A study of surgical intervention for septate uterus as a cause of recurrent miscarriage

Abstract

Septate uterus is considered to be a major cause of recurrent miscarriage.As surgical interventions for septate uterus, both-abdominal (the Jones operation) and hysteroscopic metroplasty (HM) have been utilized. We have introduced laparoscopic approach (laparoscopically-assisted Jones, LAJ) which is less invasive than conventional laparotomic metroplasty.We performed a clinical study to evaluate LAJ and HM for the surgical treatment of septate uterus. Retorospective cohort study. We retrospectively evaluated 32 patients in whom septate uterus was considered a major cause of their recurrent miscarriage. 11 and 21 patients underwent LAJ and HM, respectively. We compared characteristics of the surgery, residual uterine septum rate, pregnancy rate, abortion rate, and live birth rate between the two groups. Between the LAJ and HM groups, no significant differences were observed in age, number of abortions, and depth of the septum. Operative time, blood loss and length of hospital stay were all significantly lower in the HM group than in the LAJ group. The residual uterine septum rate was significantly lower in the LAJ group than in the HM group (LAJ 9.5±9.0% vs HM 21±7.8%; p=0.001). Regarding the interval until the next pregnancy after surgery, the LAJ group tended to have a shorter interval than the HM group (9.3±3.2 months vs 17.0±15.0 months; p=0.142), but no significant difference was found between the groups in the pregnancy rate (81.8% vs 62.5%; p=0.298), abortion rate (11.1% vs 25.0%; p=0.48) or live birth rate (81.8% vs 72.7%; p=0.631). HM is less invasive than LAJ. Regarding pregnancy prognosis after surgery, HM is equivalent to LAJ. In the future, it is likely that HM will be increasingly selected as the surgical procedure of choice for treatment of septate uterus. However, from the point of view of pregnancy prognosis, further investigation is needed to elucidate surgical technique and indication criteria in HM.