Hysteroscopic Metroplasty

EDITORIAL COMMENT: Septate uterus is a common obstetric problem often first diagnosed during pregnancy when oblique fetal lie with breech presentation is noted in an asymmetrical heart-shaped uterus in the early third trimester. The diagnosis may also be made by hysterosalpingography in patients with habitual abortion, by early second trimester ultrasonography (although sometimes the ultrasonographer cannot identify the septum), or at the time of manual removal of a retained placenta. Most obstetricians have treated many patients with a septate uterus conservatively since the majority reproduce successfully. The question of metroplasty only arises when habitual abortion occurs. The remarkably few published series of metroplasties performed abdominally indicate that the operation is seldom performed. Hysteroscopic metroplasty seems so simple and effective that it appears reasonable to recommend it in any patient who has had 2 or more spontaneous miscarriages, especially if these occurred in the second trimester and resulted in the loss of a normally formed fetus. It is unlikely that a controlled trial on patients with a uterine septum and a history of spontaneous abortion will be performed to determine the extent to which metroplasty improves reproductive performance. In the case reported here readers may question whether the blighted ovum at 9 weeks' gestation, and spontaneous abortion at 9 weeks, were related to the uterine septum. The need for laparoscopy at the time of hysteroscopic metroplasty merits emphasis.