Treatment of twenty-two patients with complete uterine and vaginal septum.

STUDY OBJECTIVE

To assess the fertility and obstetric outcome after surgical treatment of complete uterine and vaginal septum.

DESIGN

Retrospective study (Canadian Task Force Classification II-2).

SETTING

Teaching hospital in France.

PATIENTS

Twenty-two women who have experienced infertility, pregnancy losses, dyspareunia, or dysmenorrhea.

INTERVENTION

Hysteroscopic section of complete uterine septum and resection of longitudinal vaginal septum.

MEASUREMENTS AND MAIN RESULTS

Improvement of dyspareunia or dysmenorrhea and obstetric outcome, focusing on the miscarriage rate, obstetric complications, and the gestational age at delivery were assessed. Overall, 20 women had conceived a total of 37 pregnancies, with 10 and 8 deliveries before and after metroplasty, respectively. Median gestational age at delivery was not significantly different in both groups (36.5 [33-39.5] vs 38.0 weeks' gestation [35-40], respectively). Preterm delivery occurred in 4 cases (25%) before the surgery and in 3 cases (14%) after (p = .44). The live birth rate was also not significantly different before and after surgery (62.5% and 38%, respectively) (p = .19). There was a decrease of caesarean section and significantly fewer breech deliveries after metroplasty (p = .01). A decrease in the prevalence of dyspareunia or dysmenorrhea was observed after metroplasty in the 19 patients originally displaying these symptoms. No perioperative complications were observed in this series.

CONCLUSION

Resection of vaginal septum and hysteroscopic metroplasty for complete uterine septum with resection of the cervical septum is a safe procedure that may improve dyspareunia and dysmenorrhea when present. Reproductive and obstetric outcomes after this procedure do not appear to be compromised, even though a relatively high miscarriage rate remains after metroplasty, questioning its systematic practice in symptom-free women without any previous obstetric history.