OC29.01: Definitions, diagnosis, prevalence, clinical implications and treatment of t‐shaped uterus: a systematic review

To summarise the current evidence regarding definitions, diagnosis, prevalence, clinical implications and impact of surgery for t-shaped uterus not related to Diethystilbestrol (DES) exposure. We searched PubMed, Scopus and EMBASE on Jul-2018. Additionally, we have hand-searched reference list from included studies. We included all studies presenting any data regarding t-shaped uterus not related to DES exposure. Our searches retrieved a total of 2,351 records and we included 28 studies in this systematic review. The general quality of the studies was poor, and there was no universally accepted definition for t-shaped uterus. The prevalence of t-shaped uterus varied from 0.2-10% in the included studies. Regarding etiology of non-DES t-shaped uterus, there was mention to tuberculosis (2 studies), adenomyosis (1 study); Asherman syndrome (1 study). Studies evaluating clinical relevance have associated this condition with worse reproductive outcomes: miscarriage and infertility (8 studies), preterm delivery (4 studies), ectopic pregnancy and recurrent implantation failure (2 studies). From the studies that analysed benefits of surgical treatment by hysteroscopic metroplasty (9 studies), there was mention to improvement on pregnancy and live birth rates (6 and 4 studies), and with a reduction in the risk of preterm delivery and miscarriage (5 and 4 studies). The quality of the evidence regarding the ethicology, prevalence, clinical relevance, and impact of surgery on reproductive outcomes in women with t-shaped uterus is very low. This is very likely to be related to a lack of a widely accepted definition and/or measurable criteria for distinguishing between t-shaped and normal/arcuate uterus.