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J. Anat. Soc. India 50(2) 119-121 (2001)

J Anat. Soc. India 50(2) 119-121 (2001)
Anatomical Causes of Bad Obstetric History
Srinivas, N; Rajangam, S.
Division of Human Genetics, Department of Anatomy, St. Johns Medical College, Bangalore INDIA.
Abstract. The aim of the present study was to find out the incidence of the anatomical causes from the couples with bad obstetric
history referred for karyotyping and counselling. There were 104 couples whose age ranged from 18 - 40 years (mean age 26.79 5.21
years). A detailed proforma has been prepared eliciting the suspected causal factors of bad obstetric history. Any malformation/defect
affecting the components of male and female reproductive system may affect the normalcy in reproduction and more so if it is in the uterus.
In the present study, in 8 (7.69%) out of 104 females, the anatomical defect could have been the causal factor for the bad obstetric history.
These patients had either a tubal block or bicornuate uterus / hypoplastic uterus or polycystic ovaries. Their karyotypes were normal i.e. 46
XX. These patients were later referred to the Obstetricians and Gynaecologists for further surgical procedures. As a part of counselling the
follow up either in person or through correspondence was emphasised.
Key words : Recurrent abortions, Anatomical, Obstetric history.
Introduction :
Anatomical defects of the reproductive system
could be one of the commonest causes of bad
obstetric history. Approximately 12 - 15% of women
with recurrent abortion have uterine malformation
(Stirrat 1990). The polycystic ovaries, septate
uterus, Mullerian anomalies, etc are the anatomical
abnormalities linked with recurrent early
spontaneous abortions. Uterine abnormalities could
result in impaired vascularization of pregnancy and
limited space for the growing fetus due to distortion
of the uterine cavity. In addition to Mullerian
anomalies, another anatomical cause, although
uncommon, of recurrent abortions is Ashermans
syndrome chracterized by intrauterine adhesions. If
an appropriate predisposing factor, such as uterine
curettage or a severe uterine infection can be
identified, then diagnostic hysterosalpingography or
hysteroscopy could be performed. The results with
hysteroscopic repair have been impressive (Coulam
1991).
The recognition of the anatomical abnormality
usually precludes the search for other causes. The
aim of the study is to report the anatomical factors
affecting the obstetric history. The information has
been elicited as a part of a detailed study on the
etiology of bad obstetric history.
Material And Method :
One hundred and four couples (n=208) with
bad obstetric history were referred to the Division of
Human Genetics, Department of Anatomy, St.
Johns Medical College, Bangalore, for cytogenetic
investigations and counselling from St. Johns
Medical College Hospital, other hospitals, nursing
homes in and around Bangalore. Patients are
referred not only from Karnatka but also from other
states of India especially Andra Pradesh, Tamil
Nadu and Kerala. Couples were taken for study only
if they had two or more than two abortions or
neonatal deaths or offsprings with multiple
congenital anomalies. Karyotyping was done with
leucocyte microculture and Giemsa Trypsin-
Giemsa banding method. The proforma included a
detailed personal and clinical history, pedigree and
family history, information about appropriate
laboratory investigations (semen analysis, hormonal
assay, TORCH, ultrasound scanning) and
photographs.
Result and Discussion :
Anatomical causes were observed in 8 women
and they had 3.13 2.17 abortions (Table 1). Their
karyotypes were normal i.e. 46, XX. Anatomical
causes could be congenital or acquired. Congenital
anomaly includes Mullerian duct fusion or septum
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J. Anat. Soc. India 50(2) 119-121 (2001)
resorption defects and uterine/ cervical anomaly.
Acquired anomalies leading to fetal loss are the
leiomyomas and endometriosis, and the proposed
mechanisms are interference in blood supply and
immunological problems. Review has shown that in
patients with bad obstetric history anatomical
causes ranged from 1% to 20% and the percentage
of anatomical abnormality in the present study
(7.69%) falls within these findings.
Most of the losses were in the second trimester
as it is seen in women with an anatomical defect. In
couples with second trimester loss, cytogenetic
analysis may be less useful; since loss is frequently
by either the uterine malformations or cervical
incompetence (Eilias et al, 1980). In the present
study among the 8 women with anatomical causes
there were 18 first trimester and 5 second trimester
abortions.
TABLE 1. ANATOMICAL CAUSES OF
BAD OBSTETRIC HISTORY
Serial No. Age Abortions Anatomical
Feature
1 29 2 Tubal block
2 25 3 Bicornuate/septate uterus
3 31 2 Hypoplastic uterus
4 23 2 Incomplete uterine septum
5 36 8 Left block
37 3 Tubal block
6 22 2 Bilateral polycystic ovaries
7 34 4 Tubal block
Mean 29.63 3.13 (8/104) 7.69%
There is still controversy about the incidence
and classification of uterine anomalies, the extent to
which reproductive failure is associated with them,
and their optimum treatment. Thus, uncertainty and
lack of proper information surrounds even in an
apparently straightforward potential cause of
repeated pregnancy loss. The reported incidence of
uterine abnormalities associated with recurrent
abortion is between 15% and 30% (Edmonds et al,
1982; Tulpalla et al, 1993, Stephenson, 1996).
Makino (1990) has surveyed 830 couples with
repeated or habitual abortions. Among them, 124
women repeatedly aborted due to congenital uterine
anomaly, mainly bicornuate or arcuate uterus
(14.94%). Approximately 12% to 15% of women
with recurrent abortions had uterine malformation.
The septate uterus was the most frequent
anatomical abnormality linked with recurrent early
spontaneous abortions, and the results with
hysteroscopic repair have been impressive (Coulam
1994). Data was collected from 41 couples with
recurrent abortion. The probable cause of recurrent
abortion was identified in 21 out of 41 couples
(51.2%: uterine abnormalities were the most
frequent (19.5%) and one case was of cervical
incompetence (2.4%) (Maione et al 1995). In this
study uterine anomaly has occured in 3 women
(2.88%). Septate uterus has been observed in two
women (1.92%)
Cervical incompetence is another important
quoted cause of pregnancy loss, particularly in the
second trimester. In this study cervical
incompetence has not been observed to be the
causal factor for the bad obstetric history.
Tubal block and polycystic ovary are known to
contribute to bad obstetric history. These two causal
factors have been dealt as the infectious and
hormonal causes affecting obstetric history.
Management :
It becomes necessary for every woman with
bad obstetric history to undergo ultrasonography, to
rule out any anatomical abnormality, and evaluation
by their obstetricians and gynaecologists. The
recognition of the treatable anatomical abnormality
usually precludes the search for other causes.
These patients have been referred back to the
Obstetricians and Gynaecologists for further
evaluation and surgical procedures. These patients
have been requested to have a regular follow up.
Bad Obstetric History-Anatomical Causes
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J. Anat. Soc. India 50(2) 119-121 (2001)
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4. Maisone, S., et al (1990): Chromosomal analysis in Japanese
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