Uterine malformation: diagnosis and results after hysteroscopic metroplasty
Received 30 September 2009; received in revised form 8 December 2009; accepted 9 December 2009. published online 01 February 2010. Corrected Proof
Objective
To evaluate reproductive outcomes after hysteroscopic metroplasty of uterine septa using three-dimensional ultrasound.
Design
Prospective study.
Setting
University teaching hospital.
Patient(s)
One hundred fourteen women with uterine septa.
Intervention(s)
Three-dimensional ultrasound followed by hysteroscopic resection of the uterine septum (metroplasty).
Main Outcome Measure(s)
Reproductive outcome after hysteroscopic metroplasty.
Result(s)
The diagnosis of the uterine septum was made as part of a workup for the following: routine infertility workup (33.3%), miscarriage in the first trimester (22.8%), three or more miscarriages (22.8%), Cesarean section (11.4%), premature delivery (7.9%), and normal delivery (1.8%). Ten (8.8%) women had a septum involving one-quarter of their uterus, 18 (15.8%) had a septum involving one-half of their uterus, and 86 (75.4%) had a septum involving more than one-half of their uterus. After hysteroscopic metroplasty, 72 (70%) of 103 women with desired fertility delivered live-born children (63 at term [87.5%] and 9 preterm [12.5%]). Twenty-four (23%) women with desired fertility did not achieve pregnancy and 7 had spontaneous miscarriages.
Conclusion(s)
Three-dimensional ultrasound followed by hysteroscopic metroplasty of uterine septa is a safe and effective office procedure. Women with a septum occupying more than one-half of their uterine cavity have a very high chance of successful pregnancy after metroplasty.
aDepartment of Gynecology and Obstetrics, Oslo University Hospital, Ullevål, Oslo, Norway
bDepartment of Obstetrics and Gynecology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
Reprint requests: Olav Istre, M.D., Ph.D., Department of Obstetrics and Gynecology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115.
O.I. has nothing to disclose. J.S.-D. has nothing to disclose. T.T.V. has nothing to disclose.
Presented at The American Association of Gynecologic Laparoscopists meeting October 28–November 1, Las Vegas, NV; and The American Society for Reproductive Medicine meeting October 17–21, Atlanta, GA.
ABSTRACT