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Evidence-based diagnosis and treatment for uterine septum: a guideline. Fertil Steril 2024; 122:251-265. [PMID: 38556964 DOI: 10.1016/j.fertnstert.2024.02.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 02/19/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE To provide evidence-based recommendations regarding the diagnosis and effectiveness of surgical treatment of a uterine septum. METHODS This guideline provides evidence-based recommendations regarding the diagnosis and effectiveness of surgical treatment of a uterine septum. This replaces the last version of the same name (Fertil Steril. 2016 Sep 1;106(3):530-40). MAIN OUTCOME MEASURE(S) Outcomes of interest included the impact of a septum on underlying fertility, live birth, clinical pregnancy, and obstetrical outcomes. RESULT(S) The literature search identified relevant studies to inform the evidence for this guideline. CONCLUSION(S) The treatment of uterine septa and subsequent outcomes associated with infertility, recurrent pregnancy loss, and adverse obstetrical outcomes are summarized. Resection of a septum has been shown to improve outcomes in patients with recurrent pregnancy loss and to decrease the likelihood of malpresentation. In the setting of infertility, it is recommended to use a shared decision-making model after appropriate counseling to determine whether or not to proceed with septum resection.
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Goidescu IG, Staicu A, Poienar AA, Surcel M, Micu R, Muresan D. Is Hysteroscopic Metroplasty Advisable for U2bC2V1 Malformation? Diagnostics (Basel) 2024; 14:1649. [PMID: 39125524 PMCID: PMC11311479 DOI: 10.3390/diagnostics14151649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2024] [Revised: 07/22/2024] [Accepted: 07/29/2024] [Indexed: 08/12/2024] Open
Abstract
A complete uterine septum, with a double cervix and vaginal septum, is a complex and rare congenital genital tract anomaly. The diagnosis is difficult and often challenging, requiring complex imaging investigations and diagnostic hysteroscopy. The benefit of hysteroscopic metroplasty for this uterine malformation is still the subject of dispute. However, the potential benefits of obtaining pregnancies and reducing the rate of abortions make this surgical method a desirable one. We present a series of three cases with U2bC2V1 malformation that were diagnosed via magnetic resonance imaging (MRI), in which hysteroscopic removal of the uterine septum and resection of the longitudinal vaginal septum were performed, with the preservation of the two cervixes. All patients became pregnant after the hysteroscopic intervention and reported an improvement in dyspareunia and dysmenorrhea.
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Affiliation(s)
- Iulian Gabriel Goidescu
- Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- 1st Department of Obstetrics and Gynecology, Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania
| | - Adelina Staicu
- Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- 1st Department of Obstetrics and Gynecology, Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania
| | | | - Mihai Surcel
- Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- 1st Department of Obstetrics and Gynecology, Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania
| | - Romeo Micu
- Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
| | - Daniel Muresan
- Department of Obstetrics and Gynecology, “Iuliu Hatieganu” University of Medicine and Pharmacy, 400347 Cluj-Napoca, Romania
- 1st Department of Obstetrics and Gynecology, Emergency County Hospital Cluj, 400347 Cluj-Napoca, Romania
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Fayek B, Yang EC, Liu YD, Bacal V, AbdelHafez FF, Bedaiwy MA. Uterine Septum and Other Müllerian Anomalies in a Recurrent Pregnancy Loss Population: Impact on Reproductive Outcomes. J Minim Invasive Gynecol 2023; 30:961-969. [PMID: 37506876 DOI: 10.1016/j.jmig.2023.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/03/2023] [Accepted: 07/23/2023] [Indexed: 07/30/2023]
Abstract
STUDY OBJECTIVE To study the impact of Müllerian anomalies on reproductive outcomes in a recurrent pregnancy loss (RPL) population and to evaluate the effect of surgical correction of uterine septum on the odds of achieving live birth in RPL patients with a septate uterus. DESIGN A retrospective cohort study. SETTING A specialized RPL clinic at a tertiary center. PATIENTS RPL patients with ≥ 2 pregnancy losses before 20 weeks' gestation who attended a specialized RPL clinic. INTERVENTION We aimed to assess the association between a possible risk factor (Müllerian anomalies) and reproductive outcomes and that between having surgery for septate uterus and achieving a live birth. MEASUREMENTS AND MAIN RESULTS The primary outcome is live birth rate in RPL patients with Müllerian anomalies compared with those without; secondary outcome measures include rates of full-term live birth, preterm live birth, first and second trimester pregnancy loss, and stillbirth. After adjusting for patient age at the initial RPL visit, the number of pregnancy losses, and the presence of any other abnormal RPL investigation, the odds of achieving live birth were on average 49.4% lower for patients with a septate uterus than those without Müllerian anomalies (odds ratio, 0.51; 95% confidence interval, 0.30-0.86) in the studied cohort (n = 377). A subanalysis of 72 patients with septate uterus demonstrated a higher likelihood of live birth in those who underwent septum resection (46/72; 63.9%) than those who elected to go for expectant management (26/72; 36.1%), yet this study was underpowered to establish a significant difference (52.2% vs 34.6%; p = .22). CONCLUSION In RPL patients, having a septate uterus significantly decreased the chances of achieving live birth. Patients with septate uterus who received hysteroscopic septum division had a higher tendency to achieve more live births than those who elected expectant management. However, our study was underpowered to detect a statistically significant difference.
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Affiliation(s)
- Bahi Fayek
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology (Dr. Fayek), Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Emily C Yang
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Yang Doris Liu
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Vanessa Bacal
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynaecology (Dr. Bacal), University of Toronto, Toronto, ON, Canada; Mount Sinai Fertility (Dr. Bacal), Toronto, ON, Canada
| | - Faten F AbdelHafez
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada; Department of Obstetrics and Gynecology (Dr. AbdelHafez), Faculty of Medicine, Assiut University, Assiut, Egypt
| | - Mohamed A Bedaiwy
- Division of Reproductive Endocrinology and Infertility (all authors), Department of Obstetrics and Gynecology, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
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Mert SA, Dilbaz B, Akpinar F, Diktas EG, Kinay T, Ensari T, Tekin OM. Evaluation of the Success of Hysteroscopic Uterine Septum Resection. Gynecol Minim Invasive Ther 2023; 12:230-235. [PMID: 38034112 PMCID: PMC10683958 DOI: 10.4103/gmit.gmit_131_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 12/02/2023] Open
Abstract
Objectives The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Materials and Methods Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Results Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Conclusion Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.
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Affiliation(s)
- Sule Atalay Mert
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Berna Dilbaz
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Funda Akpinar
- Gynecology and Obstetrics Clinic, Ankara Training and Research Hospital, Ankara, Turkey
| | - Elif Gulsah Diktas
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Kinay
- Department of Reproductive Endocrinology, Etlik Zübeyde Hanim Women’s Health Training and Research Hospital, University of Health Sciences, Ankara, Turkey
| | - Tugba Ensari
- Gynecology and Obstetrics Clinic, Ankara City Hospital, Ankara, Turkey
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Chang Y, Shen M, Wang S, Guo Z, Duan H. Reproductive outcomes and risk factors of women with septate uterus after hysteroscopic metroplasty. Front Endocrinol (Lausanne) 2023; 14:1063774. [PMID: 37361532 PMCID: PMC10285310 DOI: 10.3389/fendo.2023.1063774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 05/24/2023] [Indexed: 06/28/2023] Open
Abstract
Background Hysteroscopic metroplasty of the uterine septum has been the standard treatment strategy to improve reproductive outcomes, but there are still controversies about the appropriateness of metroplasty. In addition, there have been few studies of the factors related to reproductive outcomes of women after surgery. The study aimed to evaluate the reproductive outcomes and the associated risk factors that influence reproductive outcomes after hysteroscopic metroplasty of women with septate uterus and the desire to conceive. Methods This study was an observational study. Cases were screened by searching electronic patient files, and demographic factors were collected. We conducted telephone follow-ups to collect the postoperative reproductive outcomes. The primary outcome of this study was live birth, and secondary outcomes were ongoing pregnancy, clinical pregnancy, early miscarriage, and preterm birth. Demographic variables included patients' age, body mass index (BMI), the type of septum, infertility and miscarriage history, and complications including intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were collected to perform univariate and multivariate analyses to predict the risk factors of reproductive outcomes after surgery treatment. Results In total, 348 women were evaluated and followed up. There were 95 cases (27.3%, 95/348) with combined infertility, 195 cases (56.0%, 195/348) with miscarriage history, and cases combined with intrauterine adhesions, endometrial polyps, endometriosis, and adenomyosis were 107 (30.7%, 107/348), 53 (15.2%, 53/348), 28 (8.0%, 28/348), and 5 (1.4%), respectively. Following surgery, the live birth rate and clinical pregnancy rate were significantly higher than prior to surgery (84.6% vs 3.7%, p= 0.000; and 78.2% vs 69.5%, p= 0.01, respectively), early miscarriage rate and preterm delivery rate were significantly lower (8.8% vs 80.6%, p= 0.000; and 7.0% vs 66.7%, p=0.000, respectively). After adjusting for body mass index, miscarriage history, and complications, multivariable logistic regression analysis revealed age ≥ 35 years and primary infertility as independent factors that affected postoperative clinical pregnancy (OR 4.025, 95% CI 2.063-7.851, p= 0.000; and OR 3.603, 95% CI 1.903-6.820, p= 0.000; respectively) and ongoing pregnancy (OR 3.420, 95% CI 1.812-6.455, p= 0.000; and OR 2.586, 95% CI 1.419-4.712, p= 0.002; respectively). Conclusions Hysteroscopic metroplasty could lead to improved reproductive outcomes of women with septate uterus. Both age and primary infertility were independent factors for postoperative reproductive outcomes. Trial registration Chi ECRCT20210343.
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Affiliation(s)
- Yanan Chang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Minghong Shen
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
- Department of Gynecology, Shengli Clinical Medical College of Fujian Medical University, Fujian Provincial Hospital, Fuzhou, Fujian, China
| | - Sha Wang
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Zhengchen Guo
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
| | - Hua Duan
- Department of Minimally Invasive Gynecology, Beijing Obstetrics and Gynecology Hospital, Capital Medical University. Beijing Maternal and Child Health Care Hospital, Beijing, China
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Linehan L, Hennessy M, O'Donoghue K. An examination of care received by women with recurrent miscarriage and infertility against guideline-based key performance indicators. Eur J Obstet Gynecol Reprod Biol 2023; 282:17-23. [PMID: 36621261 DOI: 10.1016/j.ejogrb.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/19/2022] [Accepted: 01/01/2023] [Indexed: 01/04/2023]
Abstract
OBJECTIVES International guidelines for the management of recurrent miscarriage (RM) do not provide detailed guidance for the care of women/couples with concurrent infertility. Research studies concerning the investigation and treatment of RM frequently omit this cohort. The aim of this study was to assess the care of women/couples with infertility attending a RM clinic in a large tertiary unit in the Republic of Ireland. STUDY DESIGN We conducted an audit of women with RM and infertility attending our RM clinic from 2008 to 2020 against 110 established guideline-based key performance indicators (KPIs) for RM care, encompassing five categories: structure of care, counselling/supportive care, investigation, treatment and outcomes. Information was gathered from documentation from the RM clinic, hospital laboratory and electronic health records. RESULTS We identified 128 women with infertility and RM. Information provision in RM clinics regarding modifiable risk factors (71 %; 91/128) and unexplained RM (53 %; 69/128) could be improved. Most women were investigated in line with KPIs, except for pelvic ultrasound (40 %; 51/128), cytogenetic analysis (27 %; 34/128) and 3D ultrasound (2 %; 2/128). Immunotherapies were seldom prescribed (<1%); however, 98 % (125/128) of women received aspirin, 48 % LMWH (62/128) and 16 % corticosteroids (21/128). Surgical interventions were uncommon (5 %; 6/128)). The subsequent pregnancy rate was 70 % (89/128), with 36 % undergoing artificial reproductive technology (32/89). The livebirth rate was 63 % (56/89); 37 % had a further pregnancy loss (33/89), of which two were second-trimester miscarriages. CONCLUSIONS Women with RM and infertility received care largely in line with RM guideline-based KPIs. However, we identified areas for improvement, including the quality of information provision, and access to certain investigations. While guideline-based KPIs allow for internationally applicable and reproducible audit that can direct service improvements, the experiences and needs of service-users are not captured, meriting further qualitative research.
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Affiliation(s)
- Laura Linehan
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland.
| | - Marita Hennessy
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland
| | - Keelin O'Donoghue
- Pregnancy Loss Research Group, Department of Obstetrics & Gynaecology, University College Cork, Cork, Ireland; INFANT Research Centre, University College Cork, Cork, Ireland
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Jiang Y, Wang L, Wang B, Shen H, Wu J, He J, Liu A, Wang Y, Zhang X, Ma B. Reproductive outcomes of natural pregnancy after hysteroscopic septum resection in patients with a septate uterus: a systematic review and meta-analysis. Am J Obstet Gynecol MFM 2023; 5:100762. [PMID: 36220552 DOI: 10.1016/j.ajogmf.2022.100762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2022] [Revised: 09/29/2022] [Accepted: 10/03/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The aim of this systematic review and meta-analysis was to analyze the reproductive outcomes of natural pregnancy after hysteroscopic septum resection in patients with recurrent miscarriage, primary infertility, or secondary infertility. DATA SOURCES The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, VIP Database, and Chinese Biomedical Literature Database (CBM) databases were electronically searched. The search time frame was from inception up to July 2021. The English search terms were (arcuate* and uter*), (sept* and uter*), (subseptate* and uter*), metroplast*, septoplast*, and resect*. STUDY ELIGIBILITY CRITERIA Selection criteria included randomized controlled trials, cohort studies, and case series that explored reproductive outcomes after hysteroscopic septum resection in patients with recurrent miscarriage, primary infertility, or secondary infertility with or without a control group. METHODS The primary outcomes were the live birth rate and eventual postoperative live birth rate after hysteroscopic septum resection. The secondary outcomes were the clinical pregnancy rate, preterm birth rate, and miscarriage rate. Study-level proportions of outcomes were transformed using the Freeman-Tukey double-arcsine transformation to calculate pooled values for the postoperative rates; the counted data were analyzed using relative risk as the effect analysis statistic, and each effect size was provided with its 95% confidence interval. Heterogeneity between the results of the included studies was analyzed using the I2 test. RESULTS Overall, 5 cohort studies and 22 case series involving 1506 patients were included. In patients with a septate uterus and recurrent miscarriage, hysteroscopic septum resection was associated with an increased live birth rate (relative risk, 1.77; 95% confidence interval, 1.26-2.49; P=.001; I2=0%), resulting in a postoperative live birth rate of 66% (95% confidence interval, 59-72), and septum resection was associated with a reduced preterm birth rate (relative risk, 0.15; 95% confidence interval, 0.04-0.53; P=.003; I2=0%) and miscarriage rate (relative risk, 0.36; 95% confidence interval, 0.20-0.66; P=.0009; I2=0%). In patients with a septate uterus and primary infertility, hysteroscopic septum resection was associated with an increased live birth rate (relative risk, 4.12; 95% confidence interval, 1.19-14.29; P=.03; I2=0%) and clinical pregnancy rate (relative risk, 2.28; 95% confidence interval, 1.04-4.98; P=.04; I2=0%). The postoperative live birth rate was 37% (95% confidence interval, 30-44), and the miscarriage rate of patients with primary infertility was reduced (relative risk, 0.19; 95% confidence interval, 0.06-0.56; P=.003). The efficacy of hysteroscopic septum resection in patients with secondary infertility was unclear. However, their postoperative live birth rate was found to be 41% (95% confidence interval, 2-88). CONCLUSION Hysteroscopic septum resection is associated with an increased live birth rate and a reduced miscarriage rate in patients with recurrent miscarriage or primary infertility, indicating that septum resection may improve the reproductive outcomes of these patients. The effectiveness of septum resection was unclear for patients with secondary infertility. These findings are limited by the quality of the included studies, warranting further randomized controlled trials, including only patients with recurrent miscarriage or primary infertility.
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Affiliation(s)
- Yanbiao Jiang
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Liyan Wang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang)
| | - Bin Wang
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Haofei Shen
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Jingyuan Wu
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Juanjuan He
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Ahui Liu
- First Clinical Medical College, Lanzhou University, Lanzhou, China (XX Jiang, Dr B Wang and Shen, XX Wu, XX He, Dr Liu, and Zhang)
| | - Yiqing Wang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang)
| | - Xuehong Zhang
- The First Hospital of Lanzhou University, Lanzhou University, Lanzhou, China (Dr L Wang, Y Wang, and Zhang); Key Laboratory for Reproductive Medicine and Embryo of Gansu Province, Lanzhou, China (Dr L Wang, Y Wang, and Zhang).
| | - Bin Ma
- Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China (Dr B Ma)
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CEVHER AKDULUM MF, DEMİRDAĞ E, ARIK Sİ, ERDEM M, BOZKURT N, OKTEM M, GÜLER İ, ERDEM A. Does uterine septum resection improve IVF treatment success? JOURNAL OF HEALTH SCIENCES AND MEDICINE 2022. [DOI: 10.32322/jhsm.1133577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aim: Uterine septum is the most common type of congenital uterine malformation. The septum has also been suggested as a potential cause of infertility. The role of the septum in infertility and whether the septum can be resected is debatable. We aimed to reveal the results of assisted reproductive techniques in patients with septate uterus according to whether or not resection is performed.
Material and Method: 7790 patients were scanned retrospectively. 110 patients with the uterine septum and unexplained infertility were included in the study. Patients who underwent uterine septum resection were recorded. The clinical pregnancies of patients were compared according to whether or not resection was performed. In addition, patients with complete septum were evaluated according to whether or not resection was performed, and their clinical pregnancies were evaluated.
Results: It was revealed that 79 of the patients with uterine septum underwent septum resection operation. It was determined that 31 patients were not treated. Clinical pregnancy rates were found to be statistically significantly higher in the expectant management group (p=0.02). In addition, comparing the clinical pregnancy rates of the resection and expectant management groups in patients with a complete septum, no significant difference was found between the groups (p=0.134).
Conclusion: In our study, the success of treatment with assisted reproductive techniques did not change after septum resection. Although uterine septum resection is a simple and safe method, it has disadvantages such as the development of adhesions and rupture in the uterus. There is insufficient evidence to perform septum resection in patients with uterine septum prior to infertility treatment.
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Affiliation(s)
| | | | | | - Mehmet ERDEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | | | - Mesut OKTEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | - İsmail GÜLER
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
| | - Ahmet ERDEM
- GAZI UNIVERSITY, SCHOOL OF MEDICINE, MEDICINE PR
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Noventa M, Spagnol G, Marchetti M, Saccardi C, Bonaldo G, Laganà AS, Cavallin F, Andrisani A, Ambrosini G, Vitale SG, Pacheco LA, Haimovich S, Di Spiezio Sardo A, Carugno J, Scioscia M, Garzon S, Bettocchi S, Buzzaccarini G, Tozzi R, Vitagliano A. Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes-A Systematic Review and Meta-Analysis of Observational Research. J Clin Med 2022; 11:jcm11123290. [PMID: 35743362 PMCID: PMC9224595 DOI: 10.3390/jcm11123290] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 05/24/2022] [Accepted: 05/26/2022] [Indexed: 12/04/2022] Open
Abstract
Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27−0.76; p < 0.0001; and OR 0.21, 95% CI 0.12−0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90−6.36; p < 0.0001; OR 2.56, 95% CI 1.52−4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49−2.49; p = 0.82 and OR 0.81, 95% CI 0.35−1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21−1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93−82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02−0.04; p < 0.000 and OR 0.05, 95% CI 0.03−0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.
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Affiliation(s)
- Marco Noventa
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
- Correspondence: ; Tel.: +39-347-6527255
| | - Giulia Spagnol
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Matteo Marchetti
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Carlo Saccardi
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Giulio Bonaldo
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Antonio Simone Laganà
- Unit of Gynecology Oncology, Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialities (PROMISE), University of Palermo, 90127 Palermo, Italy;
| | | | - Alessandra Andrisani
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Guido Ambrosini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Salvatore Giovanni Vitale
- Obstetrics and Gynecology Unit, Department of General Surgery and Medical Surgical Specialties, University of Catania, 95124 Catania, Italy;
| | | | - Sergio Haimovich
- Hillel Yaffe Medical Center, Technion-Israel Technology Institute, Hadera 38100, Israel;
| | - Attilio Di Spiezio Sardo
- Department of Public Health, School of Medicine, University of Naples Federico II, 80138 Naples, Italy;
| | - Jose Carugno
- Minimally Invasive Gynecology Unit, Obstetrics, Gynecology and Reproductive Sciences Department, Miller School of Medicine, University of Miami, Miami, FL 33136, USA;
| | - Marco Scioscia
- Unit of Gynecology, Mater Dei Hospital, 70125 Bari, Italy;
| | - Simone Garzon
- Department of Obstetrics and Gynaecology, AOUI Verona, University of Verona, 37126 Verona, Italy;
| | - Stefano Bettocchi
- Inter-Departmental Project Unit of Minimal-Invasive Gynecological Surgery, Policlinico of Bari, University of Bari Aldo Moro, 70121 Bari, Italy;
| | - Giovanni Buzzaccarini
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Roberto Tozzi
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
| | - Amerigo Vitagliano
- Unit of Gynecology and Obstetrics, Department of Women and Children’s Health, University of Padua, 35100 Padua, Italy; (G.S.); (M.M.); (C.S.); (G.B.); (A.A.); (G.A.); (G.B.); (R.T.); (A.V.)
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Falcone T, Wilson JR. Hysteroscopic Metroplasty for Uterine Septum: Conflicting data on Outcomes. J Minim Invasive Gynecol 2022; 29:451-452. [DOI: 10.1016/j.jmig.2022.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 02/07/2022] [Indexed: 10/19/2022]
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Effect of hyteroscopic uterine septum resection on pregnancy outcomes. J Gynecol Obstet Hum Reprod 2021; 51:102275. [PMID: 34852309 DOI: 10.1016/j.jogoh.2021.102275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 11/15/2021] [Accepted: 11/26/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To compare the reproductive outcome following hysteroscopic resection versus usual care in nulliparous women with a septate uterus. METHODS A retrospective cohort study of nulliparous women with a history of uterine septum and had singleton pregnancies at >20 weeks gestation between Jan. 2016 and Dec. 2019 were conducted. Follow-up was performed through medical record reviews and telephone conversations. The primary outcome was preterm birth at<37weeks gestation, and the secondary outcomes include cesarean delivery, malpresentation, preeclampsia, and birth weight<10th percentile for gestational age. Multivariate logistic regressions were performed to evaluate the effect of hysteroscopic resection on primary and secondary outcomes, after controlling for potential confounding factors. RESULTS Totally 198 women were included in this study, among which 112 women underwent a hysteroscopic resection and 86 women received usual care. Preterm birth incidence (7.1% vs. 18.6%, P = 0.03) and malpresentation (10.7% vs. 23.3%, P = 0.03) was significantly lower in women treated with hysteroscopic resection compared with those received usual care. Multivariate logistic regression indicated that hysteroscopic resection was significantly associated with decreased risks of preterm birth (OR = 0.36, 95% CI: 0.13-0.68; P < 0.01) and malpresentations (OR = 0.47, 95% CI: 0.25-0.71; P < 0.01), after controlling for potential confounding factors. CONCLUSION Hysteroscopic resection could significantly reduce the risks of preterm birth and malpresentations compared to usual care for nulliparous women with a septate uterus.
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Carrera M, Pérez Millan F, Alcázar JL, Alonso L, Caballero M, Carugno J, Dominguez JA, Moratalla E. Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis. J Minim Invasive Gynecol 2021; 29:465-475. [PMID: 34648934 DOI: 10.1016/j.jmig.2021.10.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Revised: 10/02/2021] [Accepted: 10/08/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes. DATA SOURCES A systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, 'cesarean delivery, and fetal malpresentation. METHODS OF STUDY SELECTION Studies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus. TABULATION, INTEGRATION, AND RESULTS The systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22-0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03-0.78), OR = 0.36 (95% CI, 0.19-0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20-1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11-0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16-0.65). CONCLUSION The results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.
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Affiliation(s)
- Maria Carrera
- Hospital Universitario Doce de Octubre (Dr. Carrera)
| | | | | | | | - Miguel Caballero
- Hospital General Universitario Gregorio Marañón (Drs. Millan and Caballero)
| | - Jose Carugno
- Minimally Invasive Gynecology Division, University of Miami, Miami, Florida (Dr. Carugno).
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