| PurposeTo evaluate the effects of transcervical resection of the septum（TCRS）for two kinds of uterine septum on reproductive outcomes among women of reproductive age and to analyze the operative complications,so as to provide valuable reference for the clinical diagnosis and treatment.MethodsA total of 80 patients with uterine septum who attended the Hospital of Anhui Medical University were enrolled from January 2010 to December 2018.The patients involved in this study presented to the clinic with either spontaneous abortion or infertility,and all of them underwent an ultrasound examination wherein the uterine septum was discovered and surgical treatment was required.Among the 80 cases,57 with incomplete uterine septum（group A）and 23 with complete uterine septum（group B）were followed up.In all cases,surgery was performed during the early proliferative phase of the menstrual cycle under general anesthesia.Oral estrogen progesterone was recommended for 1month after the operation.All patients were forbidden to have sex and bath for 1 month after surgery.We compared the preoperative and postoperative pregnancy outcomes of the patients with uterine septum,such as the pregnancy rate,spontaneous abortion rate,embryo arrest rate,fetal term birth rate,and premature birth rate,and analyzed the surgical complications,and compared the postoperative pregnancy outcomes of the complete and incomplete uterine septum groups,including the optimal postoperative pregnancy time,postoperative delivery mode,and postoperative pregnancy complications.Results1.In group A,the pregnancy rate was 82.5%,spontaneous abortion rate was 47.0%,embryo arrest rate was 30.4%,full term delivery rate was 7.8%,premature delivery rate was 0.9%.After TCRS,the pregnancy rate was 80.7%,spontaneous abortion rate was 13.1%,embryo arrest rate was 3.3%,full term delivery rate was 72.1%,premature delivery rate was 8.2%.After TCRS,the spontaneous abortion rate and fetal arrest rate were significantly decreased（P<0.001）,and the full-term delivery rate was significantly increased（P<0.001）.2.In group B,the pregnancy rate was 43.5%,spontaneous abortion rate was 33.3%,embryo stop rate was 33.3%,full term delivery rate was 0,premature delivery rate was 0.After TCRS,pregnancy rate was 82.6%,spontaneous abortion rate was 4.2%,embryo arrest rate was 12.5%,full term delivery rate was 70.8%,premature delivery rate was 4.2%.After TCRS,the spontaneous abortion rate was significantly reduced（P = 0.024）,and the full-term delivery rate was significantly increased（P<0.001）.3.The highest pregnancy rate was 34.78% in group A 3-6 months after surgery,and33.33% in group B 6-12 months after surgery.4.There was no perforation in group A.1 case of overhydration syndrome;No cases of infection have occurred;Residual mediastinum in 1 case,mild intrauterine adhesion in 1 case.There were 2 cases of perforation in group B.1 case of overhydration syndrome;No cases of infection have occurred;No residual mediastinum occurred;mild intrauterine adhesion in 1 case.5.The rates of cesarean section in group A and B after TCRS were 47.7% and 76.5%,respectively,with statistically significant differences（P < 0.001）.There was no statistical significance in placenta previa,premature rupture of membranes and premature delivery in group A and B（P > 0.05）.Conclusion1.Although complications may occur during TCRS,it is generally safe and effective to treat the uterine septum.2.TCRS can reduce the rate of spontaneous abortion,increase the rate of pregnancy and full term delivery,and the pregnancy outcome is significantly improved compared with that before surgery.3.Patients with incomplete uterine septum become pregnant earlier after TCRS than patients with complete uterine septum,thus ensuring the optimal time not to miss pregnancy.4.The rate of spontaneous abortion decreased after TCRS.Incomplete uterine septum can be vaginal trial delivery,complete uterine septum requires strict monitoring of vaginal trial delivery,if necessary,cesarean section to terminate pregnancy. |
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