The significance of hysteroscopic treatment of congenital uterine malformations

Comparison of clinical outcomes and second-look hysteroscopy of the complete and incomplete septate uterus after hysteroscopic septoplasty

PURPOSE

Septate uterus is the most common congenital uterine malformation. This retrospective cohort study compared clinical outcomes and second-look hysteroscopy findings in patients with complete and incomplete septate uteri after septoplasty.

METHODS

We reviewed the medical records of patients with a septate uterus who underwent hysteroscopic septoplasty and second-look hysteroscopy at the West China Second University Hospital between September 2013 and September 2021. Information regarding pregnancy outcomes was collected through telephone interviews. The independent samples t-test, Mann-Whitney U test, Pearson's chi-square test, and Fisher's exact test were used to explore the differences between the complete and incomplete septate uterus groups.

RESULTS

A total of 64 patients were enrolled in this study. There was no significant difference in intrauterine adhesion (IUA) rates (16.7% and 32.1%), pregnancy rates (44.1% and 42.9%), term delivery rates (35.3% and 32.1%), premature delivery rates (2.9% and 0), placenta previa rates (2.9% and 3.6%), placenta implantation/adhesion rates (5.9% and 3.6%), and premature rupture of membranes rates (2.9% and 0) between the complete and the incomplete group after hysteroscopic septoplasty (P > 0.05). Endometrial polyps in the septate uterus were common, with an incidence of 33.3% and 25% in the complete and incomplete groups, respectively (P > 0.05).

CONCLUSION

The pregnancy outcomes of complete and incomplete septate uteri after hysteroscopic septoplasty were similar. There was no statistical difference in IUAs after surgery. Different treatment strategies may not be required for complete or incomplete septate uteri.

Pregnancy and Adverse Obstetric Outcomes After Hysteroscopic Resection: A Systematic Review and Meta-Analysis

Objective

Although the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.

Search Methods

From January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.

Results

22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26–4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27–0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19–0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.

Conclusion

Hysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients

Uterine rupture in pregnancy after hysteroscopic septum resection: a 20-year retrospective analysis

INTRODUCTION

In this study, we reviewed the cases of uterine rupture in our setting, identified which of them had previously undergone hysteroscopic septum resection (HSR), and evaluated the main clinical characteristics for each case.

MATERIAL AND METHODS

We retrospectively analyzed (ClinicalTrial ID: NCT04449640) the delivery outcomes from the National Perinatal Information System of the National Institute of Public Health of the Republic of Slovenia of the last 20 years (1 January 1999 - 31 December 2019) and cross-linked the patients with surgical data from our electronic database. We collected baseline characteristics, surgical details and obstetrical outcomes. We excluded women who had undergone previous myomectomy or cesarean section (CS) and described the clinical course of each case since no statistical analysis was performed.

RESULTS

We found four patients who had uterine rupture in pregnancy after HSR. Median time to pregnancy was 17 months (range 1-60), all the women underwent CS and fetal-maternal outcomes were acceptable in half of the cases. Symptoms were nonspecific and included pain, fetal distress and vaginal bleeding.

CONCLUSION

Uterine rupture in pregnancy after a previous HSR is a very rare, but life-threatening event. Prompt diagnosis can ensure successful management and avoid adverse maternal-fetal outcomes.

Transvaginal sonographic evaluation at different menstrual cycle phases in diagnosis of uterine lesions

PURPOSE

Intrauterine lesions (IULs) are a common finding in women of reproductive age, particularly infertile women. Transvaginal sonography (TVS) is a popular tool for IUL detection, but there are conflicting data with respect to its accuracy.

METHODS

Five hundred and six women were enrolled into the study. Of these, 496 underwent hysterosalpingography and subsequent TVS six different times during the course of their menstrual cycle. If a lesion was detected, it was further evaluated by sonohysterography (SHG) and hysteroscopy.

RESULTS

Of 496 women, 41 were shown to have IULs by TVS and those lesions were confirmed in 39 by SHG and hysteroscopy. All 39 lesions were detectable during the ovulatory and early luteal phase (days 16-19) of the menstrual cycle. Accuracy of TVS during different phases was largely dependent on the size of the lesion. TVS falsely detected two lesions and missed fine adhesions in two patients.

CONCLUSION

Accuracy of TVS in detection of IULs is highly dependent on the menstrual cycle phase, with the ovulatory and early luteal phase being the optimal time for this examination.

A practical guide to determine the incision line in the treatment of septate uterus: "Süha-Levent's Sign"

OBJECTIVE

To evaluate the significance of a new sign in the hysteroscopic incision process of the septate uterus.

DESIGN

This is a prospective case control study.

DESIGN CLASSIFICATION

II-2.

SETTINGS

The study was performed in a research hospital.

PATIENTS

Fourty-seven consecutive cases were operated for septate uterus.

INTERVENTION

Septum incision was performed in all cases with a hysteroscopic resectoscope under laparoscopic supervision.

MEASUREMENTS AND MAIN RESULTS

Methylene blue 0.25% was injected through a Rubin canula in all cases for the assessment of tubal patency. Following the methylene blue injection, hysteroscopic septum incision was performed.

CONCLUSION

A line (blue line) on the top of the cavity has been observed in 33 of 47 (70.2%) cases. This line (blue line) can be used for determining the midline especially before hysteroscopic incision of uterine septum and can also shorten the operation time.

Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial

OBJECTIVE

To assess fecundity of infertile women after surgical correction of uterine septum.

DESIGN

Prospective controlled trial.

SETTING

Three academic infertility clinics.

PATIENT(S)

Forty-four women affected by septate uterus and otherwise unexplained infertility represented the study group (group A), and 132 women with unexplained infertility were enrolled as control subjects (group B).

INTERVENTION(S)

Hysteroscopic metroplasty was performed in group A, and group B was managed expectantly. All women were followed-up for 1 year without any other intervention.

MAIN OUTCOME MEASURE(S)

Fecundity rate was calculated as the number of pregnancies per 100 person-months.

RESULT(S)

Pregnancy rate (38.6% vs. 20.4%) and live birth rate (34.1% and 18.9%) were significantly higher in group A than in group B. The survival analysis showed that the probability of a pregnancy in the twelve-months follow up was significantly higher in patients who had undergone metroplasty than in women with unexplained infertility. The corresponding fecundity (10-week pregnancy) rates were 4.27 and 1.92 person-months in women who had undergone metroplasty and in women with unexplained infertility, respectively.

CONCLUSION(S)

Hysteroscopic resection of the septum improves fecundity of women with septate uterus and otherwise unexplained infertility. Patients with septate uterus and no other cause of sterility have a significantly higher probability of conceiving after removal of the septum than patients affected by idiopathic sterility.

Ambulatory gynaecology: What can we do?

The aim of ambulatory gynaecology is to admit, treat and discharge the patient on the same day in an outpatient setting. Traditional inpatient operations are being rapidly replaced by office, outpatient or day surgery procedures. In this review, a brief assessment of current ambulatory gynaecological practice is attempted, followed by a discussion of audit and quality assessment methods. Epidemiological studies, clinical trials, socio-economic studies and meta-analyses offer research opportunities in the ambulatory setting. There is a need to review the training of junior gynaecologists and nurses in this field. At present, only a few gynaecology residency programmes offer experience in outpatient procedures and ambulatory care. Specific issues that need to be addressed include training, patient selection, consenting issues, decisions to cancel/transfer as inpatients, and the management of common gynaecological problems.