HYSTEROSCOPIC RESECTION OF UTERINE SEPTUM – EFFECTS ON PREGNANCY
Background. In women with spontaneous abortions, preterm deliveries or infertility, septate uterus is often detected on transvaginal ultrasound examination. Since 1993 we have used hysteroscopic resection to correct this anomaly. The aim of this study was to evaluate the effect of the arcuate uterus on the course of pregnancy and its outcome, and the effect of hysteroscopic resection of the arcuate uterus on the prognosis of pregnancy.
Patients and methods. Retrospectively we analyzed prospectively collected data. Between 15 February 1993 and 31 December 1999 we performed 760 hysteroscopic resections of the septum at the Department of Obstetrics and Gynecology in Ljubljana. We evaluated the course of pregnancy and its outcome only, therefore we enrolled 241 women, who conceived spontaneously before and after operation.
Results. In the group of women with arcuate uterus (n = 111) there were 244 pregnancies before hysteroscopic resection: 38 (15.6%) ended with a delivery and 202 (82.8%) with a spontaneous abortion. In the group of women with septate uterus (n = 130) there were 269 pregnancies: 42 deliveries (15.6%) and 224 (83.3%) spontaneous abortions. After hysteroscopic resection there were 109 pregnancies in the women with arcuate uterus: 91 (83.5%) deliveries and 16 (14.7%) spontaneous abortions; in the septate uterus group there were 118 pregnancies: 98 (83.2%) deliveries and 16 (13.5%) spontaneous abortions. In both groups there was a significant improvement in the delivery rate (p < 0.00000). Before resection the preterm delivery rates were significantly higher in both groups (arcuate: 50.0%; septate: 35.1%) than after the resection (arcuate: 11.3%; septate 17.7%).
Conclusions. The women with either septate or arcuate uterus are at a higher risk for spontaneous abortion and preterm delivery. Hysteroscopic resection significantly decreases the risk in both groups of women.
The American Fertility Society. The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, müllerian anomalies and intrauterine adhesions. Fertil Steril 1988; 49: 944–55.
Copeland LJ. Textbook of gynecology. Philadelphia: N. B. Saunders Company, 1993: 209–15.
Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril 2000; 73: 1–14.
Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P. Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod 1998; 13: 1188–93.
Acien P. Shall we operate on mullerian defects? Incidence of mullerian defects in fertile and infertile women. Hum Reprod 1997; 12: 1372–6.
Zabak K, Benifla JL, Uzan S. Cloisons uterines et troubles de la reproduction: resultats actuels de la septoplastie hysteroscopique. Curr Probl Gynecol Obstet Fertil 2001; 29: 829–40.
Hickok LR. Hysteroscopic treatment of the uterine septum: A clinician’s experience. Am J Obstet Gynecol 2000; 182: 1414–20.
Tomaževič T, Ban H, Premru-Sršen T et al. Nosečnost pred in po histeroskopski resekciji pregrad v maternični votlini. Endoskopska Revija 2000; 5 (12-13): 69–76.
Tomaževič T, Premru-Sršen T, Ribič-Pucelj M, Ban H, Verdenik I, Vogler A, Vrtačnik Bokal E, Virant I. Reproductive performance in different grades of uterine anomalies before and after metroplasty by resectoscope. J Am Assoc Gynecol Laparosc 1999; 6: Suppl: S56.
Tomaževič T, Premru-Sršen T, Ribič-Pucelj M, Vogler A, Ban H, Vrtačnik Bokal E, Virant I. Reproductive results after metroplasty by resectoscope. Adv Reprod 1999; 3: 279–82.
Tomaževič T, Ban H, Premru T, Ribič-Pucelj M, Vogler A, Bokal E, Virant I, Kavčič T. Resection of uterine septum and the risk of preterm birth. In: IFFS 2001 selected free communications; 2001 Nov 25–30; Melbourne. Bologna: Monduzzi editore, International Proceedings Division, 2001; 341–6.
Tomaževič T, Ban H, Premru T, Ribič-Pucelj M, Vogler A, Bokal E, Virant I. The risk of preterm labour in different grades of uterine anomalies before and after hysteroscopic resection. In: Bruhat M, Carvalho SJL, Campo R et al. eds. Proceedings of the 10th Congress of the European Society for Gynaecological Endoscopy; 2001 Nov 22–24; Lisbon. Bologna: Monduzzi editore, International Proceedings Division, 2001; 189–93.
Tomaževič T, Ban H, Premru-Sršen T, Verdenik I, Ribič Pucelj M, Virant I. Histeroskopska resekcija maternične pregrade in tveganje za prezgodnji porod. Endoskopska Revija 2001; 6: 4–4.
Ban H, Tomaževič T, Premru-Sršen T, Ribič-Pucelj M, Vogler A, Vrtačnik Bokal E, Virant I. Vpliv resekcije kompletnega septuma maternice na prognozo nosečnosti. Endoskopska revija 2001; 6: 28–8.
Tomaževič T, Premru T, Ribič-Pucelj M, Vogler A, Ban H, Vrtačnik-Bokal E, Virant I. Reproductive outcomes after metroplasty by resectoscope. In: Hohl MK, Dequesne J, Eberhard M eds. 7th Congress of the European Society for Gynaecological Endoscopy, 1998 Dec 6–12. Lausanne. Bologna: Monduzzi editore, 1998: 11–5.
Tomaževič T, Premru-Sršen T, Ribič-Pucelj M, Ban H, Verdenik I, Vogler A, Bokal-Vrtačnik E, Virant-Klun I. Pregnancies before and after hysteroscopic discision of AFS5 and 6 uterine septa by resectoscope. In: Coutinho EM, Spinola P eds. Current knowledge in reproductive medicine. Proceedings of the 10th world Congress on Human Reproduction, 1999 May 4–8, Salvador, Brasil. Amsterdam: Elsevier Science, 2000: 113–20.
Tomaževič T, Slavnik L, Dintinjana M. An automated gravitational system for delivery of low – viscosity media during continuous – flow hysteroscopy. J Am Assoc Gynecol Laparosc 1996; 3: 617–21.
Tomaževič T. Histeroskopske resekcije z uporabo resektoskopa. In: Tomaževič T, Ribič Pucelj M eds. Endoskopske operacije v ginekologiji. Zbornik predavanj 3. Tečaja ginekološke endoskopske kirurgije. Ljubljana: Klinični center, Ginekološka klinika, 1996: 53–6.
Verdenik I, Pajntar M. Perinatologia Slovenica 1994. Ljubljana: Research Unit. Department of Obstetrics and Gynecology. University Medical Centre, 1995: 1–55.
Ban H. Vpliv histeroskopske odstranitve pregrade v maternici na zanositev in nosečnost. Prešernova naloga. Ljubljana: Univerza v Ljubljani, 1996.
Bekketeig LS, Bergsjo P. The epidemiology of preterm birth. In: Kurjak A eds. Textbook of perinatal medicine. London, New York: Partenon Publishing, 1998: 1331–6.
Saling E, Ai Taie T, Luthje J, Masur A, Placht A. Efficient and simple program including comunity based activities for prevention of very small prematures. In: Kurjak A eds. Textbook of perinatal medicine. London, New York: Partenon Publishing, 1998: 1337–44.
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.