Congenital anomalies of the female reproductive tract are the result of deviations from normal embryologic development. While diverse in their clinical presentation and associated medical complications, all congenital genitourinary tract abnormalities can impact reproductive health and pregnancy. Uterine anomalies in pregnancy are associated with increased risk of first-trimester pregnancy loss, preterm birth, fetal malpresentation, and poor fetal growth. The degree of risk varies based on the type of uterine anomaly. Obstetric outcomes are usually good and vaginal birth should be encouraged if the fetus is in cephalic presentation and in the absence of any other indication for cesarean section.