Question: What is the evidence that a 36 year old with a normal birth in the past and 3 miscarriages may be having these because of a bicornuate uterus?
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Answer: The RCOG green-top guideline on recurrent miscarriage (1) says:
"It is difficult to assess the exact contribution that congenital uterine anomalies make to recurrent pregnancy loss. The prevalence and reproductive implications of uterine anomalies in the general population have not been clearly established. The reported prevalence of uterine anomalies in recurrent miscarriage populations range between 1.8% and 37.6%.(14) This variability reflects the differences in the criteria and techniques used for diagnosis and the fact that available studies have included women with two, three or more miscarriages at both early and late stages of pregnancy. The prevalence of uterine malformations appears to be higher in women with late miscarriages compared with women who suffer early miscarriages but this may be related to the cervical weakness that is frequently associated with uterine malformation.(15) A recent retrospective review of reproductive performance in patients with untreated uterine anomalies has suggested that these women experience high rates of miscarriage and preterm delivery and a term delivery rate of only 50%."
(Evidence level III)
The guideline makes the recommendation that " All women with recurrent miscarriage should have a pelvic ultrasound to assess uterine anatomy and morphology."
Reference:
- The Investigation and Treatment of Couples with Recurrent Miscarriage. Green-top guideline 17. Royal College of Obstetricians and Gynaecologist, 2003.
Search date: April 2010
Classification of evidence levels
Ia Evidence obtained from meta-analysis of randomised controlled trials.
Ib Evidence obtained from at least one randomised controlled trial.
IIa Evidence obtained from at least one well-designed controlled study without randomisation.
IIb Evidence obtained from at least one other type of well-designed quasi-experimental study.
III Evidence obtained from well-designed non-experimental descriptive studies, such as comparative studies, correlation studies and case studies.
IV Evidence obtained from expert committee reports or opinions and/or clinical experience of respected authorities.
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