Surgical and Reproductive Outcomes in Patients with Complete Septate Uterus and Cervical Anomalies after Metroplasty

Abstract

<h3>Study Objective</h3> to evaluate surgical and reproductive outcomes in patients with complete uterine septa with or without cervical anomalies undergone hysteroscopic metroplasty. <h3>Design</h3> Multicenter prospective observational cohort study. <h3>Setting</h3> Gynecological departments of participating centers. <h3>Patients or Participants</h3> 64 infertile women with ultrasonographic and hysteroscopic diagnosis of complete septate uterus with or without cervical anomalies (group A: U2bC1 + U2bC2 (n=34); group B (n=30): U2bC0 according to ESHRE/ESGE classification system) from January 2018 to December 2021. <h3>Interventions</h3> in-patient hysteroscopic metroplasty with 26Fr or 15Fr resectoscope or 5mm hysteroscope with 5Fr instruments; a second surgical step was performed when at postsurgical 3D ultrasonography a residual septum was detected (Y + Z > 15 mm). <h3>Measurements and Main Results</h3> Surgical outcomes (operative times; intra- and post-operative complications; surgical satisfaction); Reproductive outcomes (clinical pregnancy rate [CPR], live birth rate [LBR], miscarriage rate [MR]). All the surgical procedures were performed without any significant complication. 18/27 (67%) patients in group A and 9/18 (50%) in group B required a second surgical step. Operative times were statistically lower in group B (12.4 min ± 2 SD vs 27min ± 8 SD, p-value:0.034); less surgical difficulty was reported by clinicians in group B. Reproductive outcomes were evaluated for 36 patients (mean follow-up 20 months) and have shown significant differences between two groups; indeed, CPR was 36% in group A and 64% in group B (p. value 0.01). <h3>Conclusion</h3> Hysteroscopic metroplasty is an effective and safe procedure for the treatment of complete septate uterus with or without cervical abnormalities; a second surgical step is often required for the optimal treatment of these anomalies. Surgical outcomes are better in the group of patients without cervical anomalies, regardless of the instrumentation used. The presence of cervical anomalies seems to significantly affect reproductive outcomes.