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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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Liu C, Liao Z, Gong X, Chen Y. Does septum resection improve reproductive outcomes for women with a septate uterus? A systematic review and meta-analysis. Front Endocrinol (Lausanne) 2024; 15:1361358. [PMID: 39104816 PMCID: PMC11298444 DOI: 10.3389/fendo.2024.1361358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 05/24/2024] [Indexed: 08/07/2024] Open
Abstract
Objective To investigate whether incising the septum facilitates reproductive outcomes for patients with a septate uterus compared to expectant management. Methods Research was retrieved from three electronic databases: PubMed, Embase, and the Cochrane Library, with no time or language restrictions. Two authors independently selected the articles and extracted data regarding study characteristics, quality, and results. A random-effects model was employed, and summary risk ratios (RR) with 95% confidence intervals (CI) were calculated. Results A total of 468 patients from two randomized controlled trials and one cohort study were included in the systematic review and meta-analysis. Pooled results showed that septum resection did not improve the live birth rate for patients with a septate uterus (RR = 0.84, 95% CI = 0.56 - 1.25, P = 0.39). Additionally, no significant differences were found between the septum resection and expectant management groups in terms of clinical pregnancy (RR = 1.08, 95% CI 0.81 - 1.44, P = 0.60), abortion (RR = 1.99, 95% CI 0.80 - 4.98, P = 0.14), and preterm delivery rates (RR = 0.99, 95% CI 0.42 - 2.31, P = 0.98). Conclusion Our data provide clear evidence that septum resection does not improve the reproductive outcomes of patients with a septate uterus. These findings might be useful for revising current clinical guidelines.
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Affiliation(s)
- Chang Liu
- Reproductive Medicine Center, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Zhiqi Liao
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xueqi Gong
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yinwei Chen
- Reproductive Medicine Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Motan T, Cockwell H, Elliott J, Antaki R. Guideline No. 446: Hysteroscopic Surgery in Fertility Therapy. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102400. [PMID: 38320665 DOI: 10.1016/j.jogc.2024.102400] [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] [Indexed: 02/08/2024]
Abstract
OBJECTIVE To evaluate the indications, benefits, and risks of hysteroscopy in the management of patients with infertility and provide guidance to gynaecologists who manage common conditions in these patients. TARGET POPULATION Patients with infertility (inability to conceive after 12 months of unprotected intercourse) undergoing investigation and treatment. BENEFITS, HARMS, AND COSTS Hysteroscopic surgery can be used to diagnose the etiology of infertility and improve fertility treatment outcomes. All surgery has risks and associated complications. Hysteroscopic surgery may not always improve fertility outcomes. All procedures have costs, which are borne either by the patient or their health insurance provider. EVIDENCE We searched English-language articles from January 2010 to May 2021 in PubMed/MEDLINE, Embase, Science Direct, Scopus, and Cochrane Library (see Appendix B for MeSH search terms). VALIDATION METHODS The authors rated the quality of evidence and strength of recommendations using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. See Appendix A (Tables A1 for definitions and A2 for interpretations of strong and conditional recommendations). INTENDED AUDIENCE Gynaecologists who manage common conditions in patients with infertility. TWEETABLE ABSTRACT When offering hysteroscopic surgery to patients with infertility, ensure it improves the live birth rate. SUMMARY STATEMENTS RECOMMENDATIONS.
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Motan T, Cockwell H, Elliott J, Antaki R. Directive clinique n o446 : Chirurgie hystéroscopique dans les traitements de fertilité. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102399. [PMID: 38325735 DOI: 10.1016/j.jogc.2024.102399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
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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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Surgical treatment of uterine septum to improve reproductive outcomes - resect or not? Fertil Steril 2021; 116:298-305. [PMID: 34274115 DOI: 10.1016/j.fertnstert.2021.06.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 11/22/2022]
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Rall KK, Schöller D, Kölle A, Brucker S. Fehlbildungen des weiblichen Genitales und operative Therapie. GYNAKOLOGISCHE ENDOKRINOLOGIE 2021. [DOI: 10.1007/s10304-020-00364-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Pregnancy Outcomes in Women With a History of Recurrent Early Pregnancy Loss and a Septate Uterus, With and Without Hysteroscopic Metroplasty. Obstet Gynecol 2020; 136:417-419. [PMID: 32649503 DOI: 10.1097/aog.0000000000003953] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Miklavcic J, Laganà AS, Premru Srsen T, Korosec S, Ban Frangež H. Effect of hysteroscopic septum resection on preterm delivery rate in singleton pregnancies. MINIM INVASIV THER 2020; 30:377-383. [PMID: 32196404 DOI: 10.1080/13645706.2020.1743721] [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] [Indexed: 10/24/2022]
Abstract
INTRODUCTION Uterine septum is the most common uterine anomaly and is often found during the work-up in primary infertile women. In this study, we aimed to evaluate the potential effect of hysteroscopic septum resection (HSR) on preterm delivery (PTD) in primary infertile women who had singleton pregnancies. MATERIAL AND METHODS We analyzed 420 singleton pregnancies after primary infertility treatment and compared the PTD rates in women who underwent previous HSR (cases) and women who did not undergo previous operative hysteroscopy or cervical dilation (controls), regardless of the modality of conception (spontaneous or by in vitro fertilization). RESULTS We did not find significant differences between cases and controls for the incidence of overall PTD rate (p = .237), PTD before 32 gestational weeks (p = .848), and between 32 and 37 gestational weeks (p = .324), premature rupture of membranes (p = .419), and neonatal birth weight (p = .129). Overall, the risk of spontaneous PTD <37 gestational weeks after HSR was not found to be significantly higher compared to controls (RR 1.29, 0.61-2.73 95% CI; p = .561). CONCLUSION According to our results, previous HSR could be not considered a risk factor for PTD in singleton pregnancies, regardless of the modality of conception (spontaneous or by in vitro fertilization).
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Affiliation(s)
- Jana Miklavcic
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, "Filippo Del Ponte" Hospital, University of Insubria, Varese, Italy
| | - Tanja Premru Srsen
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Perinatology, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Sara Korosec
- Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Helena Ban Frangež
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.,Department of Human reproduction, Division of Gynaecology and Obstetrics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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Fox NS, Connolly CT, Hill MB, Klahr RA, Zafman KB, Rebarber A. Pregnancy outcomes in viable pregnancies with a septate uterus compared with viable pregnancies after hysteroscopic uterine septum resection. Am J Obstet Gynecol MFM 2019; 1:136-143. [PMID: 33345819 DOI: 10.1016/j.ajogmf.2019.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 05/08/2019] [Accepted: 05/09/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND Septate uterus is one of the more common Müllerian anomalies and is the anomaly most amenable to surgical correction. It is currently uncertain if hysteroscopic septum resection reduces the incidence of adverse pregnancy outcomes. OBJECTIVE The purpose of this study was to compare pregnancy outcomes in women who had reached at least 20 weeks gestation with those women with a uterine septum and those women who had undergone septum resection before pregnancy. STUDY DESIGN Retrospective cohort study of women with a history of uterine septum who were cared for by a large maternal-fetal medicine practice from 2005-2018. We included women with singleton pregnancies at >20 weeks gestation. Baseline characteristics and pregnancy outcomes were compared between women with a history of a hysteroscopic uterine septum resection and women with an unresected septum. Regression analysis was performed to control for differences in baseline characteristics. The analysis was repeated in nulliparous women only. RESULTS A total of 109 women (163 pregnancies) were included. In the entire population, pregnancy outcomes did not differ between the groups, aside from a higher rate of cesarean delivery in the resected septum group. In the 63 nulliparous women, septum resection was associated with later gestational ages at delivery (39.1 vs 37 weeks; P=.030), decreased preterm birth <37 weeks gestation (4.5% vs 31.6%; adjusted odds ratio, 0.154; 95% confidence interval, 0.027-0.877), and an increased incidence of cesarean delivery in women who attempted vaginal delivery (30.6% vs 0%; P=.012). There was no difference in the rates of small for gestational age, preeclampsia, blood transfusion, retained placenta, or morbidly adherent placenta. CONCLUSION In nulliparous women with viable pregnancies, hysteroscopic resection of a uterine septum is associated with a decreased incidence of preterm birth and an increased incidence of cesarean delivery. These findings need to be confirmed in a well-designed randomized trial before uterine septum resection is recommended routinely.
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Affiliation(s)
- Nathan S Fox
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY.
| | - Courtney T Connolly
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Melissa B Hill
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Rebecca A Klahr
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Kelly B Zafman
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Andrei Rebarber
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY; Maternal Fetal Medicine Associates, PLLC, New York, NY
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Checa M, Bellver J, Bosch E, Espinós J, Fabregues F, Fontes J, García-Velasco J, Requena A. Hysteroscopic septum resection and reproductive medicine: A SWOT analysis. Reprod Biomed Online 2018; 37:709-715. [DOI: 10.1016/j.rbmo.2018.09.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 09/09/2018] [Accepted: 09/12/2018] [Indexed: 11/17/2022]
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Gabbai D, Harlev A, Friger M, Steiner N, Sergienko R, Kreinin A, Bashiri A. Pregnancy outcomes among patients with recurrent pregnancy loss and uterine anatomic abnormalities. J Perinat Med 2018; 46:728-734. [PMID: 28742523 DOI: 10.1515/jpm-2016-0411] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 06/12/2017] [Indexed: 11/15/2022]
Abstract
Abstract
Background:
Different etiologies for recurrent pregnancy loss have been identified, among them are: anatomical, endocrine, genetic, chromosomal and thrombophilia pathologies.
Aims:
To assess medical and obstetric characteristics, and pregnancy outcomes, among women with uterine abnormalities and recurrent pregnancy loss (RPL). This study also aims to assess the impact of uterine anatomic surgical correction on pregnancy outcomes.
Methods:
A retrospective case control study of 313 patients with two or more consecutive pregnancy losses followed by a subsequent (index) pregnancy. Anatomic abnormalities were detected in 80 patients. All patients were evaluated and treated in the RPL clinic at Soroka University Medical Center. Out of 80 patients with uterine anatomic abnormalities, 19 underwent surgical correction, 32 did not and 29 had no clear record of surgical intervention, and thus were excluded from this study.
Results:
Women with anatomic abnormalities had a higher rate of previous cesarean section (18.8% vs. 8.6%, P=0.022), tended to have a lower number of previous live births (1.05 vs. 1.37, P=0.07), and a higher rate of preterm delivery (22.9% vs. 10%, P=0.037). Using multivariate logistic regression analysis, anatomic abnormality was identified as an independent risk factor for RPL in patients with previous cesarean section after controlling for place of residence, positive genetic/autoimmune/endocrine workup, and fertility problems (OR 7.22; 95% CI 1.17–44.54, P=0.03). Women suffering from anatomic abnormalities tended to have a higher rate of pregnancy loss compared to those without anatomic abnormalities (40% vs. 30.9%, P=0.2). The difference in pregnancy loss rate among women who underwent surgical correction compared to those who did not was not statistically significant.
Conclusion:
In patients with previous cesarean section, uterine abnormality is an independent risk factor for pregnancy loss. Surgical correction of uterine abnormalities among RPL patients might have the potential to improve live birth rate.
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Affiliation(s)
- Daniel Gabbai
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Avi Harlev
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Michael Friger
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Naama Steiner
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Ruslan Sergienko
- Faculty of Health Sciences, Department of Epidemiology and Health Services Evaluation, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Andrey Kreinin
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Asher Bashiri
- Faculty of Health Sciences, Department of Obstetrics and Gynecology, Soroka University Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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Hysteroscopy combined with laparoscopy in treatment of patients with post-cesarean section uterine diverticulum. Wideochir Inne Tech Maloinwazyjne 2018; 14:297-303. [PMID: 31118997 PMCID: PMC6528112 DOI: 10.5114/wiitm.2018.77775] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 07/21/2018] [Indexed: 11/17/2022] Open
Abstract
Introduction Post-cesarean section uterine diverticulum (PCSUD) is a recess in the lower uterine segment of the cesarean section incision that protrudes to the serosa due to healing defects. With the abolition of the one-child policy, allowing couples to have two children in the past year in China, more and more couples plan to give birth to a second baby. However, with the significant increase in the cesarean section rate in the past two decades in China, the incidence of PCSUD also obviously increased. Aim To evaluate the clinical efficacy and safety of hysteroscopy combined with laparoscopy in treatment of patients with PCSUD. Material and methods Fifty-two cases of patients with post-cesarean section uterine diverticulum (PCSUD) who suffered from conservative treatment failure in the Beijing Obstetrics and Gynecology Hospital (affiliated to Beijing Capital Medical University) between January 2012 and June 2017 were retrospectively analyzed in this study. Patients with reproductive requirements were treated with hysteroscopy combined with laparoscopy surgery (experimental group, n = 31); those without reproductive requirements were treated with hysteroscopic surgery (control group, n = 21). The operation time, intraoperative blood loss, hospital stay period, clinical efficacy and recurrence rate of the two groups were compared. Results All the patients successfully completed the operation procedure in both experimental and control groups. The operation time, intraoperative blood loss and post-operative hospital stay in the experimental group were significantly higher than those of the control group (p < 0.05). There was no significant difference in clinical efficacy or recurrence between the two groups (p > 0.05). Six months after the operation, the uterus muscularis thickness was 4.2 ±1.9 mm and 9.8 ±6.2 mm for control and experimental groups respectively, which indicates that the muscularis thickness in the experimental group was significantly greater than that of the control group (p < 0.05). Conclusions Hysteroscopy combined with laparoscopy was safe with satisfactory results in treatment of patients with PCSUD.
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Abstract
Choosing an evidence-based workup and treatment for recurrent pregnancy loss is imperative to provide best patient care and create a culture that permits rigorous research into potential (not yet evidence-based) tests and therapeutics. As health sciences technologies become more sophisticated, more precise, and less expensive, new tools may be developed that allow better evaluation and treatment of couples with recurrent pregnancy loss. The goal must remain optimizing value and adhering to evidence-based care.
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