Relevance of Uterine Subseptations: What Length Should Warrant Hysteroscopic Resection?

Detti, Laura; Hickman, Holly; D'Ancona, R. Levi; Wright, Alicia W.; Christiansen, Mary E.

doi:10.7863/ultra.15.07073

Cited by 13 publications

(12 citation statements)

References 22 publications

(75 reference statements)

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“…This work reinforces the idea of uterine remodeling after hysteroscopic metroplasty [25,26], due to the intrinsic histological characteristics of the septum, and the ability of the myometrium to modify the shape and thickness of the uterine walls not only in physiological conditions such as pregnancy, but also iatrogenic, such as surgery.…”

Section: Discussionsupporting

confidence: 82%

“…The 3D-transvaginal sonography (3D-TVS) is currently the most widely used method for the initial study of the uterine morphology and can also be performed to study/evaluate the outcomes of hysteroscopic metroplasty [23,24]. To date, few studies has shown the modifications of the profile of uterine cavity after hysteroscopic metroplasty [25,26]. Instead, to our knowledge, this is the first work that analyzes the uterine fundal morphology before and after hysteroscopic treatment.…”

Section: Introductionmentioning

confidence: 99%

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Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

Casadio

Magnarelli

Rosa

et al. 2021

JCM

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The septate uterus is the most common congenital uterine malformation and is treated by hysteroscopic metroplasty. There are few studies on the fundal uterine changes that occur after surgery. We designed a pilot prospective observational study to evaluate by three-dimensional transvaginal ultrasound (3D-TVS) the changes not only of the internal fundal uterine profile, but also of the external one, after hysteroscopic metroplasty. Sixty women who underwent hysteroscopic metroplasty for partial or complete uterine septum (U2a and U2b subclasses of ESHRE/ESGE classification) were enrolled. We performed 3D-TVS after surgery confirming optimal removal of the septum. However, at ultrasound follow-up after three months, we observed a significant increase (p < 0.001) in the residual septum (Zr) (3.7 mm (95% CI: 3.1–4.4)), the myometrial wall thickness (Y) (2.5 mm (95% CI: 2.0–3.0)) and the total fundal wall thickness (Y + Zr) (6.2 mm (95% CI: 5.5–6.9)). Forty-three patients (72%) required a second step of hysteroscopic metroplasty. Moreover, the shape of uterine fundus changed in 58% of cases. We actually observed a remodeling of the uterine fundus with modifications of its external and internal profiles. Therefore, we propose to always perform a second ultrasound look at least three months after the metroplasty to identify cases that require a second- step metroplasty.

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Section: Discussionsupporting

confidence: 82%

Section: Introductionmentioning

confidence: 99%

Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

Casadio

Magnarelli

Rosa

et al. 2021

JCM

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“…Up to 70% of in utero DES-exposed women had uterine abnormalities. 11 The most common anomalies were T configuration and hypoplasia of the uterus. The other associated abnormalities were strictions, adhesions, and rudimentary horn.…”

Section: Discussionmentioning

confidence: 99%

“…3,7,10 In addition, a recent prospective controlled cohort trial hypothesized that infertility and adverse pregnancy outcomes may be as a result of a wider and misshapen cavity, the length of the uterine septa, and a decreased endometrial surface. 11 On the contrary, a T-shaped uterus (class U1a) is a rare uterine malformation which has been reported frequently in women exposed in utero diethylstilbestrol (DES). 12 Although the pathogenesis and the etiology still remains unknown, in some cases it may be due to Asherman syndrome.…”

Section: Introductionmentioning

confidence: 99%

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Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome

et al. 2018

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Septum Resection Prior to In Vitro Fertilization‐Embryo Transfer

Ouyang

Chen

Gong

et al. 2022

J of Ultrasound Medicine

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Objectives-To investigate the effectiveness of surgery for septate uterus in infertile patients before in vitro fertilization-embryo transfer (IVF-ET).Methods-The data of 937 infertile patients with septate uterus and achieved singleton pregnancy after IVF-ET from January 2014 to December 2015 were retrospectively analyzed. Thousand five hundred seventy-eight infertile patients with a normal uterus who achieved singleton pregnancy during the same period were selected as the control group. Patients with septate uterus were divided into two groups according to whether the septum was resected. The pregnancy and perinatal outcomes of the surgical group and the nonsurgical group were compared with the control group. The secondary infertility patients who were surgically corrected septa were also chosen as self-controls and an analysis was performed on their fertility outcomes pre-and post-surgery.Results-Compared with the control group, the surgical group had increased rates of early miscarriage, preterm delivery, and low birthweight and a significantly reduced live birth rate (P < .05). The outcomes of the nonsurgical and control groups were similar. Using secondary infertility patients who were surgically corrected septa as self-controls, after surgery, the rates of miscarriage and ectopic pregnancy were significantly lower and the live birth rate was significantly higher (P ≤ .001); however, perinatal mortality was not significantly different before and after surgery.Conclusions-Patients with a septum depth greater than 10 mm or 5-10 mm associated with a history of unexplained recurrent miscarriage, IVF failure, or infertility might benefit from resection of the uterine septum with hysteroscopic metroplasty.

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Relevance of Uterine Subseptations: What Length Should Warrant Hysteroscopic Resection?

Cited by 13 publications

References 22 publications

Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

Uterine Fundus Remodeling after Hysteroscopic Metroplasty: A Prospective Pilot Study

Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome

Septum Resection Prior to In Vitro Fertilization‐Embryo Transfer

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