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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% - PowerPoint PPT Presentation
Citation preview
Reproductive Outcome Following Resection of Uterine
Septum : A Retrospective Study
Gundabattula S, Marakani L, Yanamandra N, Dasari S, Joseph E, Nirmalan P
Hyderabad, IndiaWebsite : 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
Pre-resection
169(%)
Post resection
92(%)
1st trimester 102 (60.4)
18 (21.1)
2nd trimester 55 (32.5)
13(15.2)
Take home baby
3 (1.8)
56(60.8) Misc
arriag
e
Take home bab
y0
102030405060708090
100 92.89
1.8
36.3
60.86
Pre resectionPost re-section
Infertility Outcome
Post resection0
10
20
30
40
50
60
7059.3
39
52.2
Pregnancy rateMiscarriageLive birth rate
Pregnancy rate 59.3% Miscarriage 39.1% Live birth rate 52.2%
Pre-resection (169)
Post resection(92)
pValue
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
Preresection
169 (%)Post resection
92 (%)p
Value
Term pregnancy
2(1.2)
50 (54.34)
p< 0.001
IUFD /NND 7 (5.3)
3 (3.6)
p= 0.75
Live birth 7 (4.1)
57 (61.9)
p< 0.001
Take home baby
3 (1.8)
56 (60.8)
p< 0.001
Cervical cerclage – 41 (33%)
Type– McDonald 35– Shirodkar 02– Abdominal 04
Indication– Prophylactic 37 (4 were abdominal)– Clinically short 03– Rescue 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
MiscRate
Live Birth
PregRate
MiscRate
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
Fernandez Hospital 124 59 39 52 85 33 64
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