Anatomical changes after hysteroscopic transcervical uterine septum resection—is there a place for hysterography?

Abstract

The anatomical changes of the uterine cavity after transcervical septum resection are reported. We measured the distance between the apices of the uterine horns and the extent of the uterine septum before and after the hysteroscopic resection of the septum. We calculated the index of the uterine cavity as a distance in millimeters between the uterine horns divided by the length of the uterine septum multiplied by 100. The retrospective study was performed in 43 women with transcervical uterine septum resection treated between 1999–2002 by the Institute for the Care of Mother and Child of Prague and the Institute for Postgraduate Medical Education of Prague. Hysteroscopic resection of the uterine septum with evaluation of the surgical effect by hysterography was indicated pre- and postoperatively. For many years, hysteroscopic transcervical uterine septum resection has been a method of choice in the treatment of congenital uterine malformations. We operated on 43 women and achieved 27 intrauterine pregnancies (62.8%), including 4 spontaneous abortions (14.8%). The aim of our study was to evaluate the changes of the uterine cavity after resectoscopic surgery and find out if there is any correlation between residual septum and pregnancy outcome. The uterine cavity index was measured and calculated from hysterograms. Diagnostic hysterography was performed before and 2–3 months after surgery. The results showed significant changes of the calculated ratio before and after surgery. When the above-mentioned ratio is 10% or less, reproductive failure is not expected. There is a higher incidence of spontaneous abortion when the ratio is more than 10%. Therefore, especially in difficult cases of uterine septum resection (e.g., hypoplastic septate uterus, repeat pregnancy loss or failure after surgery), postoperative evaluation of the uterine cavity is feasible.