Septate Uterus Research Articles

Hysteroscopic Fenestration with Precise Incision of the Cavity Septum: A Novel Minimally Invasive Surgery of Complete Septate Uterus with Double Cervix

This study aimed to develop and describe a novel surgical procedure that involves hysteroscopic fenestration with precise incision of the complete uterine septum and double cervix preservation after magnetic resonance imaging (MRI) evaluation in patients and to evaluate its efficacy. A prospective consecutive clinical study. A university teaching hospital. Twenty-four patients with complete septate uterus and double cervix. Three-dimensional reconstruction of uterus was performed with pelvic MRI and three-dimensional SPACE sequence scanning. Hysteroscopic fenestration with precise incision of the cavity septum and double cervix preservation was performed in patients. Three months after operation, follow-up pelvic MRI and second-look hysteroscopy were performed conventionally. Operating time, blood loss, operative complications, MRI and hysteroscopic changes of uterus, symptoms improvement, and reproductive outcomes were assessed. The surgery was successfully completed without any intraoperative complications in all patients. Operating time was 21.71 ± 8.28 minutes (range, 10-40 minutes) and blood loss was 9.92 ± 7.14 mL (range, 5-30 mL). Postoperative MRI showed the uterine anteroposterior diameter (3.66 cm vs 3.92 cm; p <.05) was increased. Postoperative MRI and the second-look hysteroscopy showed the cavity shape and uterine volume were expanded to the normal. Symptoms of dysmenorrhea, abnormal uterine bleeding, and dyspareunia were ameliorated after the surgery in 70% of patients (7 of 10), 60% of patients (3 of 5), and 1 patient, respectively. The preoperative spontaneous abortion rate was 80% (4 of 5) and the postoperative spontaneous abortion rate was 11.11% (1 of 9). After the surgery, there were 2 ongoing pregnancies and 6 pregnancies ended in term births. Two live births were delivered by cesarean section and 4 by vaginal delivery without cervical incompetence during pregnancy. Hysteroscopic fenestration with precise incision of the uterine septum and double cervix preservation is an effective surgical procedure.

Role of Hysteroscopy on Infertility: The Eternal Dilemma

Hysteroscopy is the gold standard tool for endoscopic visualization of the uterine cavity and it assesses a simultaneous detection and treatment of intracavitary anomalies with greater accuracy than other methods. The most common uterine abnormalities, including endometrial polyps, submucosal myomas, uterine septum and intrauterine adhesions, are common in infertile women. It is object of debate whether diagnostic and/or operative hysteroscopy should be considered in the basic work-up of infertile couples.

Expression of concern: “Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: a prospective analysis of 88 cases” [Eur J Obstet Gynecol Reprod Biol. 2011 Mar;155(1):54-7. doi: 10.1016/j.ejogrb.2010.11.015. Epub 2010 Dec 23. PMID: 21185112

This is a note of a temporary expression of concern related to the above-mentioned publication. Following recent issues with the reliability of the data in articles published by some of the authors of this article (See Bordewijk E.M., Wang R., Askie L.M., Gurrin L.C., Thornton J.G., van Wely M., et al. Data integrity of 35 randomised controlled trials in women’ health. Eur J Obstet Gynecol Reprod Biol. 2020; 249: 72-83), the editors decided to open an investigation for this article in the journal. The editors have written to both authors who could not supply original data. The authors have confirmed that they no longer have the raw data as the paper in question was published in 2010. The concern and this note will remain appended to the above-mentioned article, unless the parties provide the editors of European Journal of Obstetrics & Gynecology and Reproductive Biology with the raw data or other data that validates the results of the paper. Determinants of fertility and reproductive success after hysteroscopic septoplasty for women with unexplained primary infertility: a prospective analysis of 88 casesEuropean Journal of Obstetrics and Gynecology and Reproductive BiologyVol. 155Issue 1PreviewTo evaluate prospectively the effect of hysteroscopic septoplasty as therapy for unexplained primary infertility in women with uterine septum as a sole cause for reproductive failure and to define the factors influencing reproductive success. Full-Text PDF

Comparison Between Scissors and Resectoscope in Resection of Uterine Septum

Background: Septate uterus is a common congenital uterine malformation. It is due to abnormal resorption of the Mullerian canal in embryonic life. Poor reproductive outcomes (e.g., abortion and preterm births) are associated with septate uterus.&#x0D; Aim of the work: The present study aimed to compare scissors and resectoscope regarding the efficacy and safety in resection of uterine septum.&#x0D; Patients and Methods: This study was conducted in the outpatient clinic of Al-Azhar University Hospital (New Damietta) from December 2017 to October 2020. Women were assigned into one of the two groups. The first included fifteen women, who underwent septoplasty by scissor and the Group II included fifteen women who were submitted to septoplasty by bipolar resectoscope.&#x0D; Results: Group (I) had a higher pain score in group I than group II with a significant difference. Mild pain was reported in 10 cases (66.7%) in group I and 4 (26.7%) in group II. However, moderate pain was reported for 5 cases (33.3%) and 11 cases (73.3%) in groups I and II, respectively, with a statistically significant difference. However, both groups were comparable regarding patient characteristics, operative data, postoperative complications and postoperative results of hysteroscopy, three months after the resection of the uterine septum.&#x0D; Conclusion: Scissor is preferred over the bipolar resectoscope especially in thin septum. It is associated with comparable outcome to the bipolar resectoscope. However, bipolar resectoscope was associated with significantly higher pain scores than scissors.

The influence of different methods of hysteroscopic metroplasty using a bipolar resectoscope on the restoration of reproductive function in women with a septate uterus

Uterine septum is the most common congenital anomaly of the uterus, accounting for 35% of all diagnosed malformations. Data on the effectiveness of restoring reproductive function in women with a septate uterus after hysteroscopic metroplasty are contradictory, there are no data on the comparison of reproductive results after removal and dissection of the septum using a bipolar hysteroresectoscope. The purpose of the study was to assess the effectiveness of reproductive function recovery after dissection and removal of the uterine septum using a bipolar hysteroresectoscope. Material and methods. 78 patients of group B with uterine septum, reproductive failure, bipolar hysteroscopic metroplasty were under observation. Among the examined patients, 39 suffered from miscarriage and 39 suffered from infertility. 37 women of the BI group underwent hysteroscopic bipolar dissection of the uterine septum; 41 women of the BII group underwent hysteroscopic bipolar resection of the septum. Results and their discussion. Within 2 years after metroplasty, pregnancy occurred in 86.49% of women in the BI group and in 100% of women in the BII group (p&gt;0.05); the specific weight of miscarriages was 9.38% and 0.00%, respectively (p&gt;0.05); childbirth - 58.88% and 70.97% (p&gt;0.05); premature births – 17.65% and 6.45% (p&gt;0.05); term deliveries - 38.24% and 64.52% (p&lt;0.04, SD 0.34 [0.12-0.93]). In women with initial infertility, pregnancy occurred in 61.54% of women in the BI group (n=13) within 2 years after the operation, in 69.23% in the BII group (n=13) (p&gt;0.05); the specific weight of miscarriages was 25.00% and 22.22%, respectively (p&gt;0.05); childbirth - 75.00% and 77.78% (p&gt;0.05); premature births – 12.50% and 11.00% (p&gt;0.05); term deliveries - 62.50% and 66.67% (p&gt;0.05). Analysis of recovery of reproductive function 2 years after surgery in women with initial miscarriage showed that 90.48% of women in the BI group became pregnant, 94.44% in the BII group (p&gt;0.05); the specific weight of miscarriages was 31.58% and 11.76%, respectively (p&gt;0.05); childbirth - 68.42% and 88.24% (p&gt;0.05); premature births – 26.32% and 5.88% (p&gt;0.05); term deliveries - 42.11% and 82.35% (p&lt;0.02, SD 0.16 [0.03-0.73]). Conclusions. The use of the technique of removal of the uterine septum during bipolar hysteroresectoscopy compared to the technique of its dissection in women with a septate uterus and reproductive failure leads to a probable increase in the termination of pregnancy by term delivery both in the general group and in the group of patients with initial miscarriage.

Clinical features of 102 patients with different types of Herlyn-Werner-Wunderlich syndrome.

Herlyn-Werner-Wunderlich syndrome (HWWS) is a rare female genital tract malformation, and there are few large sample studies reported at home and abroad. The clinical manifestations of this syndrome are diverse, and insufficient understanding may delay the diagnosis and treatment of the patients. This study aims to analyze the clinical characteristics of different types of HWWS patients, and to improve the diagnosis and treatment of HWWS. The clinical data of patients with HWWS who were hospitalized in the Department of Obstetrics and Gynecology, Third Xiangya Hospital of Central South University from October 1, 2009 to April 5, 2022 were retrospectively analyzed. The age, medical history, physical examination, imaging examination and treatment of the patients were collected for statistical analysis. The patients were divided into an imperforate oblique vaginal septum type, a perforate oblique vaginal septum type, and an imperforate oblique vaginal septum and cervical fistula type. The clinical characteristics of different types of HWWS patients were compared. A total of 102 HWWS patients were enrolled, with age of 10-46 years old, including 37 (36.27%) patients with type I, 50 (49.02%) type II, and 15 (14.71%) type III. All patients were diagnosed after menarche, with an average age of (20.5±7.4) years. There were significant differences in the age of diagnosis and course of disease among the 3 types of HWWS patients (both P<0.05). Patients with type I had the youngest age of diagnosis [(18.0±6.0) years] and the shortest course of disease (median course of 6 months), while patients with type III had the oldest age of diagnosis [(22.9±9.8) years] and the longest course of disease (median course of 48 months). The main clinical manifestation of type I was dysmenorrhea, and the main clinical manifestation of type II and type III was abnormal vaginal bleeding. Of the 102 patients, 67 (65.69%) patients had double uterus, 33 (32.35%) had septate uterus, and 2 (1.96%) had bicornuate uterus. The vast majority of patients had renal agenesis on the oblique septum, and only 1 patient had renal dysplasia on the oblique septum. The oblique septum located on the left side in 45 (44.12%) patients and on the right side in 57 (55.88%) patients. There were no significant differences in uterine morphology, urinary system malformation, pelvic mass, and oblique septum among the 3 types of HWWS patients (all P>0.05). Six (5.88%) patients had ovarian chocolate cyst, 4 (3.92%) patients had pelvic abscess, and 5 (4.90%) patients had hydrosalpinx. All patients underwent vaginal oblique septum resection. Among them, 42 patients underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen because they had no sexual life history, and the remaining 60 patients underwent traditional oblique vaginal septum resection. Among the 102 patients, 89 patients were followed up for 1 month to 12 years. The symptoms of vaginal oblique septum in 89 patients such as dysmenorrhea, abnormal vaginal bleeding and vaginal discharge were improved after operation. Among the 42 patients who underwent hysteroscopic incision of the oblique vaginal septum without destroying the intact hymen, 25 patients underwent hysteroscopies again 3 months after operation, and there was no obvious scar formation at the oblique septum incision site. Different types of HWWS have different clinical manifestations, but all can be manifested as dysmenorrhea. The patient's uterine morphology can be manifested as double uterus, septate uterus, or bicornuate uterus. The possibility of HWWS should be considered if uterine malformation is combined with renal agenesis. Vaginal oblique septum resection is an effective treatment.

Differences in the anatomical structure of the uterus between fertile and infertile individuals.

Infertility affects a significant portion of the reproductive population and is caused by structural and hormonal factors. The prevalence of congenital uterine anomalies is 3%-4%, with the most common anomaly being septate uterus. However, further research is needed to determine whether these anomalies can cause infertility. In this study, we compared the morphometric parameters of the uterus of fertile and infertile individuals. Based on the data obtained, we aimed to determine the parameters to be evaluated for fertility prediction and to investigate the effect of uterine septum on fertility. The uteruses of 55 infertile and 80 fertile individuals between the age range of 20-45 years were analyzed retrospectively using magnetic resonance images. Infertile individuals were categorized into two groups according to the reasons for infertility: Group I, which included women with congenital uterine anomalies (septate uterus), and Group II, which included women with tubal and male factors. Group III comprised fertile individuals. Uterine length (UL), uterine body length (UbL), cervical length (CxL), uterine cavity length (UcL), anteroposterior diameter (APD), transverse diameter (TD), fundal thickness (FT), and ostial distance (OD) were measured. The uterine positions were examined. The data of uterine variables were evaluated statistically according to age and groups. The mean ages of individuals in Groups I, II, and III were 29.88 ± 6.69, 29.21 ± 4.59, and 27.45 ± 5.43 years, respectively. Significant differences were observed between the groups in terms of UL, UbL, CxL, UcL, APD, FT, and OD variables (p < 0.05), except for TD (p > 0.05). We observed that UL, UcL, length/width ratio, and APD parameters are important factors that influence fertility. Evaluating these parameters before septum resection would be useful in predicting the contribution of this surgical operation to fertility.

Successful pregnancy in the blind hemicavity of Robert’s uterus: a rare case report and brief literature review

BackgroundRobert’s uterus is a rare congenital anomaly, characterized as an asymmetric septate uterus that has a blind hemicavity with unilateral menstrual fluid retention and a unicornuate hemicavity connecting to the cervix unimpededly. Patients with Robert’s uterus generally present with menstrual disorders and dysmenorrhea, and some may have reproductive problems as well, including infertility, recurrent miscarriage, preterm labor and obstetric complications. In this case, we describe a successful pregnancy implanted on the obstructed hemicavity and delivered a liveborn girl. Meanwhile, we highlight diagnostic and therapeutic difficulties in patients with atypical symptoms of Robert’s uterus.Case presentationA 30-year-old Chinese primigravida sought for emergency treatment at 26 weeks and 2 days of gestation because of preterm premature rupture of membranes (PPROM). At the age of 19, the patient was misdiagnosed with hyperprolactinemia and pituitary microadenoma for showing symptom of hypomenorrhea and was suspected to have a uterine septum in the first trimester. She was diagnosed with Robert’s uterus at 22 weeks of gestation by repetitious prenatal transvaginal ultrasonography, which was subsequently confirmed by magnetic resonance imaging. At 26 weeks and 3 days of gestation, the patient was suspected to have oligohydramnion, irregular uterine contraction, and umbilical cord prolapse, and she expressed a strong will of saving the baby. Emergency cesarean delivery was performed and a small hole, together with several weak spots, was found at the lower and back wall of the septum of the patient. The treatment was effective and both the mother and the infant, who had an extremely low birth weight, were discharged in good health conditions.ConclusionsPregnancy in the blind cavity of Robert's uterus with living neonates is incredibly rare. In our case, the favorable outcome may result from the unusual hole found at the septum, which may play a role in communicating amniotic fluid between the two hemicavities so to keep the neonate alive. we highlight the importance of early diagnosis and pre-pregnancy treatment of this uterine malformation, and the timely termination of pregnancy, for improving birth quality and reducing mortality.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Clinical characteristics and offspring developmental malformation of 126 patients with septate uterus.

Step-by-Step Hysteroscopic Treatment of Complete Uterine Septum Associated or Not with Cervical Anomalies

To demonstrate our hysteroscopic technique using the mini-resectoscope for the treatment of complete uterine septum with or without cervical anomalies. A step-by-step video demonstration of the technique with the use of an educational video. We present 3 patients diagnosed as having complete uterine septum (U2b according to the ESHRE/ESGE classification) with or without cervical anomalies (C0, normal cervix; C1, septate cervix; C2, double "normal" cervix"), 2 of them with a longitudinal vaginal septum (V1). The first case is a 33-year-old woman with history of primary infertility diagnosed as having a complete uterine septum with normal cervix (class U2bC0V0 according to the ESHRE/ESGE classification). Case 2 is a 34-year-old woman with infertility and abnormal uterine bleeding, diagnosed as having complete uterine and cervical septum and a partial nonobstructive vaginal septum (class U2bC1V1). Case 3 is a 28-year-old woman with infertility and dyspareunia, diagnosed as having a complete uterine septum, double "normal" cervix, and nonobstructive longitudinal vaginal septum (class U2bC2V1) Still 3. The procedures were performed in a tertiary care university hospital. The 3 procedures were performed in the operative room using a 15 Fr continuous flow mini-resectoscope and bipolar energy with the patient under general anesthesia Still 1 and Still 2. No complications were encountered in any of the 3 cases. After all procedures, a gel based on hyaluronic acid was applied to minimize postoperative adhesion formation. Patients were discharged home the same day of the procedure after a short period of observation. Hysteroscopic treatment of patients with uterine septa associated or not with cervical anomalies using miniaturized instruments is a feasible and effective option for the management of patients with these complex müllerian anomalies.

Delayed Diagnosis of Uterine Septum at Late Pregnancy

Uterine septum is one kind of Müllerian duct anomaly with a prevalence ranging from 2.3% [1, 2]. Some cases are asymptomatic which are incidentally detected on the ultrasound and obstetric surveillance is recommended; others are associated with infertility, recurrent pregnancy loss or preterm labor [3- 5]. Expectant management and serial sonographic scanning are required. Salpingography and three-dimensional ultrasound helps to detect uterine anomalies [6, 7]. Hysteroscopic examination is valuable on the condition of either diagnosis or treatment before pregnancy [8]. However, ultrasonographic diagnosis turn to be difficult due to the septa shielded by the fetus and placenta. Here we present a case of delayed diagnosis of uterine septum developed from 14-33 gestational weeks (GW). The initial impression of the sonographic image interfered our judgment.

Diagnostic Performance of Two-Dimensional Ultrasound, Two-Dimensional Sonohysterography and Three-Dimensional Ultrasound in the Diagnosis of Septate Uterus-A Systematic Review and Meta-Analysis.

The septate uterus is the most common congenital uterine anomaly, and hysteroscopy is the gold standard for diagnosing it. The goal of this meta-analysis is to perform a pooled analysis of the diagnostic performance of two-dimensional transvaginal ultrasonography, two-dimensional transvaginal sonohysterography, three-dimensional transvaginal ultrasound, and three-dimensional transvaginal sonohysterography for the diagnosis of the septate uterus. Studies published between 1990 and 2022 were searched in PubMed, Scopus, and Web of Science. From 897 citations, we selected eighteen studies to include in this meta-analysis. The mean prevalence of uterine septum in this meta-analysis was 27.8%. Pooled sensitivity and specificity were 83% and 99% for two-dimensional transvaginal ultrasonography (ten studies), 94% and 100% for two-dimensional transvaginal sonohysterography (eight studies), and 98% and 100% for three-dimensional transvaginal ultrasound (seven articles), respectively. The diagnostic accuracy of three-dimensional transvaginal sonohysterography was only described in two studies, and we did not calculate the pooled sensitivity and specificity for this method. Three-dimensional transvaginal ultrasound has the best performance capacity for the diagnosis of the septate uterus.

Primary omental pregnancy in a subseptate uterus: A novel case report and literature review

Introduction and Importance: Ectopic pregnancy is defined as a pregnancy in which the fertilized ovum implants itself in a location other than the uterine endometrium. Abdominal ectopic pregnancies involve the implantation and development of the embryo within the peritoneal cavity. Primary omental pregnancies are the rarest form of abdominal pregnancy and possibly the rarest extrauterine gestation. Case Presentation: We report the first case of a primary omental pregnancy in a subseptate uterus in literature. Our patient, a 33-year-old female, G8P4+3, presented with nausea, severe abdominal pain, and vaginal spotting at 6 weeks’ gestational age. She had mild tenderness below the umbilicus, with positive cervical and right adnexal tenderness. 2D-ultrasound revealed a subseptate uterus, normal ovaries and fallopian tubes, absence of a gestational sac, and a 4×3×2.5 cm mass in the right adnexa. A mini-laparotomy was performed due to suspicion of ruptured tubal pregnancy, revealing a primary omental pregnancy which was managed via partial omentectomy. Clinical Discussion: Ectopic pregnancies have ambiguous presentations, however correct diagnosis and management is crucial to prevent complications. A high index of suspicion must be exercised to make an accurate diagnosis of primary omental pregnancy. A subseptate uterus is a subtype of the most common uterine anomaly and should be investigated via 3D-ultrasound and magnetic resonance imaging as it causes increased risk of primary omental implantation. Conclusion: Correct identification of subseptate or septate uteri is vital. Greater research is needed to elucidate the association between septate or subseptate uteri and ectopic pregnancy, particularly primary omental pregnancy.

MRI Imaging in Congenital Mullerian Duct Abnormalities Using New Classification from the American Society of Reproductive Medicine (ASRM MAC2021)

Infertility is a very important issue. One of the causes of fertility disorders is due to congenital abnormalities in the Mullerian ducts. Congenital abnormalities of the Mullerian ducts are deviations from normal anatomy which include the uterus, fallopian tubes and or the upper two-thirds of the vagina originating from the paramesonephric. Mullerian duct anomalies originate from disturbances that occur in the three phases of uterine development starting from organogenesis, fusion, or septal resorption. MRI is an imaging modality with a fairly high level of accuracy, making it an ideal modality in the diagnosis of congenital Mullerian duct anomaly. With the ASRM MAC2021 classification system, it is easier to assess and analyze anatomical structures to diagnose congenital abnormalities of the Mullerian duct. This research is a retrospective descriptive study conducted at RSUD Dr. Soetomo Surabaya and has ethical license. There were 52 subjects in this study who were obtained from 2018-2021. In this study, the frequency according to the ASRM MAC2021 classification with the mullerian agenesis type was 36 patients (69%), cervical agenesis 4 patients (7.6%), unicornuate uterus 3 patients (5.7%), uterus didelphys 5 patients (9.6%), bicornuate uterus 1 patient (1.9%), septate uterus 1 patient (1.9%), longitudinal vaginal septum 1 patient (1.9%), transverse vaginal septum 1 patient(1.9%) %) and complex anomalies 0 patients (0%) from a total of 52 samples. To sharpen and facilitate the evaluation of congenital abnormalities, segmental descriptions are used in the results of the MRI examination.

Successful Reproductive Outcome Following Challenging Surgical Management of Mullerian Anomalies

Background: Mullerian duct anomalies consist of a set of structural malforma-tions of reproductive organ resulting from abnormal development of the paramesonephric or Müllerian ducts. The prevalence of these anomalies ranges from 0.001 to 10% in the general population and from 8-10% in women with an adverse reproductive history. The aim of this study was to diagnose different type of mullerian anomalies and to evaluate the reproductive outcome that occurs as a result of surgical management of malformation of genital tract. Methods: A prospective observational study of mullarian anomalies and its diagnosis &amp; reproductive outcome was observed by using data from women with congenital anomalies attended in OPD either with complains or incidental diagnosis with HSG,during laparoscopy at tertiary care center. Total 100 women with different types of mullarian anomalies were included in study. Results: Most common utero-vaginal anomaly seen in present study was septate uterus with on basis of clinical examination. Out of 100 patient (35)35% were diagnosed mullerian agenesis. Cervico vaginal agenesis (15)15%, Septate uterus 28(28%), Bicornaute uterus 7(7%), Transverse vaginal septum 5 % ,unicornuate 5%, Didelphi’s with longitudinal vaginal septum 2%, Microperforate Hymen 3(3%). Among all patients 26 patients were pregnant. Among primary amenorrhea 35 patient of mullarian agenesis after progressive non-surgical vaginal dilatation 22 patient had no coital difficulty. 5 patients were need vaginoplasty. Among 15 patients of cervicovaginal agenesis 6 become menstruating, 2 were pregnant, 6 patient failed anastomosis, needed total abdominal hysterectomy 3 patients on oral pill. Among 5 transverse vaginal septum, 5 having regular menestration among 2 become pregnant. Among other mullarian anamolies after challenging surgical management 22 patient become pregnant. Conclusion: Present study shows prevalence of congenital malformation of female reproductive tract is 0.83% at our .....

Presenting Three Case Reports of Congenital Vaginal and Complete Uterine Septum with Double Cervix (U2bC2V1) with Different Reproductive Outcomes: Is There a Need for Surgical Treatment?

Congenital uterine anomalies (CUAs) consist of structural disorders of the female genital tract arising as a result of abnormal fusion or resorption of the Müllerian ducts. The prevalence of CUAs is 5.5% in the general population, 8.0% in infertile women, and 13.3% in women with a history of miscarriage. Here, we present three cases of women with complex genital tract anomalies, including cervical duplication and vaginal septum with different reproductive outcomes. A complete uterine septum with double functional cervix may have a wide spectrum of reproductive outcomes: from completely normal conception and pregnancy to infertility and recurrent pregnancy losses. In these cases, we advised patients to complete their evaluation by undergoing hysteroscopy, to provide reliable information for the anatomical status of the cervix, tubal ostia, and, especially, the uterine cavity. In cases of infertility or recurrent miscarriages, the dilemma is whether to proceed with the resection of the uterine septum in combination with the resection of vaginal one. We suggest that among women with this type of CUAs, surgical treatment should be offered. Further evidence from larger population studies is needed as the risks of surgical treatment cannot be disregarded.

Efficacy of hysteroscopic septum resection in infertile women: a single center experience

Introduction We aimed to reveal the effectiveness of hysteroscopic septum resection on the reproductive outcomes of infertile patients. Material and methods We included 46 infertile women who underwent hysteroscopic septum resection of septate uterus (complete: group 1, n = 21; incomplete: group 2, n = 25). Only patients with a septate uterus as the cause of infertility were included in the study. Patients’ age, body mass, duration of infertility, type of infertility, duration of surgery, surgical complications, remnant septa, and postoperative reproductive results were recorded. Results Preoperative abortion was found to be nine (42.9%) in group 1 and 15 (60.0%) in group 2. In the postoperative control HSG, remnant septa was found to be significantly higher in group 1 compared to group 2 (three patients or 14.3% and 0%, respectively). Pregnancy was detected in 13 patients (61.9%) in group 1 and 18 patients (72%) in group 2 at the postsurgical follow-up. Abortion occurred for two patients (9.5%) in group 1 and three patients (12%) in group 2. Conclusion We obtained positive growth results after hysteroscopic septum resection in both the complete and incomplete cases. However, we found that the duration of surgery was prolonged and the rate of remnant septa increased in cases with a complete septum.

Evaluation of the Success of Hysteroscopic Uterine Septum Resection.

The aim is to use three-dimensional transvaginal ultrasonography (3-D TVUS) to evaluate the success of hysteroscopic metroplasty for the uterine septum and to compare the pregnancy outcomes. Thirty-eight patients with uterine septum who had hysteroscopic uterine septum resection were recruited. Preoperative 3-D TVUS measurements of the septal apex to the uterine fundus (s1), septal apex to internal os distance (s2), and intercornual distance (s3) were compared with the postoperative values. The pregnancies of the patients were followed up for a year postoperative period. Out of the 38 patients, thirty-five had partial uterine septum (class U2a), while 3 patients had complete uterine septum (class U2b). Eighteen (47.36%) of the patients who underwent uterine septum resection achieved pregnancy, and thirteen of these pregnancies were (72.2%) term pregnancies, and all term pregnancies resulted in a live birth. Natural conception was achieved in 77.7% (14 of 18) of the patients. Term pregnancy occurred in 68.7% (11 of 16) of the patients with a partial septum and in 66.6% (2 of 3) of the patients with a complete uterine septum. A comparison of the 3-D TVUS measurements of the uterus pre- and postoperatively showed a decrease in s1 and an increase in s2 (P < 0.05). The uterine cavity length of pregnant patients was found to be higher than nonpregnant patients (P < 0.05). Reproductive results of hysteroscopic metroplasty were favorable in achieving live and term birth. three-dimensional TVUS can be preferred as a noninvasive effective method in objective evaluation of the success of the hysteroscopic surgery.

Surgical Management of Mullerian Development Anomalies: 5 Years’ Experience of a Tertiary Care Center

Maldevelopment of the mullerian duct occurs in variety of forms and each anomaly is distinctive. This study was conducted to study clinical profile of patient with mullarian anomalies, different modalities used in diagnosis, and surgery performed to patients with mullerian duct anomalies. This was retrospective study of 23 patients who underwent surgery for different mullerian duct anomalies in last 5 years. There presenting problem, diagnostic modalities used, types of anomalies, other associated anomalies and different surgical management were evaluated. As per American Fertility society 6 patients belong to class I, 12 in class II and 5 in class III. Most of patients with Mayer Rokitansky Kuster Hauser (MRKH) syndrome had primary amenorrhea, patient of vaginal septum usually presents with cyclical abdominal pain, primary subfertility or dyspareunia. Patients with septate uterus had recurrent abortion 2D Ultrasonography (USG), Magnetic Resonance imaging (MRI) and hysteroscopy were modalities used for diagnosis of these defects. Patient of MRKH syndrome and vaginal agnesis were managed with vaginoplasty using amnion graft. Patients with septate uterus were managed with hysteroscopic septal resection. Septum resection was performed in all patients with transverse vaginal septum. Uterine anomalies are different groups of malformations with a broad spectrum of presentations. Management of each anomaly is individualized depending on the symptoms and fertility concerns.

CONGENITAL UTERINE ANOMALIES OBSERVED IN PREGNANT FEMALES PRESENTING AT PUBLIC SECTOR GOVERNMENT MATERNITY HOSPITAL OF PESHAWAR, KHYBER PAKHTUNKHWA

Objectives: The objective of current study is to fi nd out the prevalence and types of the uterineanomalies in the pregnant patients in our population of Khyber Pakhtunkhwa.Materials and Methods: This was a descriptive study carried out in a public sector maternityhospital of Peshawar. A total of 834 pregnant ladies fulfi lling the inclusion criteria were admittedinthe hospital during the aforementioned time period for delivery. All patients were examinedpervaginum and also ultrasound examinations were performed. The normal anteverted positionoranomalous retroverted positions of uterus along with other anomalies like septate uterus andindented uterine fundus were recorded by ultrasonography.Results: Out of 834 cases 108 cases were delivered by cesarean section while 726 cases weredelivered by normal vaginal delivery. The number of uterine anomalies were recorded. It was foundthat out of 834 patients, there was one patient (0.11%) having septate uterus. There wasanothersingle case of indented uterine fundus (0.11%) which was discovered accidentally duringcesareansection. The indication for surgery was transverse lie of the fetus. Two out of 834 caseswere foundto be having retroverted uteri. They were found to be having retroverted uteri (0.23%)during theirroutine ultrasonographic examination.