Small uterine septum is an important risk variable for preterm birth

Area of Science:

• Reproductive Medicine
• Obstetrics and Gynecology
• Surgical Innovation

Background:

• Uterine septum variations, including arcuate (small) and septate/subseptate (large) uteri, are associated with adverse perinatal outcomes.
• The American Fertility Society (AFS) classifies these variations, but their comparative impact on pregnancy outcomes requires further investigation.
• Hysteroscopic resection is a common surgical approach to correct uterine septum abnormalities.

Purpose of the Study:

• To compare the efficacy of hysteroscopic septum resection in women with small uterine septums (arcuate uterus, AFS Class VI) versus large uterine septums (septate/subseptate uterus, AFS Class V).
• To evaluate if a small uterine septum behaves similarly to a larger septum regarding perinatal outcomes after surgical correction.

Main Methods:

• An observational study analyzed data from 826 singleton deliveries in 730 women who underwent hysteroscopic septum resection.
• Women were divided into two groups: Group A (small septum, 1.3-1.5 cm) and Group B (large septum).
• Perinatal outcomes, including preterm birth, very preterm birth, stillbirth, neonatal death, and neonatal intensive care unit (NICU) admissions, were compared before and after surgery.

Main Results:

• Hysteroscopic resection significantly reduced preterm birth rates in both groups: from 33.9% to 7.2% in Group A and 36.5% to 8.0% in Group B (P<0.001 for both).
• Very preterm birth rates also decreased significantly post-surgery in both groups (Group A: 12.5% to 3.1%; Group B: 15.0% to 2.9%).
• Post-operative improvements included reduced NICU admissions, stillbirth rates, and neonatal death rates.

Conclusions:

• A small uterine septum (arcuate uterus) is a significant, hysteroscopically preventable risk factor for preterm birth, similar to larger uterine septums.
• Hysteroscopic septum resection is an effective treatment for improving perinatal outcomes in women with both small and large uterine septums.
• The study supports similar management strategies for different sizes of uterine septums, emphasizing the benefit of surgical correction.