delivery planning.Because many anomalies in this cohort were detected only during cesarean delivery, careful documentation and postpartum counselling are essential to guide the management of future pregnancies.