reproductive outcome following resection of uterine septum

Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study Gundabattula S, Marakani L, Yanamandra N, Dasari S, Joseph E, Nirmalan P

Hyderabad, India Website : 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

1st 2nd

trimester

trimester

Take home baby

Preresection 169(%)

Post resection 92(%)

102 (60.4)

18 (21.1)

55 (32.5)

13 (15.2)

3 (1.8)

56 (60.8)

100 90 80 70 60 50 40 30 20 10 0

92.89

60.86 Pre resection

36.3

1.8

Post resection

Infertility Outcome  Pregnancy rate 59.3%  Miscarriage 39.1%  Live birth rate 52.2% 70

60

59.3 52.2

50

40

39

Pregnancy rate

30

Miscarriage

20

Live birth rate

10

0

Post resection

Pre-resection Post resection (169) (92)

p Value

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

Term pregnancy IUFD /NND Live birth Take home baby

Pre Post resection resection 92 (%) 169 (%) 2 50 (1.2) (54.34) 7 3 (5.3) (3.6) 7 57 (4.1) (61.9) 3 56 (1.8) (60.8)

p Value p< 0.001 p= 0.75 p< 0.001 p< 0.001

Cervical cerclage – 41 (33%)  Type – McDonald – Shirodkar – Abdominal

35 02 04

 Indication – Prophylactic – Clinically short – Rescue

37 (4 were abdominal) 03 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

Misc Rate

Live Birth

Preg Rate

Misc Rate

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

124

59

39

52

85

33

64

Fernandez Hospital

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