Hysteroscopic metroplasty: surgical technique and obstetric outcome

Congenital Müllerian abnormalities, particularly the septate uterus, may result in recurrent abortion or premature labor. Twenty-five patients found to have a septate uterus during evaluation for infertility or recurrent abortion were treated by hysteroscopic metroplasty with laparoscopic visualization. Surgical outcome was excellent, intraoperative and postoperative morbidity was negligible, and the postoperative course was similar to that following laparoscopy alone. Preoperative fetal wastage in 17 previously fertile patients was 90%. Of 11 patients, 6 or more months postoperatively, 10 had conceived: 5 delivered vaginally at term, 2 delivered by cesarean section, and 2 pregnancies are in progress. One pregnancy miscarried at 21 weeks secondary to an incompetent cervix. With hysteroscopic metroplasty, septa can be incised successfully with lower morbidity and as good a surgical outcome as with abdominal procedures. If further studies confirm the pregnancy outcome reported, then hysteroscopic metroplasty should become the treatment of choice for the septate uterus.