Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases

To evaluate the impact of conventional transabdominal metroplasty on the reproductive outcome of symmetric uterine anomalies and to determine the complications of this procedure.

A retrospective clinical analysis of 157 consecutive women who underwent surgery during a 25-year period. One hundred fifty-seven patients with a subseptate, septate or bicornuate uterus and history of recurrent abortions (124 cases) or infertility (33 cases) were included in this study. Operative technique was similar to the procedure first described by Bret and Guillet and by Tompkins.

The fetal survival rate increased from 0.0% before surgery to 81.9% postoperatively in the recurrent abortion group and to 92.8% in the infertility group. Among women having undergone surgery, 63.8% gave birth to at least 1 healthy child, the proportion of previous habitually miscarrying and infertile women was 70.2% and 32.0%, respectively. No uterine rupture or any other complication was observed.

Conventional transabdominal metroplasty seems to be a safe procedure in women with symmetric uterine anomalies and a history of recurrent miscarriages or otherwise unexplained primary infertility. No perioperative or subsequent peripartum complications were observed. Even in the era of operative hysteroscopy, transabdominal metroplasty remains the only approach in cases of bicornuate uterus.