Perinatal Outcomes of Twin Pregnancies in Women with Unicornuate Uterus

Perinatal Outcomes of Twin Pregnancies in Women with Unicornuate Uterus | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Perinatal Outcomes of Twin Pregnancies in Women with Unicornuate Uterus Si Wang, Qing Hu, Hua Liao, Haiyan Yu This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4675446/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: It is known that unicornuate uterus is a type of Müllerian anomalies and is associated with adverse pregnancy outcomes. However, previous studies on unicornuate uterus were mostly on singleton pregnancies, the perinatal outcomes of twin pregnancies with unicornuate uterus remains elucidating.This research aimed to investigate the perinatal outcomes of twin pregnancies in women with unicornuate uterus. Methods: A total of 283 women with unicornuate uterus, 21 twin pregnancies (group A), 262 singleton pregnancies (group B) and 105 twin pregnancies with normal uterus (group C) were enrolled who delivered at West China Second University Hospital, Sichuan University from January 2013 to December 2022, general characteristics and perinatal outcomes were retrospectively analyzed. Results: In twenty-one twins with unicornuate uterus, 20 cases (95.2%) were dichorionic diamniotic twins and 1 case (4.8%) monochorionic diamniotic twin. Seventeen cases (81.0%) were conceived by in vitro fertilization-embryo transfer (IVF-ET) and 4 cases (19.0%) naturally. The mean gestational weeks of delivery were (33.8±5.7) weeks and 19 cases (90.5%) were cesarean section.The twin group (A) was associated with a significantly higher rate of preterm premature rupture of membranes (38.1%,8/21), preterm deliveries (85.7%,18/21) (preterm delivery (PTD) was defined as a birth occurring after 28 weeks and before 37 completed weeks of gestational age), and neonatal intensive care unit (64.3%,27/42) than that of group B and group C ( p <0.05). Moreover, the live birth weight in group A (1931.7±535.2)g was lower than in group B and group C ( p <0.001). Conclusions: The incidence of complications and risk of adverse perinatal outcomes in twin pregnancies with unicornuate uterus is higher than that in singleton with unicornuate uterine and twin pregnancies with normal uterine. Thus, maternal and fetal monitoring during pregnancy should be strengthened to achieve good outcomes. Müllerian anomalies unicornuate uterus twin pregnancy pregnancy outcomes Introduction The female reproductive organs affected by genetic or environmental factors during formation and development may result in congenital anomalies of the genital organ [ 1 ]. The unicornuate uterus is formed due to the non-development of one Müllerian duct, either partially or completely during the embryonic period, resulting in a unicornuate uterus or rudimentary uterus [ 2 ]. The incidence of unicornuate uterus is about 0.1% in the general population, increasing to about 0.5% in women with infertility or miscarriage, and ranging from about 2.5–13.2% of all uterine malformations [ 3 ]. Previous studies on unicornuate uterus were mostly on singleton pregnancies, and studies have shown that unicornuate uterus is associated with adverse pregnancy outcomes including miscarriage, fetal growth restriction (FGR), preterm delivery (PTD), malpresentation, and higher rates of cesarean delivery [ 2 , 4 – 6 ]. With the rapid development of assisted reproductive technology (ART), since the 1980s, the global twin rate has risen by a third, with the increase varying considerably by region and country [ 7 ]. However, little is known about the effects of unicornuate uterine anomaly on twin pregnancies. So far, there are only a few studies on twin pregnancies with unicornuate uterus most of which were published as case report [ 8 – 10 ]. Hence, we conducted a ten-year retrospective cohort analysis of twin pregnancies with unicornuate uterus and explored the effect of unicornuate uterus on pregnancy outcome. We hope that our findings will provide clinical consultation and maternal and infant perinatal management of twin pregnancies with unicornuate uterus. Materials and methods This retrospective cohort study was conducted on singleton and twin pregnant women who delivered at the West China Second University Hospital, between January 1, 2013, and December 31, 2022. Cases with severe medical and surgical complications, or cases with incomplete clinical information were excluded. Pregnant women with unicornuate uterus were divided into group A (twin pregnancies with unicornuate uterus) and B(singleton pregnancies with unicornuate uterus). Twin pregnant women with normal uterus were selected by stratified equal-volume random sampling by age as group C (control group). There were 283 pregnant women with unicornuate uterus, including 21 cases with twin pregnancies (group A) and 262 cases with singleton pregnancies (group B). One hundred and five twin pregnancies with normal uterus (group C) (n=105(1:5)) were selected as control group. Unicornuate uterus were diagnosed according to the criteria of the European Society of Human Reproduction and Embryo(ESHRE)European Society for Gynecological Endoscopy༈ESGE) and Chinese expert consensus[ 11 – 14 ]. Diagnostic methods include ultrasonography, hysterosalpingography, hysteroscopy and/or laparoscopy, and laparotomy. The characteristics and perinatal outcomes of the three groups were compared. The study was approved by the ethics committee of the West China Second University Hospital (No. 2023 − 272). Statistical Analyses The enumerated data are expressed as the rate (percentages), and quantitative normally distributed variables are expressed as means ± standard deviation. The chi-squared test was used to determine significant differences between percentages, with continuity correction or Fisher's exact test where appropriate. Independent sample t-test was used to compare differences between means. Non-normally distributed data (expressed as M [P25, P75]) were compared between two groups using the Mann–Whitney U-test. A P value < 0.05 was considered significant. Statistical analyses were performed using SPSS version 22.0 (SPSS, Inc., Chicago, IL, USA). Results From January 2013 to December 2022, there were 131913 cases of deliveries in our hospital, including 7002 cases of twin pregnancies. Twin pregnancies account for 5.3 percent (7002/131913) of all deliveries, and the incidence of twin pregnancies with unicornuate uterine is 0.3% (21/7002) in all twin pregnancies. 1. General characteristics In the study, 283 patients were diagnosed with unicornuate uterus, 59.7% (169/283) of cases the diagnosed before this pregnancy, 17.0% (48/283) diagnosed by ultrasound in the first trimester of this current pregnancy, and the remaining 66 cases (23.3%,66/283) diagnosed during delivery (cesarean section or vaginal delivery), including one case by ultrasound-monitored curettage for intrauterine pregnancy residues. Among the 169 patients with preconception diagnosis of the unicornuate uterus, 80 cases (47.3%,80/169) were diagnosed by previous surgical explorations, including 40 cases diagnosed by hysteroscopy and laparoscopy for infertility (8 cases rudimentary uterus hysterectomies intra-operative), 20 cases founded intraoperatively by other gynecologic or surgical procedures, 16 cases detected by previous cesarean section, and 4 cases founded during emergency surgeries for rudimentary uterus pregnancy. Seventy-seven cases (45.6%,77/169) were detected by ultrasound, and 12 cases (7.1%,12/169) diagnosed by hysterosalpingography. Among the 283 cases, there were left unicornuate uterus combined with the right rudimentary uterus in 129 cases (45.6%,129/283), right unicornuate uterus combined with left rudimentary uterus in 106 cases (37.5%,106/283), and unicornuate uterus without a rudimentary uterus in 48 cases (16.7%,48/283) as 36 cases truly with no rudimentary uterus, and 12 cases with rudimentary uterus removed ( 4 cases due to rudimentary uterus pregnancies and 8 cases with rudimentary uterus removed during hysteroscopy and laparoscopy due to infertility). In the all 283 unicornuate uterine pregnancies, 241(85.2%,241/283) were delivered by caesarean section, and 42(14.8%,42/283) had vaginal deliveries (38 with eutocia,4 with assisted vaginal deliveries). Of the 241 caesarean sections, 187 were unicornuate uterus with rudimentary uterus and 54 were unicornuate uterus without rudimentary uterus. In all rudimentary uterus found during caesarean section, only 1 case had functional endometrium in the rudimentary uterus, which was connected with the unicornuate uterus, and the rest rudimentary uterus were muscular tissue. Ten cases were detected with urinary tract malformations. Twenty-one twin pregnancy cases with unicornuate uterus, as 20 (95.2%) dichorionic diamnionic (DCDA) twin pregnancies and one (4.8%) monochorionic diamnionic (MCDA) twin pregnancy. Seventeen cases (81.0%) were conceived by in vitro fertilization-embryo transfer (IVF-ET) and 4 cases (19.0%) conceived naturally. In twin pregnancies with normal uterus,87 cases (82.9%) dichorionic diamnionic (DCDA) twin pregnancies and 18 case (17.1%) monochorionic diamnionic (MCDA) twin pregnancy. There was no statistically significant difference in the comparison of the type of twin between the two groups ( P = 0.266). Except for the proportion of primigravida in twin pregnancies with unicornuate uterus were higher than that in singleton pregnancies with unicornuate ( p =0.033), other general characteristics were all similar among these three groups ( p > 0.05). Detailed information on general characteristics is shown in Table 1 . Table 1 General characteristics of the included participants characteristics Unicornuate uterus Normal uterus Twins(n = 21) A Singleton(n = 262) B Twins(n = 105) C P (A vs. B) P (A vs. C) Maternal age(year) 23 ~ 36 20 ~ 45 23 ~ 44 ≤ 24 1(4.8) 10(3.8) 3(2.9) 0.899 a 0.689 a 25–34 17(81.0) 210(80.2) 82(78.1) ≥ 35 3(14.2) 42(16.0) 20(19.0) Infertility type Primigravida 21(100.0) 204(77.9) 96(91.4) 0.033 b* 0.353 b Multigravida 0 58(22.1) 9(8.6) Twin classification DCDA twin 20(95.2) / 87(82.9) 0.266 b MCDA twin 1(4.8) / 18(17.1) Live neonatal 42 260 208 Male 19(45.2) 139(53.5) 95(45.7) 0.322 0.959 Femal 23(54.8) 121(46.5) 113(54.3) Diagnostic period Progestation 13(61.9) 156(59.5) / 0.696 a First trimester 2(9.5) 45(17.6) / Delivery period 6(28.6) 60(22.9) / Notes: a: The Chi-squared test with Fisher’s exact test; b: The Chi-squared test with continuity correction;* P <0.05. Abbreviations: DCDA twin: dichorionic diamniotic twin; MCDA twin: monochorionic diamniotic twin. 2. Perinatal outcomes of twin pregnancies with unicornuate uterus All 21 cases of twin pregnancies with unicornuate uterine (group A) were delivered. Gestational weeks at delivery were (28 + 2 ~37 + 5 ) weeks, and mean gestational weeks of delivery were (33.8 ± 5.7) weeks, which included 19 cases (90.5%) with cesarean section, 1 case (4.8%) with vaginal delivery, and 1 case (4.8%) with assisted breech delivery. There were 42 live births, 13 males (31.0%) and 29 females (69.0%). Of the 27 neonates transferred to the neonatal intensive care unit (NICU), only one neonatal death occurred and the rest were discharged successfully. The fatal case was delivered at 33 + 6 weeks with severe fetal growth restriction and congenital heart disease (narrowing of the aortic arch, ventricular septal defect) (birth weight 700g with Apgar scores of 7 and 8 at 1 and 5min, respectively), who was transferred to the NICU after delivery and the family abandoning treatment. 3.Comparisons between the singleton pregnancies and twin pregnancies with unicornuate uterus Two hundred and sixty-two cases of singleton pregnancies with unicornuate uterine (group B) were delivered.Cases in group A had the significantly higher rates of hypertensive disorder complicating pregnancy (HDCP) (19.0% vs. 4.6%, OR,4.90,95%CI 1.43–16.83), intrahepatic cholestasis of pregnancy (ICP) (28.6% vs. 6.1%, OR, 6.15,95%CI,2.10-17.99), preterm premature rupture of membranes (PPROM) (38.1% vs. 11.5%, OR,4.76,95%CI,1.82–12.42), preterm deliveries(PTDs) (85.7% vs. 22.9%, OR, 20.20,95%CI 5.75–70.91), NICU admission (64.3% vs. 12.3%, OR, 13.05,95%CI 6.28–27.12), drugs to promote uterine contraction ≥ 3 kinds (38.1% vs. 15.6%, OR, 3.32,95%CI 1.29–8.51) than those in group B. In addition, birth weight was significantly lower in group A than that in group B (1931.7 ± 535.2 vs. 2964.8 ± 533.9, p<0.001). However, the other perinatal complications and perinatal outcomes were similar between the two groups, including placenta previa, placenta percreta/accreta, placental abruption, PROM, malpresentation, Apgar score of 5-min, PPH and Uterine rupture ( p >0.05). Detailed information is presented in Table 2 . Table 2 Perinatal outcomes of the included participants Unicornuate uterus Normal uterus Twins(n = 21) A Singleton(n = 262) B Twins(n = 105) C P (A vs. B) OR (95%CI) P (A vs. C) OR (95%CI) Maternal complications HDCP 4(19.0) 12(4.6) 28(26.7) 0.023 b* 4.90(1.43–16.83) 0.229 ICP 6(28.6) 16(6.1) 29(27.6) 0.001 b* 6.15(2.10-17.99) 0.929 DM (GDM and PGDM) 6(28.6) 55(21.0) 26(24.8) 0.591 b 0.714 Placenta previa 1(4.8) 10(3.8) 2(1.9) 0.579 a 0.424 a Placenta percreta/accreta 4(19.0) 55(21.0) 38(36.2) 1.000 b 0.128 Placental abruption 0 3(1.1) 2(1.9) 1.000 a 1.000 a PROM 9(42.9) 72(27.5) 14(13.3) 0.134 0.004 b* 4.88(1.74–13.67) PPROM 8(38.1) 30(11.5) 10(9.5) 0.002 b* 4.76(1.82–12.42) 0.002 b* 5.85(1.96–17.49) Oligohydramnios 1(4.8) 14(5.3) 1(0.9) 1.000 b 0.307 a Polyhydramnios 0 5(1.9) 10(9.5) 1.000 a 0.302 b Scarred uterus 0 45(17.1) 5(4.8) 0.078 b 0.589 a Malpresentation 10(47.6) 105(40.1) 46(43.8) 0.498 0.748 IVF-ET 17(81.0) 50(19.1) 80(76.2) <0.001 * 18.02(5.81–55.89) 0.850 Fetal complications PTDS 18(85.7) 60(22.9) 58(55.2) <0.001 * 20.20(5.75–70.91) 0.009 * 4.86(1.35–17.51) <37 weeks 8(38.1) 45(17.2) 43(40.9) <34 weeks 10(47.6) 15(5.7) 14(13.3) 7 41(97.6) 260(100.0) 208(100.0) 0.139 a 0.168 a ≤ 7 1(2.4) 0 0 Live birth weight(g) (1931.7 ± 535.2) (2964.8 ± 533.9) (2321.3 ± 517.8) <0.001 d * / <0.001 d * / LBW ≥ 2500 9(21.4) 218(83.8) 76(36.5) LBW<2500 27(64.3) 39(15.0) 114(54.8) VLBW<1500 6(14.3) 3(1.2) 18(8.7) NICU 27(64.3) 32(12.3) 50(24.0) <0.001 * 13.05(6.28–27.12) <0.001 * 5.69(2.81–11.53) Perinatal mortality 1(2.4) 2(0.8) 2(1.0) 0.363 a 0.425 a Intra-uterine death (IUD) 0 1 0 Neonatal death 1 0 2 Rivanol odinopoeia 0 1 0 Mode of delivery Cesarean section 19(90.5) 222(84.7) 99(94.3) 0.173 a 0.348 a Vaginal delivery 1(4.8) 37(14.2) 5(4.8) Assisted vaginal delivery 1(4.8) 3(1.1) 1(0.9) Labor complications Hemorrhage of delivery(ml) 500(400,600) 400(300,400) 400(300,500) <0.001 c* / 0.019 c* / PPH 0 8(3.1) 7(6.7) 1.000 a 0.487 b Drugs to promote uterine contraction ≥ 3 kinds 8(38.1) 41(15.6) 59(56.2) 0.021 b* 3.32(1.29–8.51) 0.129 Uterine rupture 0 7(2.7) 2(1.9) 1.000 a 1.000 a Hysterectomy 0 1(0.4) 0 1.000 a / Notes: a: The Chi-squared test with Fisher’s exact test; b: The Chi-squared test with continuity correction; c: Mann–Whitney U-test; d.: Independent sample t-test. * P <0.05 Abbreviations: HDCP, hypertensive disorder complicating pregnancy; ICP, intrahepatic cholestasis of pregnancy; DM, diabetes mellitus; GDM, gestational diabetes mellitus; PGDM, pregestational diabetes mellitus; IVF-ET, in vitro fertilization-embryo transfer; PROM, premature rupture of membranes; PPROM, preterm premature rupture of membranes; PTDs, preterm deliveries; NICU: Neonatal Intensive Care Unit; IUD: Intra-uterine death; LBW: Live birth weight; FGR, fetal growth restriction; PPH, postpartum hemorrhage. 4.Comparisons between twin pregnancies with unicornuate uterus and with normal uterus One hundred and five twin pregnancies with normal uterus (group C) were included in the study. When compared with group C, cases in group A were associated with significantly higher rates of PROM (42.9% vs. 13.3%, OR, 4.88,95%CI 1.74–13.67), PPROM (38.1% vs. 9.5%, OR, 5.85,95%CI 1.96–17.49), PTDs (85.7% vs. 55.2%, OR, 4.86,95%CI 1.35–17.51), NICU admission (64.3% vs. 24.0%, OR, 5.69,95%CI 2.81–11.53). Meanwhile, birth weigh was significantly lower in group A (1931.7 ± 535.2 vs. 2321.3 ± 517.8, p <0.05). (Table 2 ). Discussion Unicornuate uterus is a type of female genital malformation, and twin pregnancy with the unicornuate uterus is a rare condition that carries considerable risk to the maternal and fetus. Unicornuate uterus that is not combined with a rudimentary uterus with endometrium usually has no obvious clinical symptoms and is often difficult to detect, so the possibility of unicornuate uterus should be considered in women with a history of infertility or adverse pregnancies [ 2 – 4 ]. In this study, the pre-pregnancy diagnosis rate was up to 59.7% (169/283), and early diagnosis of unicornuate or rudimentary uterus is the key to improving pregnancy outcomes. The high pre-pregnancy diagnosis rate may be due to the improvement of the examination methods in recent years, as well as the fact that gynecologists have paid more attention to patients who are infertile or have adverse pregnancies. At present, clinical diagnosis is mainly based on ultrasound, hysterosalpingography, and hysteroscopy or laparoscopy, in addition, MRI, three-dimensional (3D) ultrasonography and 4-dimensional hysterosal⁃pornography(4D-HyCoSy)are gradually being used for diagnosis and further clarification of the type of uterine abnormalities, and it can dramatically improve the accuracy of diagnosis[ 4 , 15 – 20 ]. Previous literature has reported that unicornuate uterus is associated with adverse pregnancy outcomes [ 2 ]. Our study showed that compared with singleton pregnancy, twin pregnancies with unicornuate uterus were associated with adverse pregnancy outcomes, such as preterm premature rupture of membranes (38.1%,8/21), preterm deliveries (85.7%,18/21), and neonatal intensive care unit (64.3%,27/42), and lower live birth weight. Previous studies also have found that twin pregnancies in unicornuate uterine anomaly were associated with higher risks of preterm delivery, perinatal mortality, and low birth weight [ 21 ]. Thus, our findings are in agreement with previously published studies. On the other hand, Ouyang et al. found that selective reduction of twins to a singleton may yield better outcomes in patients with unicornuate uterine anomalies undergoing IVF-ET [ 21 ]. Therefore, if unicornuate uterus was found pre-pregnancy, comprehensive counseling about the high risk of twin pregnancy should be provided to the couple, whether or not to have a single embryo transfer or selective reduction to a singleton may be considered in pregnant women with a unicornuate uterus who have twin pregnancies after assisted reproduction to improve pregnancy outcomes. The incidence of adverse pregnancy outcomes in twin pregnancies with unicornuate uterus was higher than that in the normal uterus or singleton pregnancies in unicornuate uterus, which may be related to the fact that the unicornuate uterus has only 1 uterine artery and some small contralateral arteries supplying blood to the uterus, which affects the perfusion, reduces the muscle, has less uterine muscle mass, an abnormal uterine blood flow, abnormal shape of the uterine cavity, and reduced uterine cavity volume, which is associated with a significantly higher risk for adverse pregnancies in twin pregnancies [ 4 – 5 ]. Twin pregnancy with unicornuate uterus is a rare condition and carries a considerable risk to the maternal and fetal. In our study, patients with unicornuate uterus who detected preconception or during early pregnancy were included in the management of high-risk pregnancies, strengthening supervision and increasing the frequency of prenatal check-ups had been taken into consideration to decrease pregnancy complications and adverse pregnancy outcomes. Because patients with unicornuate uterus may be associated with renal anomalies [ 3 ], patients with unicornuate uterus are recommended to undergo routine ultrasound screening of the urinary system and to pay attention to the developmental anomalies of other organs. Meanwhile, ultrasound screening of the fetal system should be strengthened during pregnancy to detect fetal developmental abnormalities in time. Cesarean section rate for twin pregnancies in unicornuate uterus is as high as 90.5% (19/21), but malpresentation, ICP, and PROM constitute the main indication for cesarean deliveries (12/21,57.1%) in our study. Anomaly uterine pregnancy is not an absolute indication for cesarean section. However, due to the morphological and structural abnormalities of the unicornuate uterus, incomplete development of the myometrium, and poor muscle, the symmetry and polarity of contractions are affected, which may lead to abnormal labor. With IVF-ET twins, the fetus is precious and the patient mostly chooses cesarean section to terminate the pregnancy, so the indications for a cesarean section may be relaxed when terminating the pregnancy. Considering the gestational uterus with abundant blood circulation, we usually do not perform corrective surgery with a rudimentary uterus without endometrium in cesarean section. In recent years, studies have found that vaginal delivery of eligible twin pregnancies is feasible [ 10 , 22 – 23 ]. In this study, there was one case of vaginal delivery with a favorable outcome for the mother and child, and no adverse pregnancy outcomes such as uterine rupture or postpartum hemorrhage occurred. This suggests that vaginal delivery in the unicornuate uterus is feasible, however, this is only one case, and the indications for vaginal delivery in the unicornuate uterus with twin pregnancies need to be confirmed by more clinical studies. In our study, we found that hemorrhage of delivery was higher in unicornuate uterine twin pregnancies than in unicornuate singleton pregnancies and normal uterine twin pregnancies, but there was no statistically significant difference in the incidence of postpartum hemorrhage after the use of powerful drugs to promote uterine contraction and appropriate surgical management. The higher risk of postpartum hemorrhage in twin pregnancies with unicornuate uterus calls for enhanced uterine contractions, improved surgical skills as well as close monitoring of postpartum hemorrhage, and timely intervention measures. Strength and Limitation The strengths of our study are that previous studies on unicornuate uterine twin pregnancies were only case reports, and our study of unicornuate uterine twin pregnancies, with a larger number of cases, allowed for a more comprehensive analysis of the perinatal characteristics and the possible adverse pregnancy outcomes of twin pregnancies with unicornuate uterine. However, the main limitation of our study is that the present perinatal study on twin pregnancies in unicornuate uterus is only a retrospective single-center study and more prospective multicenter studies are needed for further confirmation. Conclusions The perinatal risk of twin pregnancies in the unicornuate uterus was increased compared with singleton pregnancies in the unicornuate uterus and twin pregnancies in the normal uterus. For patients with unicornuate uterus, if the diagnosis has been made pre-conception, twin pregnancy should be deliberation before IVF-ET or first trimester, and if the twin pregnancy is unavoidable, attention should be paid to the health care of the pregnancy and the supervision of the safety of mothers and children in the perinatal period, and the overall pregnancy outcome and neonatal outcome of twin pregnancies in the unicornuate uterus are favorable. Abbreviations HDCP Hypertensive disorder complicating pregnancy ICP Intrahepatic cholestasis of pregnancy DM Diabetes mellitus GDM Gestational diabetes mellitus PGDM Pregestational diabetes mellitus IVF-ET In vitro fertilization-embryo transfer PROM Premature rupture of membranes PPROM Preterm premature rupture of membranes PTDs Preterm deliveries NICU Neonatal Intensive Care Unit IUD Intra-uterine death LBW Live birth weight FGR Fetal growth restriction PPH Postpartum hemorrhage Declarations Acknowledgments We are grateful to the doctors and staff who have been involved in this work. Author Contributions SW interpreted data and literature review and drafted the manuscript. HL participated in data collection and the analysis of cases. QH participated in the design of the study. HYY conceived the study, supervised the entire study, and revised the manuscript. All authors have read and approved the final manuscript. Funding This study was supported by the Natural Science Foundation of Sichuan (2022NSFSC0659). Availability of data and materials The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate The study was approved by the ethics committee of West China Second University Hospital (No. 2023-272). Informed consent was obtained from all participants. Our study complies with the Declaration of Helsinki. Consent for publication Written informed consent was obtained from each patient or parent for publication of the patient’s identifable data. A copy of the written consent is available for review by the editor of this journal. Competing interests The authors declare no competing interests. Author details 1 Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; No. 20, 3 Section, South Renmin Road, Chengdu, Sichuan 610041,China. 2 Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China. References Passos IMPE, Britto RL. Diagnosis and treatment of Müllerian malformations. Taiwan J Obstet Gynecol. 2020;59(2):183–8. Reichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review [ J]. Fertil Steril. 2009;91:1886–94. Chan YY, Jayaprakasan K, Zamora J, et al. The prevalence of congenital uterine anomalies in unselected and high-risk populations:a systematic review[J]. Hum Reprod Update. 2011;17:761–71. Khati NJ, Frazier AA, Brindle KA. The unicornuate uterus and its variants: clinical presentation, imaging findings, and associated complications [J]. J Ultrasound Med. 2012;31:319–31. Li XQ, Qian HJ, Zhang XY, et al. Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship[J]. Arch Gynecol Obstet. 2019;299(5):1321–30. Wang S, Wang K, Hu Q, et al. Perinatal outcomes of women with Müllerian anomalies. Arch Gynecol Obstet. 2023;307(4):1209–16. Monden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Hum Reprod. 2021;36(6):1666–73. Nahra-Lynch M, Toffle RC. Multiple gestation in a unicornuate uterus. A case report. J Reprod Med. 1997;42:451–4. Sugaya S. Twin pregnancy after in vitro fertilization in a woman with a unicornuate uterus. Clin Exp Obstet Gynecol. 2010;37:317–8. Fox NS, et al. Twin pregnancy in patients with a uterine anomaly. J Matern Fetal Neonatal Med. 2014;27(4):360–4. Grimbizis GF, Di Spiezio SA, Saravelos SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod. 2016;31:2–7. Knez J, Saridogan E, Van Den Bosch T, et al. ESHRE/ESGE female genital tract anomalies classification system-the potential impact of discarding arcuate uterus on clinical practice. Hum Reprod. 2018;33:600–6. Schöller D, Hölting M, Stefanescu D, et al. Female genital tract congenital malformations and the applicability of the ESHRE/ESGE classifcation: a systematic retrospective analysis of 920 patients. Arch Gynecol Obstet. 2018;297:1473–81. Zhu L, Wang S, Lang JH. Obstetrics and gynecology branch of Chinese medical association consensus of Chinese experts on diagnosis and treatment of female genital malformation. Chin J Obstet Gynecol. 2015;50:729–33. Millischer AE, Grevent D,༲ousseau V, et al. Fetal M༲I compared with ultrasound for the diagnosis of obstructive genital malformations[J]. Prenat Diagn. 2017;37(11):1138–45. Maciel C, Bharwani N, Kubik-Huch RA, et al. MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines. Eur Radiol. 2020;30(8):4272–83. Szkodziak P, Woźniak S, Czuczwar P, et al. Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies. Ginekol Pol. 2014;85(5):354–9. He Y, Geng Q,Liu H, et al. First experience using 4-dimensional hysterosalpingo-contrast sonography with SonoVue for assessing fallopian tube patency[J]. J Ultrasound Med. 2013;32(7):1233–43. Liu Y, Zhang N, He Y, et al. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography[J]. BMC Pregnancy Childbirth. 2020;20(1):638. Kougioumtsidou A, Mikos T. Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification:a diagnostic accuracy study[J]. Arch Gynecol Obstet. 2019;299(3):779–89. Ouyang Y, Cai P, Gong F, et al. The risk of twin pregnancies should be minimized in patients with a unicornuate uterus undergoing. IVF-ET Sci Rep. 2020;10(1):5571. Barrett JF Hannah, Hutton ME. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy[J]. N Engl J Med. 2013;369(14):1295–305. Aviram A, Barrett JFR, Melamed N, et al. Mode of delivery in multiple pregnancies[J]. Am J Obstet Gynecol MFM. 2022;4(2S):100470. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4675446","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":331242516,"identity":"75c9bb10-e447-465f-8a8c-c4d622d4b414","order_by":0,"name":"Si Wang","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Si","middleName":"","lastName":"Wang","suffix":""},{"id":331242517,"identity":"56e0fe42-3322-40f2-af06-9c62a2686c2d","order_by":1,"name":"Qing Hu","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Qing","middleName":"","lastName":"Hu","suffix":""},{"id":331242518,"identity":"a212658d-0efe-41c5-b53c-57675ec59cab","order_by":2,"name":"Hua Liao","email":"","orcid":"","institution":"Sichuan University","correspondingAuthor":false,"prefix":"","firstName":"Hua","middleName":"","lastName":"Liao","suffix":""},{"id":331242520,"identity":"699eba06-5e07-41ab-83b5-a38e9f44e5c2","order_by":3,"name":"Haiyan Yu","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzElEQVRIie3QsQrCMBCA4SuBdDntGkHERzgtdAr4IC5x6VRdXAsWHFyEvoAPIfgChQMnxVeoewdHJzUdnJtRMP90w30cCYDP94OFBQAB6lEkBNdOBKuWDNN4sJMpORMAzYvjDcfKjYTXao2ZCE6M9lyu590EVybGixQJ96oazumy6CIzyCju7VEm3DcUFNxNMGoseSmMt0jKjSh7Be02CXfS0OSAhhTbTzYub8EoS6jB96YsmetHrruJTU7xOxqH9TZxfzpu+nw+35/2AYX0N7T7tZU5AAAAAElFTkSuQmCC","orcid":"","institution":"Sichuan University","correspondingAuthor":true,"prefix":"","firstName":"Haiyan","middleName":"","lastName":"Yu","suffix":""}],"badges":[],"createdAt":"2024-07-02 15:55:49","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4675446/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4675446/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":62935326,"identity":"f0b0304a-220a-493b-96a5-917b53e71561","added_by":"auto","created_at":"2024-08-21 08:31:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":876325,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4675446/v1/e88f634f-a6bd-4e7e-87b4-d531009dbbba.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Perinatal Outcomes of Twin Pregnancies in Women with Unicornuate Uterus","fulltext":[{"header":"Introduction","content":"\u003cp\u003eThe female reproductive organs affected by genetic or environmental factors during formation and development may result in congenital anomalies of the genital organ [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The unicornuate uterus is formed due to the non-development of one M\u0026uuml;llerian duct, either partially or completely during the embryonic period, resulting in a unicornuate uterus or rudimentary uterus [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. The incidence of unicornuate uterus is about 0.1% in the general population, increasing to about 0.5% in women with infertility or miscarriage, and ranging from about 2.5\u0026ndash;13.2% of all uterine malformations [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Previous studies on unicornuate uterus were mostly on singleton pregnancies, and studies have shown that unicornuate uterus is associated with adverse pregnancy outcomes including miscarriage, fetal growth restriction (FGR), preterm delivery (PTD), malpresentation, and higher rates of cesarean delivery [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan additionalcitationids=\"CR5\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. With the rapid development of assisted reproductive technology (ART), since the 1980s, the global twin rate has risen by a third, with the increase varying considerably by region and country [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. However, little is known about the effects of unicornuate uterine anomaly on twin pregnancies. So far, there are only a few studies on twin pregnancies with unicornuate uterus most of which were published as case report [\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHence, we conducted a ten-year retrospective cohort analysis of twin pregnancies with unicornuate uterus and explored the effect of unicornuate uterus on pregnancy outcome. We hope that our findings will provide clinical consultation and maternal and infant perinatal management of twin pregnancies with unicornuate uterus.\u003c/p\u003e"},{"header":"Materials and methods","content":"\u003cp\u003eThis retrospective cohort study was conducted on singleton and twin pregnant women who delivered at the West China Second University Hospital, between January 1, 2013, and December 31, 2022. Cases with severe medical and surgical complications, or cases with incomplete clinical information were excluded.\u003c/p\u003e \u003cp\u003ePregnant women with unicornuate uterus were divided into group A (twin pregnancies with unicornuate uterus) and B(singleton pregnancies with unicornuate uterus). Twin pregnant women with normal uterus were selected by stratified equal-volume random sampling by age as group C (control group).\u003c/p\u003e \u003cp\u003eThere were 283 pregnant women with unicornuate uterus, including 21 cases with twin pregnancies (group A) and 262 cases with singleton pregnancies (group B). One hundred and five twin pregnancies with normal uterus (group C) (n=105(1:5)) were selected as control group. Unicornuate uterus were diagnosed according to the criteria of the European Society of Human Reproduction and Embryo(ESHRE)European Society for Gynecological Endoscopy༈ESGE) and Chinese expert consensus[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Diagnostic methods include ultrasonography, hysterosalpingography, hysteroscopy and/or laparoscopy, and laparotomy.\u003c/p\u003e \u003cp\u003eThe characteristics and perinatal outcomes of the three groups were compared. The study was approved by the ethics committee of the West China Second University Hospital (No. 2023\u0026thinsp;\u0026minus;\u0026thinsp;272).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analyses\u003c/h2\u003e \u003cp\u003eThe enumerated data are expressed as the rate (percentages), and quantitative normally distributed variables are expressed as means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation. The chi-squared test was used to determine significant differences between percentages, with continuity correction or Fisher's exact test where appropriate. Independent sample t-test was used to compare differences between means. Non-normally distributed data (expressed as M [P25, P75]) were compared between two groups using the Mann\u0026ndash;Whitney U-test. A \u003cem\u003eP\u003c/em\u003e value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered significant. Statistical analyses were performed using SPSS version 22.0 (SPSS, Inc., Chicago, IL, USA).\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003eFrom January 2013 to December 2022, there were 131913 cases of deliveries in our hospital, including 7002 cases of twin pregnancies. Twin pregnancies account for 5.3 percent (7002/131913) of all deliveries, and the incidence of twin pregnancies with unicornuate uterine is 0.3% (21/7002) in all twin pregnancies.\u003c/p\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e1. General characteristics\u003c/h2\u003e \u003cp\u003eIn the study, 283 patients were diagnosed with unicornuate uterus, 59.7% (169/283) of cases the diagnosed before this pregnancy, 17.0% (48/283) diagnosed by ultrasound in the first trimester of this current pregnancy, and the remaining 66 cases (23.3%,66/283) diagnosed during delivery (cesarean section or vaginal delivery), including one case by ultrasound-monitored curettage for intrauterine pregnancy residues.\u003c/p\u003e \u003cp\u003eAmong the 169 patients with preconception diagnosis of the unicornuate uterus, 80 cases (47.3%,80/169) were diagnosed by previous surgical explorations, including 40 cases diagnosed by hysteroscopy and laparoscopy for infertility (8 cases rudimentary uterus hysterectomies intra-operative), 20 cases founded intraoperatively by other gynecologic or surgical procedures, 16 cases detected by previous cesarean section, and 4 cases founded during emergency surgeries for rudimentary uterus pregnancy. Seventy-seven cases (45.6%,77/169) were detected by ultrasound, and 12 cases (7.1%,12/169) diagnosed by hysterosalpingography.\u003c/p\u003e \u003cp\u003eAmong the 283 cases, there were left unicornuate uterus combined with the right rudimentary uterus in 129 cases (45.6%,129/283), right unicornuate uterus combined with left rudimentary uterus in 106 cases (37.5%,106/283), and unicornuate uterus without a rudimentary uterus in 48 cases (16.7%,48/283) as 36 cases truly with no rudimentary uterus, and 12 cases with rudimentary uterus removed ( 4 cases due to rudimentary uterus pregnancies and 8 cases with rudimentary uterus removed during hysteroscopy and laparoscopy due to infertility).\u003c/p\u003e \u003cp\u003eIn the all 283 unicornuate uterine pregnancies, 241(85.2%,241/283) were delivered by caesarean section, and 42(14.8%,42/283) had vaginal deliveries (38 with eutocia,4 with assisted vaginal deliveries). Of the 241 caesarean sections, 187 were unicornuate uterus with rudimentary uterus and 54 were unicornuate uterus without rudimentary uterus. In all rudimentary uterus found during caesarean section, only 1 case had functional endometrium in the rudimentary uterus, which was connected with the unicornuate uterus, and the rest rudimentary uterus were muscular tissue. Ten cases were detected with urinary tract malformations.\u003c/p\u003e \u003cp\u003eTwenty-one twin pregnancy cases with unicornuate uterus, as 20 (95.2%) dichorionic diamnionic (DCDA) twin pregnancies and one (4.8%) monochorionic diamnionic (MCDA) twin pregnancy. Seventeen cases (81.0%) were conceived by in vitro fertilization-embryo transfer (IVF-ET) and 4 cases (19.0%) conceived naturally. In twin pregnancies with normal uterus,87 cases (82.9%) dichorionic diamnionic (DCDA) twin pregnancies and 18 case (17.1%) monochorionic diamnionic (MCDA) twin pregnancy. There was no statistically significant difference in the comparison of the type of twin between the two groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.266).\u003c/p\u003e \u003cp\u003eExcept for the proportion of primigravida in twin pregnancies with unicornuate uterus were higher than that in singleton pregnancies with unicornuate (\u003cem\u003ep\u003c/em\u003e=0.033), other general characteristics were all similar among these three groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05). Detailed information on general characteristics is shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eGeneral characteristics of the included participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003echaracteristics\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnicornuate uterus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal uterus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c6\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTwins(n\u0026thinsp;=\u0026thinsp;21) A\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSingleton(n\u0026thinsp;=\u0026thinsp;262) B\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTwins(n\u0026thinsp;=\u0026thinsp;105) C\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e(A vs. B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e(A vs. C)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal age(year)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u0026thinsp;~\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u0026thinsp;~\u0026thinsp;45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e23\u0026thinsp;~\u0026thinsp;44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e3(2.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.899 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.689 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e25\u0026ndash;34\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e210(80.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e82(78.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;35\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e42(16.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eInfertility type\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrimigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e204(77.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e96(91.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.033\u003c/b\u003e \u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.353 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultigravida\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e58(22.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e9(8.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTwin classification\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDCDA twin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20(95.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e87(82.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.266\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMCDA twin\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e18(17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLive neonatal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(45.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e139(53.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e95(45.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.322\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.959\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23(54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e121(46.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e113(54.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDiagnostic period\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProgestation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13(61.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e156(59.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.696 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFirst trimester\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(17.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDelivery period\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eNotes: a: The Chi-squared test with Fisher\u0026rsquo;s exact test; b: The Chi-squared test with continuity correction;* \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05.\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eAbbreviations: DCDA twin: dichorionic diamniotic twin; MCDA twin: monochorionic diamniotic twin.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2. Perinatal outcomes of twin pregnancies with unicornuate uterus\u003c/h2\u003e \u003cp\u003eAll 21 cases of twin pregnancies with unicornuate uterine (group A) were delivered. Gestational weeks at delivery were (28\u003csup\u003e+\u0026thinsp;2\u003c/sup\u003e~37\u003csup\u003e+\u0026thinsp;5\u003c/sup\u003e) weeks, and mean gestational weeks of delivery were (33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;5.7) weeks, which included 19 cases (90.5%) with cesarean section, 1 case (4.8%) with vaginal delivery, and 1 case (4.8%) with assisted breech delivery.\u003c/p\u003e \u003cp\u003eThere were 42 live births, 13 males (31.0%) and 29 females (69.0%). Of the 27 neonates transferred to the neonatal intensive care unit (NICU), only one neonatal death occurred and the rest were discharged successfully. The fatal case was delivered at 33\u003csup\u003e+\u0026thinsp;6\u003c/sup\u003e weeks with severe fetal growth restriction and congenital heart disease (narrowing of the aortic arch, ventricular septal defect) (birth weight 700g with Apgar scores of 7 and 8 at 1 and 5min, respectively), who was transferred to the NICU after delivery and the family abandoning treatment.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e3.Comparisons between the singleton pregnancies and twin pregnancies with unicornuate uterus\u003c/h2\u003e \u003cp\u003eTwo hundred and sixty-two cases of singleton pregnancies with unicornuate uterine (group B) were delivered.Cases in group A had the significantly higher rates of hypertensive disorder complicating pregnancy (HDCP) (19.0% vs. 4.6%, OR,4.90,95%CI 1.43\u0026ndash;16.83), intrahepatic cholestasis of pregnancy (ICP) (28.6% vs. 6.1%, OR, 6.15,95%CI,2.10-17.99), preterm premature rupture of membranes (PPROM) (38.1% vs. 11.5%, OR,4.76,95%CI,1.82\u0026ndash;12.42), preterm deliveries(PTDs) (85.7% vs. 22.9%, OR, 20.20,95%CI 5.75\u0026ndash;70.91), NICU admission (64.3% vs. 12.3%, OR, 13.05,95%CI 6.28\u0026ndash;27.12), drugs to promote uterine contraction\u0026thinsp;\u0026ge;\u0026thinsp;3 kinds (38.1% vs. 15.6%, OR, 3.32,95%CI 1.29\u0026ndash;8.51) than those in group B. In addition, birth weight was significantly lower in group A than that in group B (1931.7\u0026thinsp;\u0026plusmn;\u0026thinsp;535.2 vs. 2964.8\u0026thinsp;\u0026plusmn;\u0026thinsp;533.9, p\u0026lt;0.001).\u003c/p\u003e \u003cp\u003eHowever, the other perinatal complications and perinatal outcomes were similar between the two groups, including placenta previa, placenta percreta/accreta, placental abruption, PROM, malpresentation, Apgar score of 5-min, PPH and Uterine rupture (\u003cem\u003ep\u003c/em\u003e\u0026gt;0.05). Detailed information is presented in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePerinatal outcomes of the included participants\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"9\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eUnicornuate uterus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNormal uterus\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"5\" nameend=\"c9\" namest=\"c5\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTwins(n\u0026thinsp;=\u0026thinsp;21) A\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003eSingleton(n\u0026thinsp;=\u0026thinsp;262) B\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003eTwins(n\u0026thinsp;=\u0026thinsp;105) C\u003c/b\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e(A vs. B)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cem\u003eP\u003c/em\u003e(A vs. C)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003eOR (95%CI)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMaternal complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHDCP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12(4.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e28(26.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.023\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4.90(1.43\u0026ndash;16.83)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eICP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16(6.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e29(27.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e6.15(2.10-17.99)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.929\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDM (GDM and PGDM)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(28.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e26(24.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.591\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.714\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta previa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10(3.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.579\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.424\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacenta percreta/accreta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4(19.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e55(21.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e38(36.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.128\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePlacental abruption\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(42.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e72(27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e4.88(1.74\u0026ndash;13.67)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPROM\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30(11.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e4.76(1.82\u0026ndash;12.42)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e5.85(1.96\u0026ndash;17.49)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOligohydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14(5.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.307\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolyhydramnios\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e10(9.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.302\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eScarred uterus\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(17.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.078\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.589\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMalpresentation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e105(40.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e46(43.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.498\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIVF-ET\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17(81.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50(19.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e80(76.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e18.02(5.81\u0026ndash;55.89)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.850\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eFetal complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePTDS\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18(85.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e60(22.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e58(55.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e20.20(5.75\u0026ndash;70.91)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.009\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e4.86(1.35\u0026ndash;17.51)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;37 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e45(17.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e43(40.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;34 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10(47.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15(5.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e14(13.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026lt;28 weeks\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLive birth\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e42(100.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e260(99.2)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e\u003cb\u003e208(99.0)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5-min Apgar score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e41(97.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e260(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e208(100.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.139\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.168\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLive birth weight(g)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e(1931.7\u0026thinsp;\u0026plusmn;\u0026thinsp;535.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(2964.8\u0026thinsp;\u0026plusmn;\u0026thinsp;533.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e(2321.3\u0026thinsp;\u0026plusmn;\u0026thinsp;517.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e \u003csup\u003e\u003cb\u003ed *\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e/\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e \u003csup\u003e\u003cb\u003ed *\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e/\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBW\u0026thinsp;\u0026ge;\u0026thinsp;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9(21.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e218(83.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e76(36.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLBW\u0026lt;2500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39(15.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e114(54.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVLBW\u0026lt;1500\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6(14.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e18(8.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27(64.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32(12.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e50(24.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e13.05(6.28\u0026ndash;27.12)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e5.69(2.81\u0026ndash;11.53)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003ePerinatal mortality\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(2.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2(0.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2(1.0)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.363\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.425\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntra-uterine death (IUD)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNeonatal death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRivanol odinopoeia\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMode of delivery\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean section\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e19(90.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e222(84.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e99(94.3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.173\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.348\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e37(14.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e5(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAssisted vaginal delivery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1(4.8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3(1.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e1(0.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eLabor complications\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHemorrhage of delivery(ml)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e500(400,600)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e400(300,400)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e400(300,500)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;0.001\u003c/b\u003e\u003csup\u003e\u003cb\u003ec*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e/\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.019\u003c/b\u003e\u003csup\u003e\u003cb\u003ec*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e/\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePPH\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8(3.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e7(6.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.487\u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDrugs to promote uterine contraction\u0026thinsp;\u0026ge;\u0026thinsp;3 kinds\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8(38.1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e41(15.6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e59(56.2)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.021\u003c/b\u003e\u003csup\u003e\u003cb\u003eb*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e3.32(1.29\u0026ndash;8.51)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.129\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUterine rupture\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7(2.7)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e2(1.9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHysterectomy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1(0.4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.000\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e/\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eNotes: a: The Chi-squared test with Fisher\u0026rsquo;s exact test; b: The Chi-squared test with continuity correction; c: Mann\u0026ndash;Whitney U-test; d.: Independent sample t-test. * \u003cem\u003eP\u003c/em\u003e\u0026lt;0.05\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"9\"\u003eAbbreviations: HDCP, hypertensive disorder complicating pregnancy; ICP, intrahepatic cholestasis of pregnancy; DM, diabetes mellitus; GDM, gestational diabetes mellitus; PGDM, pregestational diabetes mellitus; IVF-ET, in vitro fertilization-embryo transfer; PROM, premature rupture of membranes; PPROM, preterm premature rupture of membranes; PTDs, preterm deliveries; NICU: Neonatal Intensive Care Unit; IUD: Intra-uterine death; LBW: Live birth weight; FGR, fetal growth restriction; PPH, postpartum hemorrhage.\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e4.Comparisons between twin pregnancies with unicornuate uterus and with normal uterus\u003c/h2\u003e \u003cp\u003eOne hundred and five twin pregnancies with normal uterus (group C) were included in the study. When compared with group C, cases in group A were associated with significantly higher rates of PROM (42.9% vs. 13.3%, OR, 4.88,95%CI 1.74\u0026ndash;13.67), PPROM (38.1% vs. 9.5%, OR, 5.85,95%CI 1.96\u0026ndash;17.49), PTDs (85.7% vs. 55.2%, OR, 4.86,95%CI 1.35\u0026ndash;17.51), NICU admission (64.3% vs. 24.0%, OR, 5.69,95%CI 2.81\u0026ndash;11.53). Meanwhile, birth weigh was significantly lower in group A (1931.7\u0026thinsp;\u0026plusmn;\u0026thinsp;535.2 vs. 2321.3\u0026thinsp;\u0026plusmn;\u0026thinsp;517.8, \u003cem\u003ep\u003c/em\u003e\u0026lt;0.05). (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eUnicornuate uterus is a type of female genital malformation, and twin pregnancy with the unicornuate uterus is a rare condition that carries considerable risk to the maternal and fetus. Unicornuate uterus that is not combined with a rudimentary uterus with endometrium usually has no obvious clinical symptoms and is often difficult to detect, so the possibility of unicornuate uterus should be considered in women with a history of infertility or adverse pregnancies [\u003cspan additionalcitationids=\"CR3\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. In this study, the pre-pregnancy diagnosis rate was up to 59.7% (169/283), and early diagnosis of unicornuate or rudimentary uterus is the key to improving pregnancy outcomes. The high pre-pregnancy diagnosis rate may be due to the improvement of the examination methods in recent years, as well as the fact that gynecologists have paid more attention to patients who are infertile or have adverse pregnancies. At present, clinical diagnosis is mainly based on ultrasound, hysterosalpingography, and hysteroscopy or laparoscopy, in addition, MRI, three-dimensional (3D) ultrasonography and 4-dimensional hysterosal⁃pornography(4D-HyCoSy)are gradually being used for diagnosis and further clarification of the type of uterine abnormalities, and it can dramatically improve the accuracy of diagnosis[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePrevious literature has reported that unicornuate uterus is associated with adverse pregnancy outcomes [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. Our study showed that compared with singleton pregnancy, twin pregnancies with unicornuate uterus were associated with adverse pregnancy outcomes, such as preterm premature rupture of membranes (38.1%,8/21), preterm deliveries (85.7%,18/21), and neonatal intensive care unit (64.3%,27/42), and lower live birth weight. Previous studies also have found that twin pregnancies in unicornuate uterine anomaly were associated with higher risks of preterm delivery, perinatal mortality, and low birth weight [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Thus, our findings are in agreement with previously published studies. On the other hand, Ouyang et al. found that selective reduction of twins to a singleton may yield better outcomes in patients with unicornuate uterine anomalies undergoing IVF-ET [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. Therefore, if unicornuate uterus was found pre-pregnancy, comprehensive counseling about the high risk of twin pregnancy should be provided to the couple, whether or not to have a single embryo transfer or selective reduction to a singleton may be considered in pregnant women with a unicornuate uterus who have twin pregnancies after assisted reproduction to improve pregnancy outcomes.\u003c/p\u003e \u003cp\u003eThe incidence of adverse pregnancy outcomes in twin pregnancies with unicornuate uterus was higher than that in the normal uterus or singleton pregnancies in unicornuate uterus, which may be related to the fact that the unicornuate uterus has only 1 uterine artery and some small contralateral arteries supplying blood to the uterus, which affects the perfusion, reduces the muscle, has less uterine muscle mass, an abnormal uterine blood flow, abnormal shape of the uterine cavity, and reduced uterine cavity volume, which is associated with a significantly higher risk for adverse pregnancies in twin pregnancies [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTwin pregnancy with unicornuate uterus is a rare condition and carries a considerable risk to the maternal and fetal. In our study, patients with unicornuate uterus who detected preconception or during early pregnancy were included in the management of high-risk pregnancies, strengthening supervision and increasing the frequency of prenatal check-ups had been taken into consideration to decrease pregnancy complications and adverse pregnancy outcomes. Because patients with unicornuate uterus may be associated with renal anomalies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e], patients with unicornuate uterus are recommended to undergo routine ultrasound screening of the urinary system and to pay attention to the developmental anomalies of other organs. Meanwhile, ultrasound screening of the fetal system should be strengthened during pregnancy to detect fetal developmental abnormalities in time.\u003c/p\u003e \u003cp\u003eCesarean section rate for twin pregnancies in unicornuate uterus is as high as 90.5% (19/21), but malpresentation, ICP, and PROM constitute the main indication for cesarean deliveries (12/21,57.1%) in our study. Anomaly uterine pregnancy is not an absolute indication for cesarean section. However, due to the morphological and structural abnormalities of the unicornuate uterus, incomplete development of the myometrium, and poor muscle, the symmetry and polarity of contractions are affected, which may lead to abnormal labor. With IVF-ET twins, the fetus is precious and the patient mostly chooses cesarean section to terminate the pregnancy, so the indications for a cesarean section may be relaxed when terminating the pregnancy. Considering the gestational uterus with abundant blood circulation, we usually do not perform corrective surgery with a rudimentary uterus without endometrium in cesarean section. In recent years, studies have found that vaginal delivery of eligible twin pregnancies is feasible [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In this study, there was one case of vaginal delivery with a favorable outcome for the mother and child, and no adverse pregnancy outcomes such as uterine rupture or postpartum hemorrhage occurred. This suggests that vaginal delivery in the unicornuate uterus is feasible, however, this is only one case, and the indications for vaginal delivery in the unicornuate uterus with twin pregnancies need to be confirmed by more clinical studies.\u003c/p\u003e \u003cp\u003eIn our study, we found that hemorrhage of delivery was higher in unicornuate uterine twin pregnancies than in unicornuate singleton pregnancies and normal uterine twin pregnancies, but there was no statistically significant difference in the incidence of postpartum hemorrhage after the use of powerful drugs to promote uterine contraction and appropriate surgical management. The higher risk of postpartum hemorrhage in twin pregnancies with unicornuate uterus calls for enhanced uterine contractions, improved surgical skills as well as close monitoring of postpartum hemorrhage, and timely intervention measures.\u003c/p\u003e\n\u003ch3\u003eStrength and Limitation\u003c/h3\u003e\n\u003cp\u003eThe strengths of our study are that previous studies on unicornuate uterine twin pregnancies were only case reports, and our study of unicornuate uterine twin pregnancies, with a larger number of cases, allowed for a more comprehensive analysis of the perinatal characteristics and the possible adverse pregnancy outcomes of twin pregnancies with unicornuate uterine. However, the main limitation of our study is that the present perinatal study on twin pregnancies in unicornuate uterus is only a retrospective single-center study and more prospective multicenter studies are needed for further confirmation.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eThe perinatal risk of twin pregnancies in the unicornuate uterus was increased compared with singleton pregnancies in the unicornuate uterus and twin pregnancies in the normal uterus. For patients with unicornuate uterus, if the diagnosis has been made pre-conception, twin pregnancy should be deliberation before IVF-ET or first trimester, and if the twin pregnancy is unavoidable, attention should be paid to the health care of the pregnancy and the supervision of the safety of mothers and children in the perinatal period, and the overall pregnancy outcome and neonatal outcome of twin pregnancies in the unicornuate uterus are favorable.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eHDCP Hypertensive disorder complicating pregnancy\u003c/p\u003e \u003cp\u003eICP Intrahepatic cholestasis of pregnancy\u003c/p\u003e \u003cp\u003eDM Diabetes mellitus\u003c/p\u003e \u003cp\u003eGDM Gestational diabetes mellitus\u003c/p\u003e \u003cp\u003ePGDM Pregestational diabetes mellitus\u003c/p\u003e \u003cp\u003eIVF-ET In vitro fertilization-embryo transfer\u003c/p\u003e \u003cp\u003ePROM Premature rupture of membranes\u003c/p\u003e \u003cp\u003ePPROM Preterm premature rupture of membranes\u003c/p\u003e \u003cp\u003ePTDs Preterm deliveries\u003c/p\u003e \u003cp\u003eNICU Neonatal Intensive Care Unit\u003c/p\u003e \u003cp\u003eIUD Intra-uterine death\u003c/p\u003e \u003cp\u003eLBW Live birth weight\u003c/p\u003e \u003cp\u003eFGR Fetal growth restriction\u003c/p\u003e \u003cp\u003ePPH Postpartum hemorrhage\u003c/p\u003e "},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgments\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe are grateful to the doctors and staff who have been involved in this work.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSW interpreted data and literature review and drafted the manuscript. HL participated in data collection and the analysis of cases. QH participated in the design of the study. HYY conceived the study, supervised the entire study, and revised the manuscript. All authors have read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the Natural Science Foundation of Sichuan (2022NSFSC0659).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the ethics committee of West China Second University Hospital (No. 2023-272). Informed consent was obtained from all participants. Our study complies with the Declaration of Helsinki.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWritten informed consent was obtained from each patient or parent for publication of the patient\u0026rsquo;s identifable data. A copy of the written consent is available for review by the editor of this journal.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;Competing interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;The authors declare no competing interests.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1 Department of Obstetrics and Gynecology, West China Second University Hospital, Sichuan University; No. 20, 3 Section, South Renmin Road, Chengdu, Sichuan 610041,China.\u003c/p\u003e\n\u003cp\u003e2 Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, China.\u003c/p\u003e\n"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePassos IMPE, Britto RL. Diagnosis and treatment of M\u0026uuml;llerian malformations. Taiwan J Obstet Gynecol. 2020;59(2):183\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReichman D, Laufer MR, Robinson BK. Pregnancy outcomes in unicornuate uteri: a review [ J]. Fertil Steril. 2009;91:1886\u0026ndash;94.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChan YY, Jayaprakasan K, Zamora J, et al. The prevalence of congenital uterine anomalies in unselected and high-risk populations:a systematic review[J]. Hum Reprod Update. 2011;17:761\u0026ndash;71.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhati NJ, Frazier AA, Brindle KA. The unicornuate uterus and its variants: clinical presentation, imaging findings, and associated complications [J]. J Ultrasound Med. 2012;31:319\u0026ndash;31.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLi XQ, Qian HJ, Zhang XY, et al. Analysis of the reproductive outcomes and the size of the unicornuate uterus measured by magnetic resonance imaging and their relationship[J]. Arch Gynecol Obstet. 2019;299(5):1321\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWang S, Wang K, Hu Q, et al. Perinatal outcomes of women with M\u0026uuml;llerian anomalies. Arch Gynecol Obstet. 2023;307(4):1209\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMonden C, Pison G, Smits J. Twin Peaks: more twinning in humans than ever before. Hum Reprod. 2021;36(6):1666\u0026ndash;73.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNahra-Lynch M, Toffle RC. Multiple gestation in a unicornuate uterus. A case report. J Reprod Med. 1997;42:451\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSugaya S. Twin pregnancy after in vitro fertilization in a woman with a unicornuate uterus. Clin Exp Obstet Gynecol. 2010;37:317\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eFox NS, et al. Twin pregnancy in patients with a uterine anomaly. J Matern Fetal Neonatal Med. 2014;27(4):360\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGrimbizis GF, Di Spiezio SA, Saravelos SH, et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Hum Reprod. 2016;31:2\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKnez J, Saridogan E, Van Den Bosch T, et al. ESHRE/ESGE female genital tract anomalies classification system-the potential impact of discarding arcuate uterus on clinical practice. Hum Reprod. 2018;33:600\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSch\u0026ouml;ller D, H\u0026ouml;lting M, Stefanescu D, et al. Female genital tract congenital malformations and the applicability of the ESHRE/ESGE classifcation: a systematic retrospective analysis of 920 patients. Arch Gynecol Obstet. 2018;297:1473\u0026ndash;81.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhu L, Wang S, Lang JH. Obstetrics and gynecology branch of Chinese medical association consensus of Chinese experts on diagnosis and treatment of female genital malformation. Chin J Obstet Gynecol. 2015;50:729\u0026ndash;33.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMillischer AE, Grevent D,༲ousseau V, et al. Fetal M༲I compared with ultrasound for the diagnosis of obstructive genital malformations[J]. Prenat Diagn. 2017;37(11):1138\u0026ndash;45.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaciel C, Bharwani N, Kubik-Huch RA, et al. MRI of female genital tract congenital anomalies: European Society of Urogenital Radiology (ESUR) guidelines. Eur Radiol. 2020;30(8):4272\u0026ndash;83.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSzkodziak P, Woźniak S, Czuczwar P, et al. Usefulness of three dimensional transvaginal ultrasonography and hysterosalpingography in diagnosing uterine anomalies. Ginekol Pol. 2014;85(5):354\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHe Y, Geng Q,Liu H, et al. First experience using 4-dimensional hysterosalpingo-contrast sonography with SonoVue for assessing fallopian tube patency[J]. J Ultrasound Med. 2013;32(7):1233\u0026ndash;43.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLiu Y, Zhang N, He Y, et al. Spontaneous conception outcome in infertile women after four-dimensional hysterosalpingo-contrast-sonography[J]. BMC Pregnancy Childbirth. 2020;20(1):638.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKougioumtsidou A, Mikos T. Three-dimensional ultrasound in the diagnosis and the classification of congenital uterine anomalies using the ESHRE/ESGE classification:a diagnostic accuracy study[J]. Arch Gynecol Obstet. 2019;299(3):779\u0026ndash;89.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOuyang Y, Cai P, Gong F, et al. The risk of twin pregnancies should be minimized in patients with a unicornuate uterus undergoing. IVF-ET Sci Rep. 2020;10(1):5571.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBarrett JF Hannah, Hutton ME. A randomized trial of planned cesarean or vaginal delivery for twin pregnancy[J]. N Engl J Med. 2013;369(14):1295\u0026ndash;305.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAviram A, Barrett JFR, Melamed N, et al. Mode of delivery in multiple pregnancies[J]. Am J Obstet Gynecol MFM. 2022;4(2S):100470.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Müllerian anomalies, unicornuate uterus, twin pregnancy, pregnancy outcomes","lastPublishedDoi":"10.21203/rs.3.rs-4675446/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4675446/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground: \u003c/strong\u003eIt is known that unicornuate uterus is a type of Müllerian anomalies and is associated with adverse pregnancy outcomes. However, previous studies on unicornuate uterus were mostly on singleton pregnancies, the perinatal outcomes of twin pregnancies with unicornuate uterus remains elucidating.This research aimed to investigate the perinatal outcomes of twin pregnancies in women with unicornuate uterus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods: \u003c/strong\u003eA total of 283 women with unicornuate uterus, 21 twin pregnancies (group A), 262 singleton pregnancies (group B) and 105 twin pregnancies with normal uterus (group C) were enrolled who delivered at West China Second University Hospital, Sichuan University from January 2013 to December 2022, general characteristics and perinatal outcomes were retrospectively analyzed.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults: \u003c/strong\u003eIn twenty-one twins with unicornuate uterus, 20 cases (95.2%) were dichorionic diamniotic twins and 1 case (4.8%) monochorionic diamniotic twin. Seventeen cases (81.0%) were conceived by in vitro fertilization-embryo transfer (IVF-ET) and 4 cases (19.0%) naturally. The mean gestational weeks of delivery were (33.8±5.7) weeks and 19 cases (90.5%) were cesarean section.The twin group (A) was associated with a significantly higher rate of\u003cstrong\u003e \u003c/strong\u003epreterm premature rupture of membranes (38.1%,8/21), preterm deliveries (85.7%,18/21) (preterm delivery (PTD) was defined as a birth occurring after 28 weeks and before 37 completed weeks of gestational age), and neonatal intensive care unit (64.3%,27/42) than that of group B and group C (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.05). Moreover, the live birth weight in group A (1931.7±535.2)g was lower than in group B and group C (\u003cem\u003ep \u003c/em\u003e\u0026lt;0.001).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions:\u003c/strong\u003e The incidence of complications and risk of adverse perinatal outcomes in twin pregnancies with unicornuate uterus is higher than that in singleton with unicornuate uterine and twin pregnancies with normal uterine. Thus, maternal and fetal monitoring during pregnancy should be strengthened to achieve good outcomes.\u003c/p\u003e","manuscriptTitle":"Perinatal Outcomes of Twin Pregnancies in Women with Unicornuate Uterus","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-25 08:18:00","doi":"10.21203/rs.3.rs-4675446/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"85c20293-a7e8-4241-a68c-49ed2a00b644","owner":[],"postedDate":"July 25th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2024-08-21T08:23:29+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-25 08:18:00","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4675446","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4675446","identity":"rs-4675446","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}