The Reproductive Outcome After Hysteroscopic Resection Of Uterine Septum Of101Cases:a Retrospective Cohort Study

Background:Septate uterus, one of the most common form of congenital uterine malformations, accounts for about80%-90%of them. The incidence of septate uterus has been reported to be as high as2.3%in the general female population and to be significantly higher in patients with infertility and recurrent pregnancy loss. Septate uterus results from incomplete resorption of the paramesonephric Mullerian ducts during the first trimester of pregnancy. Depending on the size of the septum, the uterine cavity may be affected only partially, as in case of an incomplete septate uterus, or it may be divided into two separate components, as in case of a complete septate uterus. A uterine septum affects female reproductive health in three ways: recurrent miscarriages, infertility and obstetric complications such as preterm delivery and abnormal presentation. However, literatures on that how it acts are controversial. Septate uterus used to be treated by transabdominal metroplasty. The surgical method has been substituted by operative hysteroscopy. Now hysteroscopic resection of uterine septum(HRUS) is the most common surgical method which minimizes the risk of many complications and improves reproductive outcome. Available literatures on reproductive outcome after HRUS are inconsistent.Objective:The aim is to evaluate the reproductive outcome after hysteroscopic correction of septate uterus by HRUS and to discuss the influencing factors and the change of the pregnancy rate after treatment.Methods:In a retrospective cohort study, we evaluated the reproductive outcome after hysteroscopic septoplasty in101women with septate uterus. In addition, a comprison between different female populations was conducted. Evaluation and plotting were conducted by SPSS18.0and GraphPad.Prism5.01respectively.Results:All the patients in the study underwent HRUS, and tried to conceive after the surgery. Mean follow-up time was25.25±7.015months. It indicates an overall complication rate of3.0%, and a re-hysteroscopy rate of0. The overall pregnancy rate after hysteroscopic septoplasty was71.3%and the life birth rate (LBR) was75.3%. The overall rate of spontaneous miscarriage was24.7%. The mean time interval between surgery and the first pregnancy was9.21±5.459months. And he mean time interval between surgery and the first life birth was20.62±5.586months. The study demonstrated a consistent increase of pregnancy during the observation period.Conclusions:In women with septate uterus, hysteroscopic septoplasty is a safe and effective procedure with an increasing LBR rate and a decreasing spontaneous miscarriage rate. It shows that the size of the septum doesn’t concern the reproductive outcome after HRUS. It demonstrates that it is more likely to have a spontaneous pregnancy during the first15months following the HRUS.