Septate Uterus Research Articles

Identification of Factors Contributing to Primary Female Subfertility by Diagnostic Hystero-Laparoscopy: An Experience of Private Hospital

Background: Management of subfertility is influenced by the diagnosis of its causative factor. Combined diagnostic hystero-laparoscopy has emerged as an effective procedure in identifying causative factors of female subfertility. Objectives: This study aimed to identify contributory factors to primary female subfertility by diagnostic hystero-laparoscopy. Methods: This descriptive study was conducted at the Department of Obstetrics and Gynecology of Hameed Latif hospital, Lahore, Pakistan from December 2021 to May 2022. Data was collected from 344 women with female primary subfertility, undergoing combined diagnostic hystero-laparascopy. All the demographic data along with identified causative factors (tubal blockade, cervical Os stenosis, endometrial polyp, uterine septum, uterine fibroid, endometriosis, peri tubal adhesions and polycystic ovaries) during the procedure were recorded in predesigned study proforma. Data were analyzed through SPSS software 23. Results: Mean age of the patients was 25±5.0 years and the mean duration of subfertility was 3.8+0.55 years. Two hundred and eighty-four (82.56%) patients had abnormal findings, while sixty (17.44%) had normal findings. Out of 284 patients, 94(34%) had one identified factor, while 190 (66%) patients had two or more identified factors for primary subfertility. Polycystic ovaries were seen in 128(37.21%) patients, followed by tubal blockade in 81(23.54%), peri tubal adhesions/hydrosalpinx in 58(16.86%) patients. Conclusions: Diagnostic hystero-laparoscopy is an effective diagnostic procedure for the evaluation of female factor subfertility and may be helpful to gynecologists in devising further management plans.

Complete Uterine Septum, Double Cervix and Vaginal Septum (U2b C2 V1): Hysteroscopic Management and Fertility Outcomes—A Systematic Review

complete uterine septum, double cervix and vaginal septum is a rare complex Müllerian anomaly affecting patients' quality of life in terms of fertility and pelvic pain. The aim of our review is to gather the studies concerning the diagnosis and treatment this complex malformation and to describe the related fertility outcomes. this study was conducted in 2022, according to the criteria of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and the protocol was submitted to the International Prospective Register for Systematic Reviews (PROSPERO). PubMed, Scopus and Web of Science electronic databases were searched to find eligible articles. In total, 538 articles were identified through literature research. A total of ten articles satisfied the eligibility criteria and were included in the systematic review. 86 affected women were evaluated, and 71 of them were treated. Almost all patients included in our research presented with primary infertility or with a history of recurrent miscarriages; half of all patients also reported dyspareunia. After surgical treatment, 47 pregnancies were achieved: 41 live birth and ongoing pregnancies and six spontaneous miscarriages occurred; a significantly lower miscarriage rate was reported after surgical treatment. hysteroscopic treatment of U2b C2 V1 anomaly can be safely performed, leading to favorable fertility outcomes, measured as the achievement of pregnancy and a reduction in miscarriage rate.

Does Hysteroscopic Dissection of Partial Uterine Septum Represent a Risk Factor for Placental Abnormalities in Subsequent Pregnancy Compared with Controls Undergoing Other Hysteroscopic Surgery? Results from a Large Case–Control Analysis

Hysteroscopic septum dissection (HSD) is thought to improve fertility and pregnancy outcomes. However, the available literature suggests that uterine surgery can cause placental abnormalities in subsequent pregnancies. A case-control study was performed at the University Medical Center of Ljubljana, Department of Human Reproduction, from 1 January 2016 to 31 December 2018. The primary outcome was the association between HSD and the occurrence of placental abnormalities. We included women who underwent HSD due to infertility. Age-matched women who underwent hysteroscopic surgery for other issues were considered as controls. In addition, we divided the groups according to conception method. Only singleton pregnancies and first delivery were considered. A total of 1286 women (746 who underwent HSD and 540 controls) were included in the analysis. HSD had no influence on placental abnormalities since the ratio was comparable regardless of the method of conception (113/746 vs. 69/540; p = 0.515). Infertile women who conceived naturally after HSD had a normal placentation rate comparable to women who did not undergo HSD (380/427 vs. 280/312; p = 0.2104). The rate of placental abnormalities in women who achieved pregnancy with IVF/ICSI procedures following HSD was comparable to that of women who did not undergo HSD (52/319 vs. 33/228; p = 0.5478). Placenta previa occurred significantly more often in infertile women without HSD after IVF/ICSI compared to natural conception (2/312 vs. 7/228; p = 0.0401). HSD was not associated with higher rate of placental abnormalities in the first singleton pregnancy compared with other hysteroscopic procedures. A higher rate of placenta previa in pregnancies following IVF/ICSI procedures, which was shown by our research, is corroborated by previous research findings.

A case of uterine rupture in second term delivery after septum resection

Introduction: The decision to resect a uterine septum remains individualized. Hysteroscopic approach is the gold standard for uterine septum resection. Uterine rupture in subsequent pregnancy is a known but rare complication without identified methods of prevention. Case Report: A 32-year-old woman underwent uncomplicated hysteroscopic uterine septum resection followed by uncomplicated term vaginal delivery, with uterine rupture and intrauterine fetal demise at 38 weeks gestational age in the subsequent pregnancy. Conclusion: Term uterine rupture is possible when the only history of uterine surgery is hysteroscopic septum resection, even with an intervening delivery. Providers should have a low threshold to initiate diagnostic evaluation with fetal or maternal distress in pregnancy after any uterine surgery. Modifiable risk factors for uterine rupture after septum resection may include residual septa, short interval between surgery and pregnancy, and labor induction methodology. Providers should consider these factors when counseling regarding the risks and benefits of resection.

Reproductive Outcome in Women with different Types of Congenital Uterine Anomalies

Introduction: Mullerian ducts are the primordial analogue of female genital tract. They differentiate to form the fallopian tubes, uterine body, cervix and upper part of the vagina. A wide variety of malformation occur when this system is disrupted. The range from uterine agenesis, duplication of uterus to minor cavity abnormalities. All these congenital anomalies have been implicated as a potential cause for impaired reproductive outcome. Our aim was to evaluate the association between different types of congenital anomaly and various reproductive outcome. Material & Methods: This cross sectional descriptive study was conducted at the Department of gynae and obstetrics in Dhaka Medical College and Hospital (DMCH), Ad-din Women’s Medical College and Hospital and Gonoshasthaya Samaj Vittik Medical College and Hospital during the period of March 2012 to September 2022.The study subjects were women with uterine anomalies who were diagnosed during evaluation of causes for bad obstetric history, during infertility work up or incidental findings during antenatal investigations or during Carsarian section . Reproductive outcomes were observed in the form of infertility, miscarriage, preterm delivery, ectopic pregnancy, intra uterine growth retardation (IUGR) and post-partum haemorrhage (PPH). These were recorded in a standard research questionnaire. Data were analyzed regarding types of uterine anomalies and their reproductive performance. Results: During the study period total 84 patients were recruited with uterine anomalies. Regarding distributions of uterine anomalies in study subjects the most common uterine anomaly was bicornuate uterus (n-32,38%), followed by arcuate uterus (n-18,21%), septate uterus (n-16,19%), unicornuate uterus (n-12,14%), and uterine didelphys (n-6,7. 1%).Women with bicornuate uterus was associated with miscarriage (37.25%), term delivery (31.25%) and preterm delivery (25%). Therefore, bicornuate uterus was found more evident with miscarriage. Only two cases of ectopic pregnancy were observed in the study which was found with bicornuate uterus. And in arcuate uterus percentage of preterm delivery was 44.4%, term delivery 33.3%, miscarriage only 22.2%. Therefore, arcuate uterus was more associated with preterm delivery. In septate uterus miscarriage was maximum (37.5%) followed byl term and pre term delivery, 12.5% each We found 12 cases of unicornuateuterus, where pregnancy continued to term in 6(50%) cases,2 aborted and 4(33.3)were delivered before term. Infertility was more associated with canalization defect, 6 cases with septate and 2 with didelphys uterus. Among live births (preterm and term deliveries,) malpresentation (breech, transverse) was more common in bicornuate uterus (44%).PPh was found in 2 cases of didelphys and two of bicornuate uterus. One case of septate and one from bicornuate uterus were associated with IUGR. Conclusion: The study makes clear that congenital uterine anomaly is associated with poor reproductive outcome. The exact effect is dependent on the type of anomaly.

Treatment of septate uterus.

Although there is insufficient evidence supporting the link between septate uterus and infertility, there are many studies demonstrated the effect of spetal incision on pregnancy in women diagnosed with septate uterus associated with infertility. Hysteroscopic metroplasty can significantly improve the reproductive performance of those with septate uterus. Some Müllerian malformations can be healed by surgery. The accurate diagnosis and appropriate therapeutic approch are fundamental for successful treatment. Any attempt at surgical correction of uterine abnormalities must be aimed at preserving or improving reproductive function. Among congenital uterine anomalies, septate uterus is the most amenable to simple hysteroscopic treatment. The resection of the septum is performed as standard treatment worldwide.

Diagnosis of septate uterus.

The septate uterus is the most common structural uterine anomalies and it is associated with the poor reproductive outcome. It is believed to be the result of the failure in resorption of the tissue connecting the 2 paramesonephric ducts prior to the 20th embryonic week. The true prevalence of uterine septum is difficult to ascertain, as many uterine septal defects are asymptomatic. The septate uterus is usually diagnosed during an infertility evaluation and affects reproductive health by impairing fertility and increasing adverse pregnancy outcomes. The variations in uterine and cervical/vaginal anomalies collectively referred to as Müllerian anomalies. No consistent gold standard for the diagnosis of Müllerian anomalies exists. The preferred diagnostic method for Müllerian anomalies is two-dimensional ultrasound, other methods such as three-dimensional ultrasound, magnetic resonance imaging, hysterosalpingo contrast sonography, hysterosalpingography, hysteroscopy, and laparoscopy are also used to improve accuracy.

Septum Resection Prior to In Vitro Fertilization-Embryo Transfer: A Retrospective Controlled Study.

To investigate the effectiveness of surgery for septate uterus in infertile patients before in vitro fertilization-embryo transfer (IVF-ET). The data of 937 infertile patients with septate uterus and achieved singleton pregnancy after IVF-ET from January 2014 to December 2015 were retrospectively analyzed. Thousand five hundred seventy-eight infertile patients with a normal uterus who achieved singleton pregnancy during the same period were selected as the control group. Patients with septate uterus were divided into two groups according to whether the septum was resected. The pregnancy and perinatal outcomes of the surgical group and the nonsurgical group were compared with the control group. The secondary infertility patients who were surgically corrected septa were also chosen as self-controls and an analysis was performed on their fertility outcomes pre- and post-surgery. Compared with the control group, the surgical group had increased rates of early miscarriage, preterm delivery, and low birthweight and a significantly reduced live birth rate (P < .05). The outcomes of the nonsurgical and control groups were similar. Using secondary infertility patients who were surgically corrected septa as self-controls, after surgery, the rates of miscarriage and ectopic pregnancy were significantly lower and the live birth rate was significantly higher (P ≤ .001); however, perinatal mortality was not significantly different before and after surgery. Patients with a septum depth greater than 10 mm or 5-10 mm associated with a history of unexplained recurrent miscarriage, IVF failure, or infertility might benefit from resection of the uterine septum with hysteroscopic metroplasty.

REPRODUCTIVE OUTCOME IN WOMEN HAVING CONGENITAL UTERINE ANOMALIES: A RETROSPECTIVE STUDY

Background: Congenital uterine anomalies result from failure of or incomplete development, fusion or canalisation of one or both Mullerian ducts during foetal life. [1] These anomalies are often asymptomatic and unrecognized, until menarche or starting of reproductive life. The spectrum of uterine anomalies ranges from an arcuate uterus, uterine didelphys , unicornuate , bicornuate, t-shaped and septate uterus.[3] Pregnancy occurs in many women despite these anomalies. The complication rates with pregnancy are considerably increased; complications include intrauterine fetal growth restriction, fetal malposition, preterm labor, preterm premature rupture of membrane and malpresentation (breech) [21]. Not surprisingly, the rate of caesarean delivery is markedly higher. [4] Thus we want to conduct a systematic review to evaluate the association between the different subtypes of uterine anomaly and various clinical presentations and reproductive outcomes. This study was carried out retrospectively in 52 patients Method: that were in the age group of 12-38 years and having congenital uterine anomalies and presenting with either primary or secondary infertility / amenorrhoea, bad obstetrical history, recurrent abortions, preterm deliveries and ectopic pregnancies using consecutive sampling. All patients were evaluated and investigated further including reproductive &amp; perinatal outcome. Data were analyzed regarding type of uterine anomalies and their reproductive performance. Results &amp; Conclusion: Results of study shows that patients with uterine anomalies have higher rates of reproductive loss, preterm deliveries, that increase obstetric intervention and perinatal mortality.

NONCARDIOGENIC PULMONARY EDEMA AS SEQUEL OF VENOUS AIR EMBOLISM IN A CASE OF OPERATIVE HYSTEROSCOPY – A CASE REPORT.

Hysteroscopy is minimally invasive procedure performed widely for diagnosis and treatment of intrauterine and endocervical pathologies.Venous air embolism,though rare complication,is catastrophic if encountered.We report one such case of venous air embolism leading to non-cardiogenic pulmonary edema encountered by us during hysteroscopic uterine septum resection done for infertility under general anaesthesia.Quick identification,preventing further gas entry and timely intervention saved our patient.

Endometrial Serous Adenocarcinoma with Septate Uterus: A Rare Case Report

Abstract Introduction/Objective Congenital structural malformations of the uterus rarely coincide with uterine malignancies and can cause significant challenges to the detection of tumors originating from the uterine cavity. We report a case of delayed diagnosis of endometrial high-grade serous adenocarcinoma following an initial false-negative endometrial biopsy result. A septate uterus was discovered incidentally upon gross dissection, and it was recognized as the cause of the initial false-negative biopsy result. Exceptionally rare cases of uterine malformation combined with carcinoma have been reported in the literature and we are sharing this case to provide further awareness of such clinical scenario. Methods/Case Report A 67- year-old multigravida (G3P2103) female presented with postmenopausal bleeding. Initially, the patient underwent an endometrial biopsy revealing strips of benign glandular epithelium. Three months later endometrial biopsy showed high-grade serous carcinoma. A computed tomography scan (CT) of the abdomen and pelvis showed expanded and heterogeneously hypodense endometrium. The patient underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy. Gross examination of the specimen revealed a septate uterus with two cavities. Within the right cavity, there was an infiltrating polypoid mass and a superficial benign-appearing endometrial polyp was identified in the left cavity. After histologic examination of the right cavity mass, a diagnosis of endometrial high-grade serous adenocarcinoma was rendered. Results (if a Case Study enter NA) N/A Conclusion Congenital structural malformations of the uterus carry a higher risk of delayed or missed uterine cancer diagnosis. Septate uterus is associated with a higher chance of failed endometrial biopsy and can result in a false- negative outcome. The use of hysteroscopy, hysterosonography, and three-dimensional ultrasound could improve the diagnostic modality of malignant uterine tumors associated with structural malformations.

Uterine rupture in labor following perforation during operative hysteroscopy-a case report and review of literature

Background: Hysteroscopic surgeries have become the standard treatment for uterine septa, synechiae, submucous myomas and endometrial polyps. It is considered a safe procedure: the incidence of surgical complications, including uterine perforation, is low (0.95% - 2.7%). Uterine rupture secondary to operative hysteroscopy is rare but potentially catastrophic. It can occur both before the onset of labor or during labor, severely compromising fetal and maternal outcomes. An operative hysteroscopy for retained placenta done one month after a normal vaginal delivery was complicated by a fundal uterine perforation whilst the removal of the abnormal tissue. The perforation was assessed laparoscopically and minimal bleeding was electrocoagulated. The patient was counseled that this complication should not affect future deliveries. In her subsequent pregnancy, an emergency cesarean hysterectomy was performed during advanced labor due to cornua-to-cornua fundal uterine rupture. Conclusion: There are many potential risk factors for uterine rupture in pregnancy. While previous cesarean delivery is the most well-known, prior complex hysteroscopy appears to also be a risk factor. While the exact relative risk is still unclear we feel that patients undergoing hysteroscopy for uterine septum and cases complicated by fundal uterine perforation during hysteroscopy must be informed about the risk of future uterine rupture, both during labor and during pregnancy. Out: We then summarize previous literature regarding hysteroscopy and uterine rupture focusing on risk factors such as surgery for uterine septum, use of electrocautery and uterine perforation. The Time interval between hysteroscopy and pregnancy does not appear to be a risk factor. Precis: Operative hysteroscopy complicated by fundal uterine perforation is a risk factor for uterine rupture both during pregnancy and labor.

MRI Evaluation of Mullerian Duct Anomalies: Practical Classification by the New ASRM System.

To describe variable mullerian duct anomalies using magnetic resonance imaging (MRI) and to classify these anomalies according to the available classification systems, namely the American Fertility Society (AFS) system, the European Society of Human Reproduction and Embryology (ESHRE) system, and the new American Society for Reproductive Medicine (ASRM) system. Retrospective chart review. The pelvic MRI studies and the clinical records of 64 females with mullerian congenital anomalies were retrospectively reviewed between January 2010 and December 2021. The mean age was 22 years (age range 2-63 years). Detailed imaging findings were recorded, and the resulting mullerian anomalies were then classified according to the three classification systems of interest. Variable mullerian anomalies were found among patients with multiple frequencies. Mullerian agenesis and hypoplasia were found in 12 patients (19%) and 16 patients (25%), respectively. Uterus didelphys was found in 5 patients (8%). Twelve (19%) patients had septate uterus, while 8 (12.5%) had a bicornuate anomaly. Unicornuate uterus was present in 7 patients (11%). Isolated vaginal anomaly was diagnosed in 4 patients (6%). Renal/urinary tract imaging was available for 27 (42%) patients, and accompanying urinary tract anomalies were noted in 10 of them (37%). Few ovarian and other extra-renal anomalies were observed. MRI could efficiently delineate the mullerian anomalies regardless of their complexity. Most of these anomalies were more efficaciously categorized by the ESHRE and the new ASRM systems, compared to the originally widely used AFS system. The new ASRM classification was found to be more practical as it is a modification of the original AFS system, using drawings with clear descriptions instead of symbols. This is particularly helpful in the radiological era, saving time and effort.

Hysteroscopic Resection of Uterine Septum: An Updated Approach

<h3>Study Objective</h3> Demonstrate an updated technique for hysteroscopic resection of uterine septum. <h3>Design</h3> Case Study–Surgical Technique. <h3>Setting</h3> Major academic medical center. <h3>Patients or Participants</h3> Patient with known uterine septum undergoing hysteroscopic resection of septum with concomitant indicated laparoscopy. <h3>Interventions</h3> Operative hysteroscopy with resection of septum, with laparoscopic assistance. <h3>Measurements and Main Results</h3> The purpose of this video is to demonstrate the combined technique of traditional hysteroscopic scissors with an advanced hysteroscopic tissue removal system to optimally remove the avascular septal tissue and restore normal uterine cavity architecture. The patient later underwent a successful intrauterine device insertion with sonographic guidance, demonstrating a normal uterine cavity and fully resected septum. <h3>Conclusion</h3> Use of an advanced hysteroscopic tissue removal system in combination with traditional incision of the uterine septum results in optimal anatomic cavity restoration. This technique can be used alone or in combination with indicated laparoscopy, which provides additional visual confirmation of adequate resection using a "jack-o-lantern" technique. Further prospective studies should be conducted to evaluate the impact of this updated technique on gynecologic (i.e., bleeding) and obstetric outcomes.

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

<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.

Reporting a near term pregnancy with septate uterus presenting with abruption.

Reporting a near term pregnancy with septate uterus presenting with abruption.

Reproductive outcomes after uterine septum resection in patients with recurrent miscarriage or infertility: a retrospective study in Chinese women.

Septate uterus is the most common structural uterine anomaly, which is related to the adverse pregnancy outcomes in women of childbearing age. This article provides a retrospective review of hysteroscopic uterine septum resection performed in our hospital during recent years, focusing on the patients with recurrent miscarriage and primary infertility, and also to identify which patients are more likely to benefit from the surgery. This is a single-center retrospective study. Cases of women who underwent hysteroscopic septum resection at West China Second Hospital of Sichuan University from January 2014 to December 2019, retrieved through the medical record system, were divided into three groups: Group A was the recurrent miscarriage group, Group B had a history of pregnancy with spontaneous abortion once at most, and Group C was the primary infertility group. Each patient was followed up by telephone about further pregnancy, miscarriage and live birth for at least 1year. A total of 176 surgical patients were included in this study. Group A, B, and C include 42, 74, and 60 cases, respectively. The postoperative pregnancy rates of the three groups were 71.4, 82.4, and 75.0%; live births rates were 50.0, 74.3, and 71.7%; and spontaneous abortion rates were 21.4, 17.6, and 13.3%. 62 patients had a complete uterine septum and 114 had a partial uterine septum. For patients with complete septate uterus, the preoperative pregnancy rate was 54.84% and the pregnancy rate increased to 85.48% after surgery; and yet the preoperative and postoperative pregnancy rates in patients with partial septate uterus were close (from 71.9 to 72.8%). After uterine septum resection, the pregnancy rate and spontaneous abortion rate in RSA patients were not significantly different from the other two groups, but the live birth rate was still significantly lower. Patients with complete uterine septum may benefit more from surgery. The surgical indications should be carefully and strictly evaluated.

Diagnostic Value of Hysterosalpingography

Objective: Hysterosalpingography (HSG) is a contrast-enhanced, radiographic examination method of the internal female reproductive organs, which is used in the context of infertility diagnostics for the clarification of uterine malformations. The aim of this study was to investigate the significance of HSG as a diagnostic method in reproductive medicine. Methods: The results of HSG examinations from the Clinic for Reproductive Medicine and Andrology of the University Hospital Halle (Saale) between 2006 and 2020 were retrospectively examined. Results: Normal uterine findings were diagnosed by HSG in 151(51.01%) patients. The most common uterine malformation was uterus arcuatus, which was found in 46 patients (15.54%); 30(10.14%) patients had uterus bicornis unicollis. Uterus bicornis, unicornis, and subseptus were present in 5(1.69%) patients each. A duplex uterus was detected in 3(1.01%) patients, and malformations of a uterus arcuatum unicollis, uterus septus, bicornis subseptus, and uterus corpora in case of sectio bicornis were detected in 1(0.34%) patient each. A comparison of HSG findings with those from initial baseline diagnostics (gynecologic manual examination, sonography, etc.) revealed a correlation of findings in 105 cases (35.84%) and divergence of findings in 79 cases (26.96%). With the assistance of the HSG findings, further specification of the previously collected findings was achieved in 27 cases (9.22%). The diagnostic significance of HSG in reproductive medicine was demonstrated by the fact that findings were obtained and could not be detected in the preliminary examinations. In addition, basic diagnostic findings were confirmed by HSG, and conversely, previously collected findings could be further specified. HSG is a less invasive diagnostic imaging procedure with a short examination time. The fluoroscopy time is usually only a few seconds. Therefore, the radiation exposure is negligible. Conclusion: HSG is a method of radiologic examination that can be used to diagnose and specify uterine malformations. The diagnosis by HSG often opens up new therapeutic options to correct uterine malformations.

What type of uterine anomalies had an additional effect on pregnancy outcomes, compared to other uterine anomalies? An evaluation of a large population database

Objective To compare pregnancy risks between different congenital uterine anomalies utilizing other congenital anomalies as a control group in a large population database. Design, setting, and sample A retrospective population-based cohort study from the Healthcare Cost and Utilization Project-Nationwide Inpatient Sample (HCUP-NIS) included 3,846,342 births (2010–2014). Of them, 6195 deliveries were to women with bicornuate uteri, 798 with arcuate uteri, 2255 with didelphys uteri, 802 with unicornuate uteri and 1404 with septate uteri. Main outcome measures and results After adjustment for confounders, women with bicornuate uteri were more likely to deliver vaginally (aOR 1.4, 95%CI: 1.1–1.9), p = .01), less likely to deliver by cesarean (CD) and had lower risk of small for gestational age (SGA) (aOR 0.8, 95%CI: 0.7–0.9, p = .03) when compared to the other anomalies (aOR 0.6, 95%CI: 0.5–0.6, p = .0001). Pregnant women with arcuate uterus had lower risks of preterm delivery (PTD) (aOR 0.6, 95%CI: 0.5–0.8, p = .0001), less chance of operative vaginal delivery (aOR 0.5, 95%CI: 0.2–0.9, p = .04), and higher risk for CD (aOR 1.6, 95%CI: 1.4–2, p = .0001). Pregnant women with didelphys uteri had higher risk of preterm premature rupture of membranes (PPROM) (aOR 1.6, 95%CI: 1.3–1.9, p = .0001), PTD (aOR 1.5, 95%CI: 1.3–1.6, p = .0001), CD (aOR 1.4, 95%CI: 1.2–1.5, p = .0001) and wound complications (aOR 1.6, 95%CI: 1.1–2.4, p = .02). Pregnant unicornuate uteri had increased risks of PTD (aOR 1.4, 95%CI: 1.1–1.6, p = .0001), CD (aOR 2, 95%CI: 1.6–2.5, p = .0001) and of SGA (aOR 1.8, 95%CI: 1.4–2.3, p = .0001). Pregnant septate uteri had higher risk of chorioamnionitis (aOR 1.5, 95%CI: 1.1–2.1, p = .048) and CD (aOR 1.4, 95%CI: 1.2–1.6, p = .0001). Conclusions We demonstrated that there are different risks for certain adverse pregnancy and neonatal outcomes in diverse uterine anomalies as compared to the other anomalies.

SINGLE EUPLOID EMBRYO TRANSFER OUTCOMES AFTER UTERINE SEPTUM RESECTION

A septate uterus is the most common Müllerian anomaly. There is limited evidence supporting surgical versus expectant management of uterine septa. The objective of this study is to compare single euploid embryo transfer (SEET) outcomes in patients who underwent prior uterine septum resection to those with uteri of normal contour without Müllerian anomaly and without a history of prior uterine surgeries.