Successful twin pregnancy in a patient with complete uterine septum corrected during cesarean section
Ariel Weissman1, Ido Eldar, Gustavo Malinger
1In Vitro Fertilization Unit, Edith Wolfson Medical Center, Holon, Israel. a_w@zahav.net.il
Objective:
To describe a successful in vitro fertilization (IVF) twin pregnancy in a patient with complete uterine septum who underwent partial correction during cesarean section.
Design:
Case report.
Setting:
An IVF unit at a university hospital.
Patient(S):
A 29-year-old female patient with complete uterine septum undergoing IVF-intracytoplasmic sperm injection.
Intervention(S):
In vitro fertilization-intracytoplasmic sperm injection with single embryo transfer to each uterine cavity.
Main Outcome Measure(S):
Pregnancy course and outcome.
Result(S):
Both transferred embryos underwent implantation, resulting in twin pregnancy with a single embryo in each hemi-uterus. Cesarean section was performed at 34 weeks' gestation. Two healthy neonates were born. Resection of the uterine septum by electrocauterization was attempted during cesarean section. Diagnostic hysteroscopy performed 6 months later demonstrated the presence of the uterine septum reaching approximately 40% of the cavity.
Conclusion(S):
Whether prophylactic metroplasty should be performed in patients with uterine septae without prior history of miscarriage or pregnancy complications is still under debate. Successful implantation and fetal development might occur without prior metroplasty, as described in our case report. Metroplasty during cesarean section might be only partly successful because part of the septum might be confined in the stretched gravid uterus.
