Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis

Reproductive prognosis after abdominal metroplasty was assessed in 73 women with a septate and 71 with a bicornuate uterus who underwent metroplasty at the First Obstetric and Gynecologic Clinic of the University of Milan between 1972 and 1985. The overall cumulative 5-year delivery rates were respectively 70% and 73% in women with septate and bicornuate uterus, rising constantly with time. The number of previous miscarriages did not affect the reproductive prognosis: the 5-year probability of giving birth was 64% and 75% in the women with septate uterus and respectively fewer than two or more previous miscarriages, and the corresponding values were 66% and 73% in the bicornuate uterus subgroup. The miscarriage rate (about 20%) was similar with both types of malformation.     

Reproductive outcome of septate uterus after hysteroscopic metroplasty

We evaluated the reproductive outcome after hysteroscopic metroplasty in the patients with septate uterus. The reproductive performance of 361 patients with septate uterus during the follow-up period of 18 months after the surgery was analyzed retrospectively for a period of 10 years. A total of 180 (49.8%) pregnancies were achieved after metroplasty during the follow-up period of 18 months. Of the 180 pregnancies 117 (57.2%) reached to term and 34 (18.8%) ended in preterm delivery and the remaining 29 (16%) resulted in abortion. Of the preterm babies 18 (52.9%) were able to live. We obtained 135 (75%) live babies totally. Hysteroscopic metroplasty improves the reproductive performance of septate uterus significantly especially in the cases with recurrent pregnancy loss and should be considered highly as a corrective approach for such patients.     

Reproductive outcome after strassman metroplasty in women with a bicornuate uterus

OBJECTIVE: To describe the reproductive outcome in 22 women with a bicornuate uterus who underwent Strassman metroplasty. STUDY DESIGN: The study analyzed pregnancy outcomes. RESULTS: Of women who had undergone Strassman metroplasty, 88% achieved pregnancies that ended with the birth of a viable infant. A total of 19 infants were born. All pregnancies that ended at term had normal courses, and a cesarean section was performed in all cases. The "take-home-baby" rate was 100% for the first postoperative pregnancy. CONCLUSION: The postmetroplasty reproductive capacity of women with a bicornuate uterus was very good. Strassman metroplasty should be reserved for selected women with bicornuate uteri who have experienced recurrent spontaneous abortion or preterm birth.     

Fertility after metroplasty of the septate uterus

Congenital uterine anomalies are well known to affect a woman's fertility and ability to deliver a viable infant. A retrospective chart review with recent follow-up was performed for 38 women who underwent a modified Tompkin's metroplasty. All septate uterine configurations were proven by hysterosalpingography and laparoscopy. We examined the preoperative and postoperative fertility and pregnancy salvage rates. An examination to exclude other absolute infertility and pregnancy wastage factors was completed before surgery. Of 38 women studied, 30 (78.9%) had conceived before surgery, for a 6.2% pregnancy salvage rate. Of the 36 women operated on at least one year previously, 24 (66.7%) had become pregnant, for a 77.8% pregnancy salvage rate. Fertility after metroplasty is dependent on many individual factors, and efforts must be made to maximize them. Metroplasty improves the pregnancy salvage rate in women with septate uteri.     

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.     

Ultrasound surveillance of pregnancies after metroplasty for septate uterus

Metroplasties were performed on twenty three septate uterus associated with recurrent reproductive wastage (19 cases) or primary infertility (4 cases). The surgical procedure and ultrasound monitoring of pregnancies conceived postoperatively are reported. Eighteen pregnancies occurred in sixteen patients; fourteen ended in live birth and four spontaneous abortions, including two blighted ova and one mole occurred. It appears from the results that uterine anomalies are rarely the sole cause of primary infertility; therefore, selection of patients is emphasized.     

Wedge metroplasty for the septate uterus: an update

Twenty-one patients with septate uteri and 2 patients with a T-shaped uterine anomaly and recurrent abortions underwent wedge metroplasty during the period from September 1978 to August 1983. Thirteen patients had a characteristic history of one or more abortions associated with the septate uterus and absence of other metabolic and endocrine abnormalities. Ten other patients, including the two with a T-shaped uterine anomaly, either had one or more abortions of an uncharacteristic nature with absence of other abnormalities or had one or more characteristic abortions in addition to the presence of other metabolic, endocrine, or surgically correctable disease. The application of wedge metroplasty for the surgical reconstruction of the uterus yielded equally gratifying results in both groups with approximately two thirds of the patients having a term delivery or carrying a pregnancy in the third trimester.     

Successful outcome of twin gestation after endoscopic metroplasty of complete septate uterus

The successful outcome of twin gestation after the endoscopic metroplasty of uterus septus class Va was described. Authors described and discussed the technical details of diagnosis and treatment of this rare malformation. Five months after treatment the patient spontaneously became pregnant. The pregnancy was determined as dizygotic twins. The cesarean section was performed in the 36th week of gestation because of growth arrest of one fetus and two healthy newborns were delivered.     

A study of hysteroscopic metroplasty in 141 women with a septate uterus

141 patients who had a hysteroscopic septum resection of a partial uterine septum (class Vb, American Society for Reproductive Medicine, ASRM) were divided into two groups: Group I (69 patients) presented with infertility and Group II (72 patients) with recurrent abortion. The mean±SD post-operative follow up period was 36±19.5 months. Thiry-six Group I patients (52.1%) and 38 Group II patients (52.7%) achieved pregnancy, with respective abortion rates of 20% and 25%. Received: 18 April 2001 / Accepted: 11 June 2001     

Hysteroscopic metroplasty for septate uterus and repetitive abortions: reproductive outcome

OBJECTIVES: The aim of this study is to assess fertility outcome and obstetrical prognosis of 63 patients after hysteroscopic section of uterine septa. MATERIALS AND METHODS: This is a retrospective study about 63 patients consulting for septate uterus and repeated pregnancy loss or abnormal fetal presentation between January 1988 and December 1996 in La Conception hospital in Marseille. Septal lysis was performed with microscissors or resectoscope. Statistical analysis was performed using the CHI2-test. RESULTS: The anatomical result was considered satisfactory in 57.1% of cases. Forty-five pregnancies were obtained, two after an IVF-program in 56 patients. Twenty-eight living children were born: twenty-six at term. Twenty patients delivered normally. Two women are still pregnant. Obstetrical prognosis of these patients is statistically improved by the treatment (P=0.001). CONCLUSION: Obstetrical prognosis of patients presenting repeated pregnancy loss and septate uterus is statistically improved by hysteroscopic metroplasty.     

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.     

Chronic abdominal pregnancy following rupture from a bicornuate uterus

The authors report a rare occurrence of a chronic abdominal pregnancy secondary to a ruptured bicornuate uterus. It is unusual in that rupture of the uterine horn probably occurred 2 weeks prior to diagnosis. Management was laparotomy to remove the fetus with resection and repair of the uterus. Uterine anomalies, their imaging and diagnosis, as well as the patient’s subsequent reproductive prognosis are discussed.