Abstract 
Background and aim: To study the pattern of congenital uterine anomalies and their impact on reproductive outcomes.   
Methods: A Prospective clinical study included 100 women of childbearing age with reproductive failure either infertility, repeated miscarriage, or preterm birth, and diagnosed to have congenital uterine anomalies either inside or outside Mansoura university hospitals. Hysterosalpingogram (HSG), hysteroscope, and or laparoscope were performed to confirm the undiagnosed cases. The main outcome measure was reproductive complications among studied patients.     
Results: The mean age (+SD) of the studied cases was 27.07 (±4.04) years, with the frequency of complaints as failure to conceive being recorded as the commonest (45%), 27 cases as primary while 18 as secondary infertility with a duration shorter in primary than secondary infertility (3.01+ 1.1 vs 4.02+ 1.2 respectively) followed by recurrent pregnancy loss (39%), preterm labor (13%), and lastly acute abdominal pain (3%). On the other hand, anomalies demonstrated according to their frequencies were arcuate uterus (35%), bicornuate unicolis uterus (17%), incomplete uterine septum (15%), complete uterine septum (9%), didelphys uterus (7%), uni-cornuate uterus with a rudimentary horn (6%) and without a horn (6%), complete uterine agenesis (4%) and lastly T-shaped uterus (1%). Ninety-one patients got pregnant after intervention but 21 ended by abortion, and 27 had preterm labor meanwhile the rest (43) passed fetal maturity despite some complications already occurred in about 65% of them including low birth weight (17) premature placental separation (8), and rupture uterus (3). All cases planned for delivery were delivered by Lower segment cesarean section.
Conclusion: There is a strong association between congenital uterine anomalies and adverse reproductive outcomes. The arcuate uterus was the commonest congenital uterine anomaly found in the study and this occurred mostly among women presenting with secondary infertility or recurrent pregnancy loss.