Impact of hysteroscopic septum resection on pregnancy Outcomes: A 20-Year retrospective monocentric study

The uterine septum is the most common uterine malformation, associated with increased risk of early miscarriage and preterm birth. The benefits of surgical resection remain debated. We compared pregnancy outcomes before and after hysteroscopic septum resection within the same patients.

Retrospective monocentric study at the department of Obstetrics, Gynecology and Reproductive medicine Foch Hospital, Suresnes, France from January 2001 to December 2021, with follow-up until June 2023.

women aged 18-42 years with a confirmed septate uterus (ESHRE/ESGE criteria) complete pre- and post-operative pregnancy data, and hysteroscopic metroplasty.

change in early miscarriage rate before and after surgery.

recurrent miscarriage, live birth rates, and selected obstetric/neonatal outcomes. Statistical analysis used McNemar's, paired t-test, chi-squared, and Mann-Whitney U tests.

A total of 101 patients underwent uterine septum resection (median age 32.1 ± 5.7 years); 48 (47.5 %) had infertility, 36 (35.6 %) miscarriage and 11(10.9 %) recurrent miscarriage. Nineteen (18.9 %) had no history of infertility or miscarriage. After surgery, the proportion of patients with early miscarriage decreased from 35.6 % (36/101) to 14.8 % (15/101) (p < 0.001) and recurrent miscarriage from 10.9 % (11/101) to 2.0 % (2/101) (p = 0.001). Live births increased from 17.8 % (18/101) to 36.6 % (37/101) (p < 0.001). Premature rupture of membranes fell from 23.5 % (4/17) to 4.3 % (2/46) (p = 0.02) and the mean birth weight increased from 2734 ± 605.0 g to 3095 ± 663.4 g (p = 0.01).

In this cohort, hysteroscopic septum resection was associated with reduced miscarriage and increased live birth rates, supporting surgery in selected patients particularly those with adverse reproductive history.