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The female genital tracts develop from Mullerian ducts in the absence of AMH (Anti Mullerian Hormone), which is secreted by testicular gonads. The new ESHRE/ESGE classification system was proposed on the basis of clinical significance of anatomical deviations of the female genital tract. There are seven main classes of uterine anomaly, U0 to U6. Class U4 genital tract anomaly (Hemi uterus) is intriguing owing to the varied obstetric associations ranging from life threatening rudimentary horn rupture in early pregnancy to a term delivery. Aims and Objectives: The objectives of the present study is to test the clinical validity of the new ESHRE/ESGE classification in U4 class: "Presence (U4a / Absence (U4b) of a functional cavity in the contralateral horn is the only clinically important factor for complication and to analyse whether the characteristics of pregnancy in the developed hemi uterus differ in classes U4a and U4b. Material and Methods: The present study is retrospective cohort study, carried out between January 2012– May 2017 at a tertiary care teaching hospital, Pt. B.D. Sharma PGIMS, Rohtak. Emergency obstetric surgeries were analysed and characterisation of the maternal and perinatal associations of class U4 genital tract anomalies and the subclasses U4a (with rudimentary cavity) and U4b (without rudimentary cavity) was done. A p value of <0.05 was considered significant. Results: Prevalence – female genital tract anomalies in emergency obstetric surgery 1.3%. Class U4a had a very high prevalence of breech presentation (75.8%) and prematurity (48.3%). One fifth cases were associated with FGR. Comparison between U4a and U4b classes (identified during caesarean section) did not reveal a significant difference in the maternal and perinatal outcomes. There was no cervical or vaginal malformation in any subclass. However, life threatening conditions were significantly higher in U4a class than U4b class (15.9% vs. 2.9%) and majority were identified during laparotomy (p <0.0001). Conclusion: Life threatening events are significantly higher in class U4a, which validates the new ESHRE/ESGE classification (class U4) in our study. Obstetric outcomes are significantly unfavorable if the pregnancy occurs in the contralateral underdeveloped horn of class U4a. But there is no difference in maternal and perinatal characteristics if pregnancy occurs in the developed hemi uterus.

Emergency obstetric performance in ESHRE / ESGE class U4 female genital tract anomalies