Hysteroscopic management of recurrent abortion caused by septate uterus

Between April 1982 and April 1986, 91 patients underwent hysteroscopy for treatment of septate uteri. In 88 patients simultaneous laparoscopy was performed and one patient had a simultaneous laparotomy. Ninety procedures were performed on an outpatient basis with the patients under general anesthesia. The septum was incised with flexible scissors. Sequential estrogen-gestagen therapy was used immediately after operation to reepithelialize the freshly dissected surfaces. Patients were permitted to conceive in the first month after operation. The indications for hysteroscopy were multiple but included recurrent abortion in 79 patients. Among those patients in this category the pretreatment reproductive wastage was 95%. Most losses were in the first trimester. Among those patients who conceived after therapy, the gestational outcome markedly improved. Eighty-seven percent of the pregnancies have resulted in a living infant or have progressed beyond 20 weeks of gestation. Because the gestational outcome equals or exceeds that achieved by transabdominal metroplasty and because of its lower morbidity and the option for vaginal delivery, hysteroscopic incision of the symptomatic septate uterus should replace transabdominal metroplasty.