Missed, Misclassified or Misunderstood? Clinician Perspectives on Congenital Uterine Anomalies in Australia and New Zealand.

OBJECTIVE

To describe clinical management of congenital uterine anomalies in Australia and New Zealand and identify areas requiring standardisation, we conducted a cross-sectional online survey of members of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and the Australasian Society for Ultrasound in Medicine.

METHODS

A 23-item Qualtrics survey assessed clinical experience, diagnostic approaches, imaging, classification use, training and challenges among clinicians providing reproductive healthcare. Participation was voluntary and anonymous. The survey was distributed via institutional channels: ASUM at multiple time points and its 2024 annual meeting, and RANZCOG over 5 weeks (July-August 2024) with committee approval. Ethics was obtained from the Australian National University Human Research Ethics Committee (ANU HREC 2023/1238). Descriptive analyses were performed.

RESULTS

A total of 317 responses were analysed. CUAs were infrequently encountered, with septate, arcuate and bicornuate anomalies most commonly identified. Classification practices varied, with ESHRE/ESGE most frequently used, although no system was uniformly adopted. Referrals were most common for infertility care and second opinions, while surgical intervention was less frequent. Limited access to specialised imaging and subspeciality care was a key barrier, particularly outside metropolitan areas. Training and confidence varied by location, with greater limitations in remote settings. Clinicians supported standardised classification, improved imaging access and integration of CUA risk factors into national care systems. ASUM findings were consistent.

CONCLUSION

Clinical management of CUAs in Australia and New Zealand remains variable, highlighting the need for greater standardisation, improved diagnostic access and multidisciplinary collaboration to support consistent, evidence-based care.