Hospital Universitario Doce de Octubre (Dr. Carrera).
Hospital General Universitario Gregorio Marañón (Drs. Millan and Caballero).
J Minim Invasive Gynecol. 2022 Apr;29(4):465-475. doi: 10.1016/j.jmig.2021.10.001. Epub 2021 Oct 11.
The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes.
A systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, 'cesarean delivery, and fetal malpresentation.
Studies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus.
TABULATION, INTEGRATION, AND RESULTS: The systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22-0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03-0.78), OR = 0.36 (95% CI, 0.19-0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20-1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11-0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16-0.65).
The results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.
本系统评价和荟萃分析旨在评估宫腔镜子宫整形术对既往不孕或不良产科结局患者的不良生殖结局（如流产、早产和胎儿胎位不正）的影响。
从每个数据库的创建到 2021 年 4 月进行了系统的电子搜索，包括以下数据库：PubMed-MEDLINE、EMBASE、Web of Science、The Cochrane Library、CGF 专门注册的对照试验、Google Scholar 和试验登记处。使用了以下关键词的组合：子宫纵隔、纵隔子宫、先天性子宫畸形、2 类子宫、5 类子宫、子宫整形术、宫腔镜、妊娠、临床妊娠、持续妊娠、流产、活产、早产、剖宫产、剖宫产分娩和胎儿胎位不正。
纳入比较宫腔镜子宫纵隔切除术和期待治疗的女性生殖结局的研究。合格人群包括不孕妇女、产科病史不良的妇女、或无既往妊娠失败和诊断为纵隔子宫的妇女。
列表、整合和结果：系统的电子搜索检索到 1076 项研究；消除重复项后，筛选了 688 个标题和摘要，并对 55 项进行了资格评估。11 项研究纳入了定量综合分析：一项随机对照试验和 10 项观察性研究涉及 1589 例完全或部分子宫纵隔患者的生殖结局。流产的汇总 OR 为 0.45（95%CI，0.22-0.90）。当根据隔膜类型进行亚组分析时，完全隔膜亚组的汇总 OR 为 0.16（95%CI，0.03-0.78），部分隔膜亚组的 OR 为 0.36（95%CI，0.19-0.71），而那些未区分完全或部分隔膜的研究则为 0.58（95%CI，0.20-1.67）。两组在临床妊娠、足月活产或剖宫产风险的 OR 无显著差异。行部分纵隔切除术的患者早产频率显著降低（OR=0.30，95%CI，0.11-0.79）。在完全隔膜患者或未区分部分或完全隔膜的研究中均未发现这一差异。胎儿胎位不正的风险也显著降低（OR=0.32，95%CI，0.16-0.65）。
本荟萃分析的结果支持宫腔镜子宫整形术可有效降低完全或部分子宫纵隔患者的流产风险，尽管这些数据需要通过精心设计的随机对照试验来证实。
