The techniques and outcomes of hysteroscopic metroplasty

Paradisi, Roberto; Barzanti, Rita; Fabbri, Raffaella

doi:10.1097/gco.0000000000000077

Cited by 22 publications

(15 citation statements)

References 55 publications

(50 reference statements)

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“…Hysteroscopic metroplasty seems to significantly improve the obstetric outcome in a population of women with previous miscarriage. The procedure seems to be safe when done by skilled surgeons [ 34 , 35 ].…”

Section: Discussionmentioning

confidence: 99%

Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?

Šuster

Gergolet²

2015

Gynecol Surg

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The aim of the study was to evaluate whether hysteroscopic metroplasty for septate uterus represents a risk factor of adverse outcome in pregnancy, during labor, and after delivery. This is a retrospective comparative study of obstetric complications of 99 patients who underwent hysteroscopic metroplasty in a 5-year period (study group) and 4155 women, who gave birth in the same hospital in the same period (control group). No difference in obstetric outcome (preterm labor, hemorrhage before and after delivery, mean weeks of gestation at delivery, mean birth weight, breech presentation, and cesarean section rate) between the two groups has been found. The results of this study suggest that patients who underwent hysteroscopic metroplasty for septate uterus are at no higher risk of adverse obstetric outcome at term and during labor, comparing to the general population. Though vaginal delivery seems to be safe, rare but serious complication, reported by several studies, like uterine rupture during pregnancy or labor, should always be taken into consideration.

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Section: Discussionmentioning

confidence: 99%

Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?

Šuster

Gergolet²

2015

Gynecol Surg

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“…Women with a history of miscarriages ( Valle and Ekpo, 2013 ) and infertility ( Pabuçcu and Gomel, 2004 ; Mollo et al , 2009 ), after diagnosis of septate uterus by ASRM classification criteria, commonly undergo hysteroscopic metroplasty to improve reproductive outcomes ( Grimbizis et al , 2001 ; Brucker et al , 2011 ; Paradisi et al , 2014 ). Many non-controlled studies have confirmed the validity of such a procedure ( Nouri et al , 2010 ; Valle and Ekpo, 2013 ), although we are waiting for confirmation in randomized controlled trials ( Christiansen et al , 2005 ; Bosteels et al , 2010 ; Kowalik et al , 2011 ).…”

Section: Introductionmentioning

confidence: 99%

Comparison of the ESHRE-ESGE and ASRM classifications of Mullerian duct anomalies in everyday practice

Ludwin

2014

Human Reproduction

152

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STUDY QUESTIONDoes the European Society of Human Reproduction and Embryology–European Society for Gynaecological Endoscopy (ESHRE–ESGE) classification of female genital tract malformations significantly increase the frequency of septate uterus diagnosis relative to the American Society for Reproductive Medicine (ASRM) classification?SUMMARY ANSWERUse of the ESHRE–ESGE classification, compared with the ASRM classification, significantly increased the frequency of septate uterus recognition.WHAT IS KNOWN ALREADYThe ESHRE–ESGE criteria were supposed to eliminate the subjective diagnoses of septate uterus by the ASRM criteria and replace the complementary absolute morphometric criteria. However, the clinical value of the ESHRE–ESGE classification in daily practice is difficult to appreciate. The application of the ESHRE–ESGE criteria has resulted in a significantly increased recognition of residual septum after hysteroscopic metroplasty, with a possible risk of overdiagnosis of septate uterus and problems for its management.STUDY DESIGN, SIZE, AND DURATIONA prospective observational study was performed with 261 women consecutively enrolled between June and September 2013.PARTICIPANTS/MATERIALS, SETTING, AND METHODSNon-pregnant women of reproductive age presented for evaluation to a private medical center. A gynecological examination and 3D ultrasonography were performed to assess the anatomy of the uterus, cervix and vagina. Congenital anomalies were diagnosed using the ASRM classification with additional morphometric criteria as well as with the ESHRE–ESGE classification. We compared the frequency and concordance of diagnoses of septate uterus and all congenital malformations of the uterus according to both classifications. The morphological characteristics of septate uterus recognized by both criteria were compared.MAIN RESULTS AND ROLE OF CHANCEOf the 261 patients enrolled in this study, septate uterus was diagnosed in 44 (16.9%) and 16 (6.1%) patients using the ESGE–ESHRE and ASRM criteria, respectively [relative risk (RR)ESHRE–ESGE:ASRM 2.74; 95% confidence interval (CI), 1.6–4.72; P < 0.01]. At least one congenital anomaly were diagnosed in 58 (22.2%) and 43 (16.5%) patients using the ESHRE–ESGE and ASRM classifications (RRESHRE–ESGE:ASRM, 1.35; 95% CI, 0.95–1.92, P = 0.1), respectively. The two criteria had moderate strength of agreement in the diagnosis of septate uterus (κ = 0.45, P < 0.01). There was good agreement in differentiation between anomaly and norm between the two assessment criteria (κ = 0.79, P < 0.01). The percentages of all congenital malformations and results of the differentiation between the anomaly and norm were obtained after excluding the confounding original ESHRE–ESGE criterion of dysmorphic uterus (internal indentation <50% uterine wall thickness). The morphology of septa identified by the ESHRE–ESGE [length of internal fundal indentation (mm): median 10.7; lower–upper quartile, 8.1–20] significantly differed (P < 0.01) from that identified by the ASRM criteria [length of internal fun...

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“…Therefore, in RIF cases without endometrial pathology monopolar electrocoagulation to 1-3 regions was implemented as a standard approach in the study group. Supporting our method, a recent review evaluating hysteroscopic septum resection in infertile patients, suggested electro-surgery with specially designed electrodes fitting to the hysteroscope as a safe method for reproductive functions [27]. Hysteroscopy has been reported to be a positive prognostic factor for women with RIF in order to conceive in the subsequent IVF cycle [5,28].…”

Section: Discussionmentioning

confidence: 90%

Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

Seval

Şükür

Özmen

et al. 2016

Gynecological Endocrinology

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The techniques and outcomes of hysteroscopic metroplasty

Cited by 22 publications

References 55 publications

Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?

Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?

Comparison of the ESHRE-ESGE and ASRM classifications of Mullerian duct anomalies in everyday practice

Does adding endometrial scratching to diagnostic hysteroscopy improve pregnancy rates in women with recurrent in-vitro fertilization failure?

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