Hysteroscopic Treatment Of The Uterine Septum: A Clinician's Experience

Uterus septus is the most frequent congenital uterine anomalies caused by insufficient resorption of the müllerian ducts. Retrospective statistical analysis shows that the uterine septa have the worst reproductive outcome with a high incidence of early abortions. It is well recognized that it increased the incidence of recurrent (> or = 3) miscarriages (79% among 1,601 pregnancies), reproductive failure and obstetric complications. Hysteroscopic surgery has replaced conventional abdominal route. Hysteroscopic metroplasty improves obstetrical prognosis in women with septate uterus, and it's advantages are easiness, low morbidity rate, without the hysterotomy's consequences like adnexial adhesions. Metroplasty is indicated in women with a history of miscarriages (2 or more), which decreased to 15%, in patients with an unexplained infertility, and in women in whom assisted reproductive treatment is being contemplated. Combined with laparoscopy, the hysteroscopic metroplasty is the gold standard for assessing uterine septa, especially in these infertile women.Objective:We reviewed our experience with the diagnosis and hysteroscopic treatment of uterine septa.Study Design: This article is a retrospective review of cases of Hebei Medical University the 4th Hospital during the year 2003-2009. Patients were on preoperative ultrasound examination, of which 10 cases preoperatively MRI examination, both patients diagnosed by hysteroscopy and all underwent a hysteroscopic uterine septum resection,A septate uterus was diagnosed in a total of 71patients, and all were treated by hysteroscopic resection.Results:In 60% of the cases post-operative hysteroscopic examination showed a normal cavity with a little fundal notch,which is less than 1cm. In two cases, second surgery was needed.The rate of reoperative pregnancy loss was 72.98%. After hysteroscopic septum resection 35 patients reported a total of 39 pregnancies with an 14.3% miscarriage rate.Conclusion: Hysteroscopic treatment of uterine septa is a safe, simple, and effective procedure. It can be used for all types of uterine septa, and it attains optimal obstetric outcomes, and it should be undertaken whenever a uterine septum is diagnosed.