title: Bicornuate uterus is an independent risk factor for cervical os insufficiency: A retrospective population based cohort study.
abstract: BACKGROUND
  The purpose of our study was to explore maternal and fetal outcomes in the second and third trimester in women with bicornuate uterus.
  
  
  METHODS
  A total of 280,106 pregnancies met the inclusion criteria and were divided in two study groups: (1) pregnancies in women with bicornuate uterus (n = 444); and (2) controls (n = 279,662). The diagnosis of bicornuate uterus was performed in all patients during the workup for infertility or recurrent pregnancy loss, during pregnancy, or at the time of cesarean delivery. Multivariate logistic regression models were performed in order to assess the risk factors for cervical insufficiency in women with bicornuate uterus.
  
  
  RESULTS
  The rate of women with a bicornuate uterus in our population was 0.15%. Women with bicornuate uterus had lower parity (2.93 ± 1.90 vs. 3.42 ± 2.51, p < 0.001) and a higher rate of previous cesarean deliveries (54.1% vs. 12.3%, p < 0.001). In addition, these patients were more prone to conceive with assisted reproductive techniques (5.6% vs. 1.9%, p < 0.001) and had a significantly higher rate of recurrent abortions (12.4% vs. 5.1%, p < 0.001) compared to controls.
  
  
  CONCLUSIONS
  Bicornuate uterus is an independent risk factor for cervical os insufficiency. This is an important finding due to the burden of the risk for midtrimester periviable birth associated with cervical incompetence.
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.|b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy.
authors.forename: Salvatore Andrea
authors.initials: SA
authors.lastname: Mastrolia
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Yael
authors.initials: Y
authors.lastname: Baumfeld
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Reli
authors.initials: R
authors.lastname: Hershkovitz
authors.affiliation: b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Loverro
authors.affiliation: b Department of Obstetrics and Gynecology , Azienda Ospedaliera Universitaria Policlinico di Bari, School of Medicine, University of Bari "Aldo Moro" , Bari , Italy.
authors.forename: Edoardo
authors.initials: E
authors.lastname: Di Naro
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: David
authors.initials: D
authors.lastname: Yohai
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Polina
authors.initials: P
authors.lastname: Schwarzman
authors.affiliation: a Department of Obstetrics and Gynecology , Soroka University Medical Center, Faculty of Health Sciences, School of Medicine, Ben-Gurion University of the Negev , Beer Sheva , Israel.
authors.forename: Adi Yehuda
authors.initials: AY
authors.lastname: Weintraub
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002584:Cervix Uteri / Q000002:abnormalities* / Q000473:pathology; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011247:Pregnancy; D011248:Pregnancy Complications / Q000453:epidemiology / Q000209:etiology; D011256:Pregnancy Outcome / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D014564:Urogenital Abnormalities / Q000150:complications* / Q000453:epidemiology; D002581:Uterine Cervical Incompetence / Q000453:epidemiology / Q000209:etiology*; D014599:Uterus / Q000002:abnormalities*; D055815:Young Adult
keywords: Cesarean delivery; obstetrical complications; preterm labor; uterine malformation