Does hysteroscopic resection of uterine septum improve reproductive outcomes: a systematic review and meta-analysis

Krishnan, Monica; Narice, Brenda F.; Ola, Bolarinde; Metwally, Mostafa

doi:10.1007/s00404-021-05975-2

Cited by 19 publications

(13 citation statements)

References 27 publications

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“…A meta-analysis on this topic concluded that septum resection was associated with a lower rate of miscarriage compared with untreated women and no significant effect was seen on live birth, clinical pregnancy rate or preterm delivery [ 75 ]. Although interesting, this meta-analysis is incomplete considering the poor number of papers included (only seven) and the fact that all patients were evaluated together without distinction between infertile patients and patients with recurrent miscarriage.…”

Section: Main Findings and Implicationsmentioning

confidence: 99%

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Noventa

Spagnol

Marchetti

et al. 2022

JCM

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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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Section: Main Findings and Implicationsmentioning

confidence: 99%

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Noventa

Spagnol

Marchetti

et al. 2022

JCM

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“…Similarly, a recent meta-analysis involving 7 studies demonstrated a lower miscarriage rate in the hysteroscopic septum resection group compared to the expectant management group, but clinical pregnancy, live, and preterm rates were similar. [ 28 ] In addition, in patients with RPL, the rate of term pregnancy after surgery was found to be quite successful with 66%.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of the Success of Hysteroscopic Uterine Septum Resection

Mert,

Dilbaz,

Akpinar

et al. 2023

Gynecology and Minimally Invasive Therapy

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Objectives: The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Materials and Methods: Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Results: Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Conclusion: Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.

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“…21 Retrospective studies reported reduced abortion rates and increased live birth rates in patients who underwent hysteroscopic metroplasty compared to untreated patients. 22 Recentely, a meta-analysis involving seven observational studies found that surgical removal of the septum was associated with a low rate of miscarriage (OR 0.25, 95% CI 0.07-0.88), yet there was no difference regarding the live birth rate (OR 1.92, 95% CI 0.37-9.99). 22 The TRUST trial, a multicentre randomized controlled trial published in 2021, also measured the effect of surgical resection of the septum for pregnancy outcomes in women with septate uterus.…”

Section: Uterine Abnormalitiesmentioning

confidence: 99%

“…22 Recentely, a meta-analysis involving seven observational studies found that surgical removal of the septum was associated with a low rate of miscarriage (OR 0.25, 95% CI 0.07-0.88), yet there was no difference regarding the live birth rate (OR 1.92, 95% CI 0.37-9.99). 22 The TRUST trial, a multicentre randomized controlled trial published in 2021, also measured the effect of surgical resection of the septum for pregnancy outcomes in women with septate uterus. Eighty patients were randomized to undergo surgical septum resection (n=40), or expectant management (n=40).…”

Section: Uterine Abnormalitiesmentioning

confidence: 99%

Recurrent Pregnancy Loss: reviewing therapeutic approaches

Oliveira¹,

Praça²,

Garcia³

et al. 2022

Hum. Reprod. Arch.

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Objetive: to discuss recurrent pregnancy loss (RPL) causes and shed light on the current evidence in the management of each one. Methods: A comprehensive and non-systematic search of the theme was carried out through online databases (PubMed and Cochrane database), using the terms "recurrent pregnancy loss", "treatment", "genetic or chromosomal abnormalities", "uterine factor", "uterine septum", "fibroid", "myoma", "cerclage", "endocrine causes", "polycystic ovary syndrome", "thyroid", "hypothyroidism", "hyperprolactnemia", "antiphospholipid syndrome", "hereditary thrombophilia", "inherited trombophilia", "obesity", "lifestyle", "unexplained miscarriages", "progestogens", "vaginal progesterone", "assisted reproductive technologies", "in vitro fertilization", preimplantation genetic screening", "obstetric complications" and variants as keywords. Results: Couples with structural chromosomal rearrangements should be advised of the good reproductive prognosis after natural conception, so that in vitro fertilization plus preimplantation genetic diagnosis should not be offered as first-line treatment for them. Treatment of women with subclinical hypothyroidism may reduce the risk of miscarriage. Bromocriptine treatment can be considered in women with hyperprolactinemia. There is insufficient evidence to recommend metformin supplementation in pregnancy to prevent pregnancy loss in women with glucose metabolism defect. Treatment of Antiphospholipid Syndrome with low-dose aspirin started preconceptionally and heparin started after the first positive pregnancy test is recommended. The evidence to recommend the use of progesterone to improve live birth rate in women with RPL and luteal phase insufficiency is insufficient. Conclusion: The treatment for RPL should be directed to the cause of the miscarriages. Since the outcomes for most couples with unexplained RPL are favorable without treatment, therapy interventions that have not been proven are not recommended.

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Does hysteroscopic resection of uterine septum improve reproductive outcomes: a systematic review and meta-analysis

Cited by 19 publications

References 27 publications

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Evaluation of the Success of Hysteroscopic Uterine Septum Resection

Recurrent Pregnancy Loss: reviewing therapeutic approaches

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