Reproductive Outcome Following Resection of Uterine

Septum : A Retrospective Study

Gundabattula S, Marakani L, Yanamandra N, Dasari S, Joseph E, Nirmalan P

Hyderabad, IndiaWebsite : www.fernandezhospital.com

Introduction

Prevalence of uterine malformation : 4.3%

Septate uterus – mean incidence : 35%

– Infertility

– First and Second trimester loss

Aim

To evaluate the reproductive outcome of

septal resection in women with

– Infertility

–Prior pregnancy losses

Methods Retrospective study 2003 – 2010

Data retrieved via electronic database as

well as manually through case records

124 women identified

–74 women (59.7%) – incomplete septum

–50 (40.3%) – complete septum

Procedure Under general anaesthesia Septoplasty was performed

– 26 Fr Resectoscope (Karl Storz) with a cutting monopolar electrode

– Versapoint Hysteroscopy system (Gynaecare Versapoint)

Septum was divided in upward direction until both tubal ostia were visualised in same plane

Results Total no. of women : 124 Mean age : 27 years Indication–Prior pregnancy losses

52–Primary infertility (1 – 17 years) 43– Secondary infertility 21– Incidental finding 08

Total 124

Lost follow up 40 Data available 84

Conceived 63

Total pregnancies 98

Lost to follow up 6

Outcome known 92

Laparoscopy

Not performed 24

- Laparotomy x 1

- Caesarean section x 1

Performed 100

First and Second Trimester Miscarriage

Pre-resection

169(%)

Post resection

92(%)

1st trimester 102 (60.4)

18 (21.1)

2nd trimester 55 (32.5)

13(15.2)

Take home baby

3 (1.8)

56(60.8) Misc

arriag

e

Take home bab

y0

102030405060708090

100 92.89

1.8

36.3

60.86

Pre resectionPost re-section

Infertility Outcome

Post resection0

10

20

30

40

50

60

7059.3

39

52.2

Pregnancy rateMiscarriageLive birth rate

Pregnancy rate 59.3% Miscarriage 39.1% Live birth rate 52.2%

Pre-resection (169)

Post resection(92)

pValue

No. of pregnancies 169 92

1st trimester miscarriage 102

(60%)18

(19%) p< 0.001

2nd trimester miscarriage 55

(32%)13

(14%) p= 0.002

Preresection

169 (%)Post resection

92 (%)p

Value

Term pregnancy

2(1.2)

50 (54.34)

p< 0.001

IUFD /NND 7 (5.3)

3 (3.6)

p= 0.75

Live birth 7 (4.1)

57 (61.9)

p< 0.001

Take home baby

3 (1.8)

56 (60.8)

p< 0.001

Cervical cerclage – 41 (33%)

Type– McDonald 35– Shirodkar 02– Abdominal 04

Indication– Prophylactic 37 (4 were abdominal)– Clinically short 03– Rescue 01

Cervical Cerclage

Post-resection cervical cerclage was done in

33% women

Over three fourths of pregnancies that had

cerclage carried pregnancy to term

Study No. of Patients Iry Infertility (%) Miscarriage +/-

IIry infertilty (%)Preg Rate

MiscRate

Live Birth

PregRate

MiscRate

Live Birth

Ayas 2011 181 44 17 42 77 15 67

Nouri 2010 64 75 25 50 68 19 49

Selvaraj 2010 26 32 33 6 86 33 67

Mollo 2009 44 39 4.5 34 - - -

Saygili-Yilmaz 2002 361 25 16 75 75 16 75

Fernandez Hospital 124 59 39 52 85 33 64

Discussion

Inadequate septal vascularization

Abnormal placentation

In-coordinated contractility of septum

Summary

This study demonstrates:–Reduction in miscarriage rates– Enhances pregnancy rate in those with

infertility– Increases ‘take-home baby’ rate in those

with previous miscarriages and infertility

Conclusion

Metroplasty:

– Significant improvement in reproductive

performance

–Outcome of patients with miscarriages is

better than those with primary infertility

Thank You