Office hysteroscopic metroplasty: three "diagnostic criteria" to differentiate between septate and bicornuate uteri

Study objectiveTo evaluate the benefits of adopting 3 simple “diagnostic criteria” in the differential diagnosis between septate and bicornuate uteri, and the relative treatment by hysteroscopy in an office setting.DesignProspective clinical study (Canadian Task Force classification III).SettingUniversity-affiliated hospital.PatientsTwo hundred-sixty patients with a hysteroscopic diagnosis of a double uterine cavity were enrolled.InterventionsOffice hysteroscopic metroplasty was performed without analgesia or anesthesia using 5F scissors.Measurements and Main ResultsThe presence of vascularized tissue, sensitive innervation, and the appearance of the tissue at the incision of a supposed septum during an office hysteroscopic procedure were the criteria used to differentiate a septate from a bicornuate uterus. In 93.1% of the cases, office hysteroscopic metroplasty was successfully performed during the same diagnostic procedure. In 15 of 18 patients scheduled for laparoscopic control of the uterine anatomy, the suspicion of a bicornuate uterus was confirmed. Hysteroscopic follow-up at 3 months showed a regular uterine cavity with a fundal notch less than 1 cm.ConclusionThe study demonstrates the possibility of obtaining complete, safe removal of uterine septae in most cases by office hysteroscopy confirmation, using mechanical instruments, in an office setting. This was achieved by relating the diagnosis and treatment to simple anatomic and physiologic diagnostic criteria.     

Accuracy of three-dimensional ultrasonography in differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging

Study ObjectiveTo estimate the accuracy of 3-dimensional (3-D) ultrasonography in the differential diagnosis of septate and bicornuate uterus compared with office hysteroscopy and pelvic magnetic resonance imaging (MRI).DesignProspective cohort study (Canadian Task Force Classification II-2).SettingUniversity hospital.PatientsThirty-one patients referred with a suspected diagnosis of septate (n = 20) or bicornuate (n = 11) uterus.InterventionsAll patients underwent 3-D ultrasonography displaying the rebuilt coronal view of the uterus, office hysteroscopy, and pelvic MRI. Operative hysteroscopic assessment and treatment was performed in case of sonographically diagnosed septate uterus. Bicornuate uterus was confirmed by laparoscopy.Main Outcomes MeasuresConcordance between suspected diagnosis with 3-D ultrasonography, hysteroscopy, and pelvic MRI and final diagnosis.ResultsA septate uterus was diagnosed with 3-D ultrasonography in 29 patients and bicornuate uterus in 2 patients. Hysteroscopic transcervical section of the uterine septum was achieved in the 29 patients. Bicornuate uterus was laparoscopically confirmed in the 2 patients. Concordance between ultrasonography and operative hysteroscopy or laparoscopy was verified in all 31 cases. Twenty-five uterine septa and 5 bicornuate uteri were diagnosed by hysteroscopy (3 false-positive diagnoses of bicornuate uterus, 1 unfeasible hysteroscopy). Hysteroscopic diagnosis was correct in 27/30 patients. Twenty-four septate uteri and 7 bicornuate uteri were diagnosed by MRI (5 false-positive diagnoses of bicornuate uterus). Two complete septate uteri diagnosed by MRI were finally confirmed as incomplete septate uteri after 3-D ultrasonography and operative hysteroscopy. MRI diagnosis was correct in 24/31 patients.ConclusionTransvaginal 3-D ultrasonography appears to be extremely accurate for the diagnosis and classification of congenital uterine anomalies, more than office hysteroscopy and MRI. It may conveniently become the only mandatory step in the assessment of the uterine cavity in patients with a suspected septate or bicornuate uterus.     

Office hysteroscopic findings in patients with two,three, and four or more,consecutive miscarriages

ABSTRACT

Objectives To assess hysteroscopic findings in patients with two, three, and four or more, consecutive miscarriages, and to compare the prevalence of uterine abnormalities between women with different numbers of such miscarriages.

Methods Two hundred and sixty-five women with two or more consecutive miscarriages were enrolled in the study. Patients were divided into three groups according to the number of their miscarriages: Group 1 (two miscarriages, n =?151), Group 2 (three miscariages, n =?69), and Group 3 (four or more miscarriages, n =?45). All participants underwent a diagnostic hysteroscopy. Congenital (arcuate uterus, septate uterus, unicornuate uterus) and acquired uterine abnormalities (intrauterine adhesions, polyp and submucous myoma) were recorded. The hysteroscopic results were compared between the groups.

Results No anomalies were detected in 152 patients (57%), whereas 43 (16%) had a septate uterus, 30 (11%) an arcuate uterus, three (1%) a unicornuate uterus, 18 (7%) intrauterine adhesions, 17 (6 %) endometrial polyps, and two (1%) a submucous myoma. No significant differences were found between the groups with regard to either congenital or acquired uterine abnormalities.

Conclusions Patients with two, three, and four or more consecutive miscarriages have a similar prevalence of uterine anatomical abnormalities. Diagnostic hysteroscopy should be carried out after two such miscarriages.     

Hysteroscopic findings in infertile women: A retrospective study

BackgroundLower pregnancy rates are observed in patients with uterine cavity anomalies. The correction of these anomalies has been associated with improved pregnancy rates. Diagnostic hysteroscopy can be performed in an office with minimal discomfort and superior sensitivity and specificity in evaluation of the uterine cavity. Our study was done to evaluate the importance of office hysteroscopy (OH) in diagnosis of pathology among infertile women.ObjectiveTo study incidence of abnormal hysteroscopic findings among infertile women.Materials and MethodsWe retrospectively studied 432 office hysteroscopies in patients referred to our unit because of their infertility problem. Two hundred and seventy-four patients (63.43%) were with primary infertility and 158 (36.57%) were with secondary infertility.ResultsNormal hysteroscopic findings were reported in 344 women (79.63%). The other 88 (20.37%) were with abnormal hysteroscopy. The most common reported hysteroscopic abnormality was intrauterine adhesions (IUA) 31.81% (28/88) followed by endometrial polyp 26.13% (23/88). Pre-hysteroscopic uterine investigations (ultrasound or hysterography) were available, only, in 207 women. In 143 patients with normal pre-hysteroscopic uterine investigations, office hysteroscopy revealed uterine cavity abnormalities in 21 women (14.68%). Of those with abnormal pre-hysteroscopic findings, 64 patients, hysteroscopy examinations were normal in 16 patients (25%).ConclusionsOffice hysteroscopy should be a part of routine work up in infertile patients as routine uterine investigatory methods (ultrasonography and hysterography) have only sensitivity and specificity value of 67.19% and 85.31% respectively.     

Malformations utérines et infertilité

The effective incidence of uterine malformations is not clearly defined in the literature. If minor uterine abnormalities are considered, this incidence is about 6-7 % among the normal fertile population and >25 % in women with recurrent miscarriages. Nevertheless, major malformations are observed in only 0.5% to 5% of the general population, in 0.1% to 3% of fertile women, in 3% of infertile women and in 5-10 % of women with recurrent miscarriage. The most frequently encountered uterine malformations are bicornuate and septate uteri. The diagnosis is confirmed by both hysterosalpingography and endoscopy (hysteroscopy and laparoscopy). Hysteroscopic metroplasty is commonly used to repair uterine septa and enlarge T-shaped uterus in women exposed in utero to deithylstilbestrol.     

Reproductive outcomes after Versapoint hysteroscopic metroplasty

ObjectiveTo determine the feasibility, safety and the outcomes of hysteroscopic metroplasty with bipolar Versapoint electrode.DesignProspective, observational study.SettingEndoscopy Unit, Suzan Moubark Maternity and Pediatric University Hospital.Patient(s)Twenty-six patients with different degree of uterine septa and poor reproductive outcomes (spontaneous abortion, habitual abortion, preterm labor and unexplained primary infertility).Intervention(s)Versapoint hysteroscopic division of the uterine septum.Main outcome measure(s)Prospective evaluation of the reproductive outcomes during 24months follow up.Result(s)There was significant changes in the results after metroplasty, as 23 (88.46%) patients became pregnant, of them 3/23 (13.04%) had habitual abortion, 2 patients (4.34%) ended in preterm labor, 14/23 (60.86%) had reached to term delivery with a total pregnancy loss of 5/23 (21.73%) and pregnancy complications occurred in 5/23 (21.73%), these results represent a statistically significant difference (P?0.05). The mean gestational age, the mean neonatal weight at delivery, early neonatal condition judged by apgar scores both in 1 and 5min after delivery were significantly improved after hysteroscopic metroplasty (P<0.05). There were no intraoperative or postoperative complications, and complete removal of the septum was achieved in 21 patients (80.67%), a residual septum was found in 5 woman (19.23%), and a 2nd intervention was done in only 2 patients (7.69%) with a residual septum >1cm using office hysteroscopy.Conclusion(s)Hysteroscopic metroplasty using the Versapoint is a successful alternative to the resectoscope technique; it has the same effectiveness and broad safety profile with its simplicity, minimal postoperative squeal, and improved reproductive outcome, this approach should be recommended for metroplasty.     

宫腔镜子宫纵隔切开术治疗纵隔子宫

诊断纵隔子宫的金标准仍然是宫腔镜联合腹腔镜手术。文章阐述宫腔镜子宫纵隔切开术的手术技巧,回顾分析190例纵隔子宫患者术后的妊娠结局。宫腔镜下子宫纵隔切开术可减少流产率,提高活产率。宫腔镜下子宫纵隔矫形手术安全,并发症少,可明显改善纵隔子宫合并不良孕产史患者的妊娠结局。     

Hysteroscopic incision of the septate uterus

Fifteen women underwent hysteroscopic incision of symptomatic septate uteri between April, 1982, and July, 1983. All procedures were performed on an outpatient basis with general anesthesia, by means of dextran hysteroscopy with direct-vision scissors incision of the septa under external laparoscopic guidance. No significant intraoperative nor postoperative complications occurred. Preoperative indications included repetitive pregnancy loss (eight), repetitive pregnancy loss and infertility (four), infertility and total uterine septum (one), preinsemination by donor (one), and intractable dysmenorrhea (one). A total of 72 hysteroscopic septal incision/resection procedures unassociated with any significant morbidity have been reported in the literature. Compared to transabdominal metroplasty, hysteroscopy is an outpatient procedure that avoids abdominal and uterine incisions and requires no long-term postoperative delay in attempting pregnancy. In addition, subsequent pregnancy does not require cesarean section. With these advantages, hysteroscopic incision of the symptomatic septate uterus can replace transabdominal metroplasty and allow liberalization of operative indications.     

Two- and Three-Dimensional Ultrasonography and Sonohysterography versus Hysteroscopy With Laparoscopy in the Differential Diagnosis of Septate,Bicornuate, and Arcuate Uteri

Study ObjectiveTo estimate the diagnostic accuracy and to compare the diagnostic value of 3-dimensional sonohysterography (3D-SIS), 3-dimensional transvaginal ultrasonography (3D-TVS), 2-dimensional sonohysterography (2D-SIS), and 2-dimensional transvaginal ultrasonography (2D-TVS) (initial and expert diagnosis) in the differential diagnosis of septate, bicornuate, and arcuate uteri.DesignProspective clinical study (Canadian Task Force II-2).SettingUniversity hospital and private hospital and clinic.PatientsA total of 117 women with a history of recurrent abortions or infertility and a 2D-TVS initial diagnosis of a septate, bicornuate, or arcuate uterus.InterventionsExpert 2D-TVS, 3D-TVS, 2D-SIS, and 3D-SIS performed by experienced examiners and hysteroscopy with laparoscopy to establish the final diagnosis.Measurements and Main ResultsHysteroscopy performed in conjunction with laparoscopy (HL) detected 23 arcuate, 60 septate, 22 bicornuate, and 12 normal uteri. 3D-SIS showed perfect diagnostic accuracy (100.0%) in general detection of uterine abnormalities, compared with initial 2D-TVS (77.8%), expert 2D-TVS (90.6%), 2D-SIS (94.0%), and 3D-TVS (97.4%). In the overall diagnosis of uterine anomalies, all of the diagnostic methods had statistically significantly better diagnostic value than initial 2D-TVS (p < .001), whereas 3D-SIS was the only method that was better than expert 2D-TVS (p < .001).ConclusionsAlthough 3D-SIS was identical to HL, with the highest accuracy, there was no significant difference in diagnostic value between 3D-TVS with 2D-SIS and 3D-SIS or between expert 2D-TVS and 3D-TVS with 2D-SIS. The high diagnostic value of these ultrasonographic tools questions the need for endoscopy in the differential diagnosis of the most common congenital uterine anomalies.     

Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases

OBJECTIVE: To evaluate the impact of conventional transabdominal metroplasty on the reproductive outcome of symmetric uterine anomalies and to determine the complications of this procedure. STUDY DESIGN: A retrospective clinical analysis of 157 consecutive women who underwent surgery during a 25-year period. One hundred fifty-seven patients with a subseptate, septate or bicornuate uterus and history of recurrent abortions (124 cases) or infertility (33 cases) were included in this study. Operative technique was similar to the procedure first described by Bret and Guillet and by Tompkins. RESULTS: The fetal survival rate increased from 0.0% before surgery to 81.9% postoperatively in the recurrent abortion group and to 92.8% in the infertility group. Among women having undergone surgery, 63.8% gave birth to at least 1 healthy child, the proportion of previous habitually miscarrying and infertile women was 70.2% and 32.0%, respectively. No uterine rupture or any other complication was observed. CONCLUSION: Conventional transabdominal metroplasty seems to be a safe procedure in women with symmetric uterine anomalies and a history of recurrent miscarriages or otherwise unexplained primary infertility. No perioperative or subsequent peripartum complications were observed. Even in the era of operative hysteroscopy, transabdominal metroplasty remains the only approach in cases of bicornuate uterus.     

Septate uterus: role of hysteroscopic metroplasty

The uterus septum is the most frequently encountered uterine malformation. The prevalence of the uterine septa in the infertile patients is estimated at approximately 1%. On the other hand, it increases to reach 3,3% among women presenting repeated fetal losses. The objective of this article is to propose an updating of the data of the literature concerning the cure of uterine septa by hysteroscopic metroplasty. Operative hysteroscopy, with its simplicity, its reproducibility and its low morbidity between the hands of a trained operator, remains the gold standard treatment of the uterine partitions. The abortive disease always constitutes the main indication of the cure of septum. In the infertile patients, a metroplasty seems to be legitimate in the following situations: women more than 35 years old; unexplained infertility, resistant to any technique of assisted reproduction; discovery of a uterine septum at the time of the coelioscopy and the diagnostic hysteroscopy realized within the framework of an assessment of infertility; patients for whom it is assumed that Assisted reproductive technique (ART) is needed; women with past obstetrical history. The complications related to the hysteroscopic metroplasty are not very frequent. However, the hysteroscopic resection of a uterine septum could expose later to the risk of uterine rupture.     

Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis

ObjectiveThe aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes.Data SourcesA systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, ‘cesarean delivery, and fetal malpresentation.Methods of Study SelectionStudies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus.Tabulation, Integration, and ResultsThe systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22?0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03?0.78), OR = 0.36 (95% CI, 0.19?0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20?1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11?0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16?0.65).ConclusionThe results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.     

Metroplasty for AFS Class V and VI Septate Uterus in Patients With Infertility or Miscarriage: Reproductive Outcomes Study

Study ObjectiveTo assess reproductive outcomes in patients after surgical correction of septate uterus.DesignObservational retrospective study (Canadian Task Force classification II-2).SettingTwo university hospitals.PatientsOne hundred twenty-eight patients with primary infertility or recurrent miscarriage with partial (American Fertility Society [AFS] class Va), complete (AFS class Vb), or fundic (AFS class VI) septate uterus. Metroplasty is the current method of choice for surgically correcting septate uterus. The procedure and its indications are a matter of debate.InterventionsMetroplasty via hysteroscopy.Measurements and Main ResultsOutcomes including the numbers of pregnancies, first live births (FLBs), and miscarriages were determined. After metroplasty, 78 women (60.9%) became pregnant, and 70 live neonates were delivered. The FLB rate in infertile women was 53.1%. Of the 25 pregnancies, 13 (52%) resulted from assisted reproductive technology. In women who experienced recurrent miscarriage, the miscarriage rate was significantly improved. Outcomes (miscarriages and FLBs) differed significantly according to anatomical type of septum after surgery.ConclusionHysteroscopic septum resection is accompanied by safe improvement in reproductive performance in patients with symptoms of AFS class V/VI septate uterus.     

Uterine anomalies and pregnancy outcome following resectoscope metroplasty.

OBJECTIVE: To compare reproductive outcome in women with uterine anomalies and women with a normal uterus, and evaluate the effect of resectoscope metroplasty. METHODS: The pregnancy outcomes, past and present, of 105 women with congenital uterine anomalies were compared with those of 182 women with a normally shaped uterus. The outcomes of 25 women with septate and bicornuate uteri before and after resectoscope metroplasty were also analyzed. The chi(2) and Mann-Whitney U test were used for statistical analysis, with P<0.05 considered statistically significant. RESULTS: Uterine anomalies were associated with higher rates of spontaneous abortion, preterm delivery, intrauterine growth retardation, breech presentation, and cesarean delivery (P<0.001). The highest incidence of early spontaneous abortion was noted among women with septate uteri, and the highest incidence of preterm labor was noted among women with arcuate or bicornuate uteri. Among women with arcuate uteri, significantly lower gestational age and birth-weight were observed compared with any other type of adverse outcome. Compared with their previous pregnancies, the abortion rates were lower and delivery rates were higher in women who conceived following hysteroscopic metroplasty (P<0.001). CONCLUSION: Resesctoscope metroplasty significantly improved pregnancy outcome in women with uterine anomalies.     

Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility

OBJECTIVE: To evaluate the reproductive outcome of hysteroscopic metroplasty performed in women with septate uterus and otherwise unexplained primary infertility. DESIGN: Prospective, observational study. SETTING: Tertiary center for reproductive medicine. PATIENT(S): Sixty-one patients with uterine septa and otherwise unexplained primary infertility. INTERVENTION(S): Hysteroscopic division of the uterine septum. MAIN OUTCOME MEASURE(S): Reproductive outcome after hysteroscopic metroplasty. RESULT(S): Of 61 women, 25 (41%) conceived within 8-14 (mean 11.2) months after hysteroscopic metroplasty. Of these, 18 (29.5% of the total group) had live births (13 carried to term and 5 had preterm deliveries), and 7 (11.5% of the total group) had spontaneous abortions. Cervical cerclage was performed in 9 women; only 1 (11.1%) of these patients and 4 (44.4%) of the 9 who did not have a cerclage had preterm deliveries. Twelve of the 18 women (66.6%) who had live births were delivered by cesarean section. CONCLUSION(S): Women with uterine septum and otherwise unexplained infertility might benefit from hysteroscopic metroplasty.     

Post-abortion hysteroscopy: a method for early diagnosis of congenital and acquired intrauterine causes of abortions

Objective

Recurrent pregnancy loss is often defined as three or more consecutive pregnancy losses but there are no strict criteria for initiation of investigations after a miscarriage. We compared the frequency of uterine anomalies diagnosed by hysteroscopy following one, two and three or more miscarriages.

Study design

In our study 151 patients underwent diagnostic hysteroscopy following a missed or an incomplete abortion. Uterine septum, subseptum, arcuate uterus, and uterine hypoplasia are classified as congenital uterine anomalies and polyps, synechia, and submucous myomas are classified as acquired uterine abnormalities.

Results

151 Patients were enrolled in the study. The pregnancy numbers of the patients varied between 1 and 12. Sixty nine (46%) of the patients had one miscarriage, 42 (28%) had two miscarriages and 40 (26%) had three or more miscarriages. Diagnostic hysteroscopy revealed normal uterine cavity in 61.1% of the patients, congenital uterine anomalies in 20.4% and acquired uterine pathologies in 18.5%. Among the congenital anomalies, 14 (9.3%) were uterine septum, 10 (6.6%) were subseptate uterus, 4 (2.6%) were arcuate uterus and 3 (1.9%) were uterine hypoplasia. Among acquired abnormalities 14 (9.3%) were uterine synechia, 12 (7.9%) were endometrial polyps, and 2 (1.3%) were submucous myoma. Among patients who had one miscarriage 64.1% had a normal uterine cavity, 18.2% had congenital abnormalities and 17.7% had acquired uterine pathologies. Of patients with two miscarriages, 52% had a normal uterine cavity, 21.9% had congenital anomalies and 26.1% had acquired uterine pathology. In the three or more miscarriage group, 58.4% had normal uterine cavity, 25.3% had congenital anomalies, and 16.3% had acquired uterine pathology. We did not find any statistically significant difference between the number of miscarriages and pathologic diagnostic hysteroscopy findings.

Conclusions

Post-abortion office hysteroscopy is a simple and efficient tool in the early diagnosis of congenital and acquired uterine pathologies. Diagnostic hysteroscopy can be performed after the first miscarriage in order to determine congenital and acquired uterine pathologies, with regard to the patient's age and anxiety level.     

Assessment of hysteroscopic role in management of women with recurrent pregnancy loss

Objectives: To assess the hysteroscopic value in the management of intrauterine lesion in women with recurrent pregnancy loss.

Methods: This study was done in Ain Shams Maternity Hospital after the approval of the research Ethics Committee, during the period between August 2014 and December 2015 where 200 nonpregnant women with a history of three or more consecutive unexplained first and second trimester miscarriages before 20?weeks were recruited from recurrent miscarriage clinic. A written informed consent was obtained from all women before participation.

Results: This current study was conducted in Ain Shams University Maternity Hospital during the period between August 2014 to May 2015 a total of 200 women with history of recurrent miscarriage were included in the study. Regarding the results of this study the mean age was 30.5(5.7), the mean number of previous abortion 3(3–5) the mean number of the first trimesteric abortion was 2 with range (2–2) the mean number of second trimesteric abortion was 2 with range (1–2). In this study, 88% of patients were nullipara. It was also found that hysteroscopic findings were found in 58.5%. Uterine anomalies was present in 21%, including septate uterus and intrauterine adhesion (IUAs) were present in 12.5%. Endometrial polyps were present in 8.5%, bicornute uterus in 4.5%, unicornuate uterus in 4.5% while submucous myomas were present in 7.5%. It was found that 48.5% need hysteroscopic intervention including 21% need septectomy 12.5% need adhesiolysis, 6.5% need myomectomy while 8.5% need polypectomy. The study found that no statistically significant difference between patients with normal hysteroscopic finding and patients with abnormal hysteroscopic finding as regard age, time of previous abortion and number of previous abortion. But there was statistically significant difference as regard number of previous delivery and abnormal HSG.

Conclusions: It appears that hysteroscopy is a useful tool in the diagnosis and treatment of the causes of recurrent miscarriage that can be performed safely without anesthesia in most cases. The prevalence of uterine anomalies in patients with recurrent miscarriages is 54.5%, septate uterus is the most common anomaly and for this reason uterine anomalies should be systematically assessed in patients with recurrent miscarriage.     

Effect of previous uterine surgery on the operative hysteroscopic outcomes in patients with reproductive failure: analysis of 700 cases

Objective

To determine the effect of previous uterine surgery according to whether the uterine cavity is opened or not on the operative outcomes in a series of women undergoing surgical hysteroscopy guided by concomitant diagnostic laparoscopy for management of reproductive failure.

Methods

Records of 700 consecutive major hysteroscopic surgical procedures guided by concomitant diagnostic laparoscopy and performed for women with previous pelvic surgery were reviewed. All women were suffering from reproductive failure. Patients were categorized according to whether the uterine cavity was opened or not and according to the type of hysteroscopic procedure performed. Analysis of overall previous uterine surgery of any type combined and of individual matched types of hysteroscopic procedure separately was done. Patient age, American Society of Anesthesiologists (ASA) patient classification, surgical history, perioperative change in serum sodium concentration and hemoglobin level, fluid balance, transfusion rate, rate of failed hysteroscopic procedure, operative hysteroscopic time, complication rate and hospital stay were assessed in each patient.

Results

Of the 700 patients, 366 (52%) had never undergone uterine surgery, 105 (15%) had a history of uterine surgery with cavity opened and 229 (33%) had uterine surgery with cavity not opened. Overall previous uterine surgery of any type was associated with an increased age, and higher ASA score (P = 0.001). A history of uterine surgery with cavity opened was associated with increased operative time (P = 0.03) and increased hospital stay (P = 0.02). No patients have required a transfusion. Differences in perioperative serum sodium concentration and hemoglobin level, the complication and failure rates in patients with and without a history of uterine surgery did not attain significance. Outcomes analysis of individual matched types of hysteroscopic surgery showed similar results except for hysteroscopic metroplasty. In these cases, previous uterine surgery was not associated with increased age or ASA score.

Conclusion

Previous uterine surgery among young women with reproductive failure whether the uterine cavity is opened or not does not appear to affect adversely the performance and safety of subsequent major surgical hysteroscopy guided by concomitant diagnostic laparoscopy.     

Pregnancy and delivery after hysteroscopic metroplasty

AIM OF THE STUDY: Outcomes of treatment of habitual miscarriages and course of pregnancy and delivery in women after hysteroscopic metroplasty i.e. hysteroscopic resection of uterine septum. MATERIAL AND METHODS: Material consisted of 31 women with uterine septum operated between years of 1995-2002 because of habitual miscarriage by surgical hysteroscopic technique. The control group consisted of 26 women treated between years of 1990-1997 by Strassman's operation. Outcomes of treatment of habitual abortions, course of pregnancy and delivery were analyzed in both groups. The statistical analysis was performed by Chi 2 test (p < 0.05). RESULTS: After such treatment 27 out of 31 hysteroscopic treated women became pregnant. In first pregnancy in 12 women miscarriages and in 3 cases premature delivery were observed. Twelve pregnant women delivered pregnancy till 37 week. 15 infants survived (3 premature baby). Out of 26 women in control group after Strassman's operation 24 became pregnant, but 12 had miscarried. All pregnancy in control group i.e. ten mature pregnancy and 2 during premature delivery were ended by Cesarean section. The efficacy of treatment of habitual miscarriage due to uterine septum by hysteroscopic surgery was 55.5%, and there was no statistical significant difference between hysteroscopic surgery and Strassman's operation (50.0%). CONCLUSIONS: On the basis of result obtained the hysteroscopic metroplasty should be method of choice in the treatment of the uterine septum. Although the vaginal delivery is preferred one should have in mind the late complications of hysteroscopic surgery.