Reproductive Outcome Following
Resection of Uterine Septum :
A Retrospective Study
Gundabattula S, Marakani L, Yanamandra N, Dasari S,
Joseph E, Nirmalan P
Hyderabad, India
Website : www.fernandezhospital.com
Introduction
 Prevalence of uterine malformation : 4.3%
 Septate uterus – mean incidence : 35%
– Infertility
– First and Second trimester loss
Aim
 To evaluate the reproductive outcome of
septal resection in women with
– Infertility
– Prior pregnancy losses
Methods
 Retrospective study 2003 – 2010
 Data retrieved via electronic database as
well as manually through case records
 124 women identified
– 74 women (59.7%) – incomplete septum
– 50 (40.3%) – complete septum
Procedure
 Under general anaesthesia
 Septoplasty was performed
– 26 Fr Resectoscope (Karl Storz) with a cutting
monopolar electrode
– Versapoint Hysteroscopy system (Gynaecare
Versapoint)
 Septum was divided in upward direction until
both tubal ostia were visualised in same plane
Results
 Total no. of women : 124
 Mean age : 27 years
 Indication
– Prior pregnancy losses
52
– Primary infertility (1 – 17 years) 43
– Secondary infertility
21
– Incidental finding
08
Total 124
Lost follow up 40
Data available 84
Conceived 63
Total pregnancies
98
Lost to
follow up 6
Outcome
known 92
Laparoscopy
Not performed
24
- Laparotomy x 1
- Caesarean section x 1
Performed
100
First and Second Trimester Miscarriage
1st
2nd
trimester
trimester
Take home
baby
Preresection
169(%)
Post
resection
92(%)
102
(60.4)
18
(21.1)
55
(32.5)
13
(15.2)
3
(1.8)
56
(60.8)
100
90
80
70
60
50
40
30
20
10
0
92.89
60.86
Pre
resection
36.3
1.8
Post
resection
Infertility Outcome
 Pregnancy rate 59.3%
 Miscarriage 39.1%
 Live birth rate 52.2%
70
60
59.3
52.2
50
40
39
Pregnancy rate
30
Miscarriage
20
Live birth rate
10
0
Post resection
Pre-resection Post resection
(169)
(92)
p
Value
No. of
pregnancies
169
92
1st trimester
miscarriage
102
(60%)
18
(19%)
p< 0.001
2nd trimester
miscarriage
55
(32%)
13
(14%)
p= 0.002
Term
pregnancy
IUFD /NND
Live birth
Take home
baby
Pre
Post resection
resection
92 (%)
169 (%)
2
50
(1.2)
(54.34)
7
3
(5.3)
(3.6)
7
57
(4.1)
(61.9)
3
56
(1.8)
(60.8)
p
Value
p< 0.001
p= 0.75
p< 0.001
p< 0.001
Cervical cerclage – 41 (33%)
 Type
– McDonald
– Shirodkar
– Abdominal
35
02
04
 Indication
– Prophylactic
– Clinically short
– Rescue
37 (4 were abdominal)
03
01
Cervical Cerclage
 Post-resection cervical cerclage was done in
33% women
 Over three fourths of pregnancies that had
cerclage carried pregnancy to term
Study
No. of
Patients
Iry Infertility (%)
Miscarriage +/IIry infertilty (%)
Preg
Rate
Misc
Rate
Live
Birth
Preg
Rate
Misc
Rate
Live
Birth
Ayas 2011
181
44
17
42
77
15
67
Nouri 2010
64
75
25
50
68
19
49
Selvaraj 2010
26
32
33
6
86
33
67
Mollo 2009
44
39
4.5
34
-
-
-
Saygili-Yilmaz 2002
361
25
16
75
75
16
75
124
59
39
52
85
33
64
Fernandez Hospital
Discussion
 Inadequate septal vascularization
 Abnormal placentation
 In-coordinated contractility of septum
Summary
 This study demonstrates:
– Reduction in miscarriage rates
– Enhances pregnancy rate in those with
infertility
– Increases ‘take-home baby’ rate in those
with previous miscarriages and infertility
Conclusion
 Metroplasty:
– Significant improvement in reproductive
performance
– Outcome of patients with miscarriages is
better than those with primary infertility
Thank You