Surgical and reproductive outcomes of hysteroscopic metroplasty for complete septate uterus with or without associated cervical anomalies and/or vaginal septa.

STUDY OBJECTIVE

To evaluate surgical outcomes of hysteroscopic metroplasty for complete uterine septa with or without associated cervical anomalies and/or vaginal septa, and to compare reproductive outcomes to determine if the presence of these anomalies affects surgical success and fertility outcomes.

DESIGN

multicentre retrospective observational study.

SETTING

2 university affiliated hospitals in Italy.

PARTICIPANTS

The study cohort comprised patients with history of primary infertility, recurrent pregnancy loss or severe preterm birth with complete uterine septum with or without cervical and/or vaginal septa anomalies diagnosed on 3D transvaginal ultrasound and hysteroscopy for which they had hysteroscopic metroplasty between January 2020 and May 2023 in either of the 2 participating centres.

INTERVENTIONS

hysteroscopic metroplasty performed in the operating room under general or loco-regional anesthesia, using either miniaturized instruments (5Fr electrodes or 15Fr bipolar resectoscope) or 27Fr bipolar resectoscopes followed by application of auto-cross-linked hyaluronic acid gel for the prevention of post-operative adhesions.

MEASUREMENTS AND MAIN RESULTS

A total of 101 patients were included in our study. We collected perioperative outcomes including operative time, operative complications, ease of the procedure and need for a repeat resection for residual septum. We also explored reproductive outcomes including clinical pregnancy, live birth and miscarriage rates. All surgical procedures were successfully performed without any significant complications. Operative time was shorter and procedures were reported to be easier in patients without cervical anomalies (U2bC0V0). A second surgical resection was required in most cases regardless of the presence of cervical abnormalities. Reproductive outcomes were available for 66 (65.3 %) patients and there were no significant differences in reproductive outcomes between patients with and without cervical/vaginal anomalies.

CONCLUSION

Hysteroscopic metroplasty for complete uterine septum, with or without cervical/vaginal abnormalities is effective and safe. The presence of cervical anomalies doesn't seem to affect the need for a second resection or reproductive outcomes.