Pregnancy Outcomes in Women With a History of Recurrent Early Pregnancy Loss and a Septate Uterus, With and Without Hysteroscopic Metroplasty

Whelan, Anna; Burks, Channing; Stephenson, Mary D.

doi:10.1097/aog.0000000000003953

Cited by 11 publications

(13 citation statements)

References 14 publications

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“…So, 38 observational papers were included in the meta-analysis. Ten manuscripts were included in the first section: infertile/recurrent miscarriage patients with uterine septum versus controls (no septum) [ 10 , 14 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]; nine manuscripts were included in the second section: infertile/recurrent miscarriage patients with treated uterine septum versus controls (untreated septum) [ 19 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]; and, finally, nineteen manuscripts were included in the third section: infertile/recurrent miscarriage patients before and after septum removal [ 12 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 ]. Figure 1 shows the flow chart summarizing literature identification and selection.…”

Section: Resultsmentioning

confidence: 99%

“…In the second section we analyzed nine manuscripts including a total of 1053 patients (603 cases and 450 controls). Table 2 (study features) [ 19 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Research Findingsmentioning

confidence: 99%

“…LBR was investigated in eight studies. [ 19 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. A higher LBR was associated with removed vs. unremoved septate uterus (OR 3.07, 95% CI 1.22 to 7.73; p = 0.02) with substantial heterogeneity (I 2 = 76%) ( Figure 3 B).…”

Section: Research Findingsmentioning

confidence: 99%

“…SA during the first and second trimesters was investigated in nine studies [ 19 , 29 , 34 , 35 , 36 , 37 , 38 , 39 , 40 ]. SA seemed lower in women who had their uterine septum removed vs. not removed (OR 0.47, 95% CI 0.21 to 1.04; substantial heterogeneity I 2 = 80%) but did not achieved statistical significance ( p = 0.06) ( Figure 3 C).…”

Section: Research Findingsmentioning

confidence: 99%

“…In six studies reporting data from recurrent abortion, preterm labor was not different in women who had their uterine septum removed vs. not removed (OR 0.74, 95% CI 0.26 to 2.15; p = 0.58) with moderate heterogeneity (I 2 = 36%) [ 35 , 36 , 37 , 38 , 39 , 40 ].…”

Section: Research Findingsmentioning

confidence: 99%

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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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