Term Delivery Rate after Hysteroscopic Metroplasty in Patients with Recurrent Spontaneous Abortion and T-Shaped, Arcuate and Septate Uterus

Abstract

Background: To evaluate the improvement of the term delivery rate after uterine surgery in various uterine malformations. Methods: 170 patients were eligible for the present retrospective case series study. Data were weighted for the number of pregnancies observed (n = 218) after surgical intervention, stratified to the number of previous abortions (at least 2) and type of malformation. Results: Before surgery, the overall term delivery rate was 5.5%. After surgery, the overall term delivery rate was 59% (absolute benefit increase, ABI, was 54.5) and correlated with the number of previous abortions (69.7% ABI = 64.2, 56.5% ABI = 51 and 26.3% ABI = 20.8 for 2, 3–4 and >4 abortions, respectively; p = 0.0008, log-rank test). Data stratified according to uterine malformations yielded the following term delivery rate: 66.7% for T-shaped uterus, 62.8% for septum/partial septum and 55.6% for arcuate uterus (NS, log-rank test). The number of previous abortions and maternal age also affected the term delivery rate. Their effect upon the term delivery rate, expressed as an odds ratio, was 1.73 (95% CI: 1.20–2.49) and 1.11 (95% CI: 1.05–1.18), respectively. Conclusion: The term delivery rate was about 10-fold higher after surgery. T-shaped uterus surgery yielded the best term delivery rate.

Significance of hysteroscopy in diagnosis and treatment of congenital uterine anomalies

“…Only 3% of our respondents have previous successful pregnancies, while 38% of the respondents have previous miscarriages; of which 19% with 1 miscarriage, 14% with 2 miscarriages and 5% with three or more miscarriages. Similar data is available in the literature, and the percentage of births in the examined group before the hysteroscopic operation is 5% (8). During the first trimester, the risk of spontaneous abortion in patients with uterine septum is 28-45%, according to literature data (2,9,10), and the cause of weaker vascularization of the implant site is considered to be the cause.…”

“…Therefore, some authors advise the routine use of office hysteroscopy as the basic method preceding the IVF / ICSI attempt, even in subjects with correct results in trans-vaginal ultrasound examination (26). In the literature, 63% of the respondents experienced pregnancy after hysteroscopy septum resection, while 56% of the subjects reported pregnancy in arquatus (8). Data from other studies indicate an improvement in fertility following hysteroscopy resections in other anomalies, except in the uterus bicornis (27).…”

The Value of Routine Hysteroscopy before the First Intracytoplasmic Sperm Injection Treatment Cycle

“…Hysteroscopic septum resection has been recommended for correction of uterine cavity and enhancing pregnancy outcomes [24,25] . Rackow et al [26] designed a case-control study to evaluate molecular markers of endometrial receptivity in women with endometrial polyps.…”

Management Dilemma of Concurrent Fundal Submucous Fibroid and Incomplete Uterine Septum in a Patient with Recurrent Pregnancy Loss

“…1,9,10 Correction of a subseptate (septum ‡ 1.5 cm) or arcuate uterus (septum £ 1.5 cm) in women with prior CONCURRENT UTERINE FACTORS: MISCARRIAGE pregnancy loss equally results in a significant decrease in rates of abortion. 11,12 The real challenge in this case was the suspicion of a concurrent uterine pathology based on the hysteroscopic findings at the conclusion of the laparoscopic myomectomy. In fact, most practitioners will not perform a hysteroscopy, especially when the uterine cavity has not been entered.…”