Hysteroscopic metroplasty: surgical technique and obstetric outcome

Daly, Douglas C.; Walters, Clifford A.; Soto-Albors, Carlos E.; Riddick, Daniel H.

doi:10.1016/s0015-0282(16)47056-1

Cited by 72 publications

(21 citation statements)

References 9 publications

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“…The classical publications of Chervenak and Neuwirth, 38 Daly et al, 39,40 DeCherney et al, 41 Israel and March 42 established equal efficacy of hysteroscopic metroplasty as well as its reduced morbidity compared with laparotomically performed techniques.…”

Section: Surgical Treatmentmentioning

confidence: 99%

“…In such instances, preservation of the cervical component of the septum has been traditionally proposed to reduce the risk of cervical incompetenence. 10,39,53 However, sparing of the cervical septum has not yet been proved to be advantageous. Donnez and Nisolle 54 systematically incised the cervical septum in all patients with complete septum without recording cases of cervical incontinence.…”

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confidence: 99%

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Septums and Synechiae: Approaches to Surgical Correction

Fedele

Bianchi

Frontino

2006

Clinical Obstetrics &Amp; Gynecology

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If the Müllerian ducts fail to fuse, or, if the wall which is the result of fusion is not adequately resorbed, the result is a spectrum of uterine abnormalities called Müllerian fusion and absorption defects. The impact of these abnormalities on fertility is a subject for debate, but at least a subset seems to have a negative impact on reproductive performance manifesting in recurrent abortion and/or premature labor. Previous surgical interventions required laparotomy, but, with careful application of imaging techniques, a group of patients can be identified with a uterine septum amenable to removal under hysteroscopic direction with little morbidity. Intrauterine adhesions or synechiae are usually secondary to curettage in the context of missed abortion or pregnancy-related hemorrhage. These lesions cover a spectrum that ranges from minor and insignificant to severe cohesive adhesions that affect menstrual function and fertility. Surgical repair of the endometrial cavity affected with such adhesions presents a challenge to the hysteroscopic surgeon. Appropriate management is controversial but may include second loop hysteroscopy and the use of postoperative adjuvants such as systemic estrogens and intrauterine devices or systems designed to impede the development of adhesions.

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Section: Surgical Treatmentmentioning

confidence: 99%

mentioning

confidence: 99%

Septums and Synechiae: Approaches to Surgical Correction

Fedele

Bianchi

Frontino

2006

Clinical Obstetrics &Amp; Gynecology

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“…Hysteroscopic metroplasty can be done via several procedures, including use of flexible mechanical scissors [58], electrosurgery with specially designed electrodes fitted to the hysteroscope or resectoscope [29], vaporizing or bipolar electrodes [59], lasers of the fiber type such as the neodymium-YAG [31], the argon laser with extruded [60], and mechanical morcellators [61]. The cervical canal is dilated to allow passage of the hysteroscope that has a diameter ranging from 7 to 9 mm and that would not pass without this preparatory procedure.…”

Section: Techniques Of Hysteroscopic Metroplastymentioning

confidence: 99%

The techniques and outcomes of hysteroscopic metroplasty

Paradisi

Barzanti²,

Fabbri³

2014

Current Opinion in Obstetrics &Amp; Gynecology

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The hysteroscopic metroplasty with its simplicity, safety, and improved reproductive outcomes has liberalized the approach to treatment. Today, hysteroscopic metroplasty is a common practice to treat septate uterus with salutary effects both in infertile patients and in patients with recurrent pregnancy loss or premature labor, especially if in-vitro fertilization is being contemplated. Decisions on when to treat uterine septa are discussed in particular because of lack of prospective, randomized controlled trials.

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“…Nonetheless, substantially improved outcomes have been reported after hysteroscopic resection of a uterine septum in women with recurrent pregnancy loss compared to historic self-controls. (81,82) Considering these admittedly biased data, as well as the relatively low morbidity of hysteroscopic surgery, it seems reasonable to consider hysteroscopic resection of septate uteruses in cases of otherwise unexplained stillbirth. In contrast, metroplasty is required to repair a bicornuate uterus or other anomalies such as didelphys.…”

Section: Umbilical Cord Accidentsmentioning

confidence: 99%

Stillbirth: Obstetric conditions

Silver¹

2010

Stillbirth

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IntrOductIOnStillbirth is one among the most tragic obstetric complications. Over the past half century, considerable progress has been made by reducing the risk of stillbirth due to a variety of conditions including red cell alloimmunization, hypertension, and diabetes. However, stillbirth rates have stabilized over the past 20 years with a rate of 6.2 per 1,000 live births in the United States in 2004.(1) Studies of stillbirth often focus on genetic problems, fetal malformations, infections, and maternal medical conditions. However, a meaningful proportion of stillbirths are due to obstetric complications. Such conditions include fetalmaternal hemorrhage, cord abnormalities, placental abruption, amniotic band syndrome, multiple gestation, uterine abnormalities, cervical insufficiency, preterm labor, preterm premature rupture of membranes, placenta previa, and preeclampsia. Taken together, these disorders account for approximately 20% to 45% of stillbirths.(2-6) However, these numbers should be considered with caution. Many cases of stillbirth may be attributed to obstetric complications such as a cord accident without sufficient proof of causality. This chapter will review the association between these conditions and stillbirth with an emphasis on diagnosis, treatment, and prevention.

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Hysteroscopic metroplasty: surgical technique and obstetric outcome

Cited by 72 publications

References 9 publications

Septums and Synechiae: Approaches to Surgical Correction

Septums and Synechiae: Approaches to Surgical Correction

The techniques and outcomes of hysteroscopic metroplasty

Stillbirth: Obstetric conditions

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