Uterine surgery by operative hysteroscopy

Area of Science:

• Reproductive Medicine
• Gynecologic Surgery
• Obstetrics

Background:

• Uterine anomalies are implicated in 10-15% of recurrent pregnancy loss cases.
• Müllerian fusion defects and submucous fibroids can impair implantation and placental development.
• Traditional abdominal metroplasty for uterine malformations involves significant surgical trauma and necessitates Cesarean delivery.

Purpose of the Study:

• To evaluate hysteroscopy as a diagnostic and therapeutic tool for uterine anomalies causing pregnancy complications.
• To compare hysteroscopic septotomy with traditional abdominal metroplasty.
• To assess the impact of hysteroscopic treatment on pregnancy outcomes and delivery mode.

Main Methods:

• Hysteroscopy was utilized for both diagnosis and trans-cervical resection of uterine septa.
• This endoscopic approach avoids abdominal incisions and damage to uterine musculature.
• Pregnancy outcomes, including term progression and delivery mode, were assessed post-intervention.

Main Results:

• Hysteroscopic septotomy successfully treated uterine septa without abdominal wall or uterine wall injury.
• Two-thirds of pregnancies in women with duplicated uteri progress to term.
• Vaginal delivery is possible after hysteroscopic septotomy, with a reduced risk of uterine rupture compared to abdominal metroplasty.

Conclusions:

• Hysteroscopy is an effective and minimally invasive treatment for uterine septa, improving reproductive outcomes.
• Endoscopic correction of uterine anomalies offers advantages over traditional surgery, including reduced morbidity and enabling vaginal birth.
• Hysteroscopic septotomy represents a significant advancement in managing uterine malformations associated with recurrent pregnancy loss.