Research Article
Histeroskopik septoplasti sonrası gebelik sonuçları ve farklı cerrahi tekniklerin karşılaştırılması: Retrospektif kohort çalışma
Abstract
Amaç: Uterin septum kadınların büyük bir kısmını, özellikle tekrarlayan düşüğü olan hastaları etkilemektedir. Histeroskopik septoplasti tedavi için yararlı ve minimal invaziv bir tekniktir. Histeroskopi sonrası gebelik oranları değişik çalışmalarda değişkenlik göstermektedir. Çalışmamızda histeroskopik septoplasti sonrası gebelik sonuçları ve farklı histeroskopik tekniklerin yararlı etkilerini karşılaştırmayı amaçladık.
Gereç ve Yöntem: Ege Üniversitesinde 2007-2013 tarihleri arasında histeroskopik septoplasti gerçekleştirilen hastalar retrospektif olarak tarandı. Hastaların gebelik sonuçları üniversite bilgi sistemi ve telefon görüşmeleri ile takip edildi. Canlı doğum oranları ve düşükler değerlendirilmeye alındı. Farklı cerrahi teknikler (rezektoskop, soğuk makas) canlı doğum oranları baz alınarak karşılaştırıldı.
Bulgular: Yüz yirmi iki hasta çalışmaya dahil edildi. Doksan dört gebelik %77 oran ile gerçekleşti. Yetmiş dokuz canlı doğum ve 15 düşük saptandı. Altmış dört (%54) kadın en az bir canlı doğum gerçekleştirmişti. Histeroskopik septoplasti; 72 (%59) hastada rezektoskop, 50 (%41) hastada 5 mm histeroskop ve soğuk makas kullanılarak gerçekleştirildi. Rezektoskop ile işlem gören hastalardan 42’sinde (%58) ve soğuk makas ile gerçekleştirilen hastalardan 24’ünde (%48) canlı doğum gerçekleşti. Cerrahi tekniklere göre canlı doğum oranları karşılaştırıldığında istatistiksel anlamlı fark saptanmadı.
Sonuç: Histeroskopik septoplasti; uterin septum tedavisinde güvenli, yararlı ve minimal invaziv bir yöntemdir. Rezektoskop ve soğuk makas kullanımına göre canlı doğum oranları arasında istatistiksel anlamlı fark saptanmamıştır. Uterin septuma sahip infertil hastalara histeroskopi seçeneği düşük komplikasyon oranları ve yüksek gebelik sonuçları ile önerilebilir.
References
- Ashton D, Amin H, Richart R, Neuwirth R. The incidence of asymptomatic uterine anomalies in women undergoing transcervical tubal sterilization. Obstet Gynecol 1988;72(1):28-30.
- Saravelos SH, Cocksedge K A, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: A critical appraisal. Hum Reprod Update 2008;14(5):415-29.
- Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reprod Update 2001;7(2):161-74.
- Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2008;89(1):1-16.
- Troiano RN, McCarthy SM. Müllerian duct anomalies: Imaging and clinical issues. Radiology 2004;233(1):19-34.
- Sparac V, Kupesic S, Ilijas M, Zodan T, Kurjak A. Histologic architecture and vascularization of hysteroscopically excised intrauterine septa. J Am Assoc Gynecol Laparosc 2001;8(1):111-6.
- Clifford K, Rai R, Watson H, Regan L. Pregnancy: An informative protocol for the investigation of recurrent miscarriage: Preliminary experience of 500 consecutive cases. Hum Reprod 1994;9(7):1328-32.
- Propst AM, Hill JA 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 2000;18(4):341-50.
- Tonguc EA, Var T, Batioglu S. Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. Int J Gynecol Obstet 2011;113(2):128-30.
- Maneschi F, Zupi E, Marconi D, Valli E, Romanini C, Mancuso S. Hysteroscopically detected asymptomatic mullerian anomalies. Prevalence and reproductive implications. J Reprod Med 1995;40(10):684-8.
- Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: A meta-analysis of comparative studies. Reprod BioMed Online 2014;29(6):665-83.
- Mollo A, De Franciscis P, Colacurci N, et al. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: A prospective controlled trial. Fertil Steril 2009;91(6):2628-31.
- Acien P. Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 1997;12(7):1372-6.
- Hollett-Caines J, Vilos GA, Abu-Rafea B, Ahmad R. Fertility and pregnancy outcomes following hysteroscopic septum division. J Obstet Gynaecol Can 2006;28(2):156-9.
- Wang JH, Kai-Hong X, Lin J, Chen XZ. Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility. Fertil Steril 2009;91(6):2643-9.
- Valle RF. Hysteroscopic treatment of partial and complete uterine septum. Int J Fertil Menopausal Stud 1995;41(3):310-5.
- March CM, Israel R. Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 1987;156(4):834-42.
- Rutstein SO, Shah IH. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No. 9. Maryland; ORC Macro and the World Health Organisation 2004.
- Nicolini U, Bellotti M, Bonazzi B, Zamberletti D, Candiani GB. Can ultrasound be used to screen uterine malformations? Fertil Steril 1987;47(1):89-93.
- Bermejo C, Martínez Ten P, Cantarero R, et al. Three‐dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol 2010;35(5):593-601.
- Fedele L, Dorta M, Brioschi D, Massari C, Candiani GB. Magnetic resonance evaluation of double uteri. Obstet Gynecol 1989;74(6):844-7.
- Salim R, Woelfer B, Backos M, Regan L, Jurkovic D. Reproducibility of three‐dimensional ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol 2003;1(6):578-82.
- Raga F, Bonilla-Musoles F, Blanes J. Osborne NG. Congenital Müllerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertil Steril 1996;65(3):523-8.
- Ghirardi V, Bizzarri N, Remorgida V, Venturini PL, Ferrero S. Intraoperative transrectal ultrasonography for hysteroscopic metroplasty: Feasibility and safety. J Minim Invasive Gynecol 2015;22(5):884-8.
- Vigoureux S, Fernandez H, Capmas P, Levaillant J-M, Legendre G. Assessment of abdominal ultrasound guidance in hysteroscopic metroplasty. J Minim Invasive Gynecol 2016;23(1):78-83.
- Malik R, Rizwan S, Rizk B. Resection of uterine septum using the myosure tissue removal system. J Minim Invasive Gynecol 2015;6(22):S123.
- Homer HA, Li T-C, Cooke ID. The septate uterus: A review of management and reproductive outcome. Fertil Steril 2000;73(1):1-14.
- Cararach M, Penella J, Ubeda A, Labastida R. Hysteroscopic incision of the septate uterus: Scissors versus resectoscope. Hum Reprod 1994;9(1):87-9.
- Fedele L, Arcaini L, Parazzini F, Vercellini P, Di Nola G. Reproductive prognosis after hysteroscopic metroplasty in 102 women: Life-table analysis. Fertil Steril 1993;59(4):768-72.
- Nouri K, Ott J, Huber JC, Fischer E-M, Stögbauer L, Tempfer CB. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus-a retrospective cohort study and systematic review of the literature. Reprod Biol Endocrinol 2010;21(8)52.
- Sentilhes L, Sergent F, Roman H, Verspyck E, Marpeau L. Late complications of operative hysteroscopy: Predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol 2005;120(2):134-8.
Reproductive outcomes after hysteroscopic septoplasty and comparison of different surgical techniques: A retrospective cohort study
Abstract
Aim: Uterine septum affects a large proportion of women, especially patients with recurrent abortion. Hysteroscopic septoplasty is a novel and minimally invasive method for its treatment. Pregnancy rates after hysteroscopy vary in different studies. We aimed to evaluate pregnancy outcomes after hysteroscopic septoplasty and to compare the beneficial effects of different hysteroscopic techniques.
Materials and Methods: Patients undergoing hysteroscopic septoplasty between 2007 and 2013 in Ege University were retrospectively reviewed. Patients’ pregnancy outcomes were followed-up by using the university’s registry system and telephone interviews. Live birth rates and miscarriages were determined. Different surgical techniques (resectoscope, cold scissors) were compared regarding live birth ratios.
Results: One hundred twenty two patients were included in this study. Ninety-four pregnancies occurred with an overall pregnancy rate of 77%. Seventy nine live births and 15 abortions had occurred. Sixty-six women (54%) gave at least one live birth. Hysteroscopic septoplasty was performed in 72 (59%) and 50 (41%) patients using resectoscope and cold scissors with 5mm hysteroscope, respectively. Fourty two (58%) of patients undergoing septoplasty by resectoscope and 24 patients (48%) of patients undergoing septoplasty by cold scissors group had a live birth. There was no statistically significant difference among the pregnancy outcomes of the two surgical techniques.
Conclusion: Hysteroscopic septoplasty is a safe, effective and minimally invasive method for uterine septum treatment. There is no significant difference in the live birth rates according to whether the resectoscope or cold scissors were used. Infertile patients with uterine septum should be offered the option of hysteroscopy which is feasible with low complication rates and high pregnancy rates.
References
- Ashton D, Amin H, Richart R, Neuwirth R. The incidence of asymptomatic uterine anomalies in women undergoing transcervical tubal sterilization. Obstet Gynecol 1988;72(1):28-30.
- Saravelos SH, Cocksedge K A, Li TC. Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: A critical appraisal. Hum Reprod Update 2008;14(5):415-29.
- Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Human Reprod Update 2001;7(2):161-74.
- Taylor E, Gomel V. The uterus and fertility. Fertil Steril 2008;89(1):1-16.
- Troiano RN, McCarthy SM. Müllerian duct anomalies: Imaging and clinical issues. Radiology 2004;233(1):19-34.
- Sparac V, Kupesic S, Ilijas M, Zodan T, Kurjak A. Histologic architecture and vascularization of hysteroscopically excised intrauterine septa. J Am Assoc Gynecol Laparosc 2001;8(1):111-6.
- Clifford K, Rai R, Watson H, Regan L. Pregnancy: An informative protocol for the investigation of recurrent miscarriage: Preliminary experience of 500 consecutive cases. Hum Reprod 1994;9(7):1328-32.
- Propst AM, Hill JA 3rd. Anatomic factors associated with recurrent pregnancy loss. Semin Reprod Med 2000;18(4):341-50.
- Tonguc EA, Var T, Batioglu S. Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. Int J Gynecol Obstet 2011;113(2):128-30.
- Maneschi F, Zupi E, Marconi D, Valli E, Romanini C, Mancuso S. Hysteroscopically detected asymptomatic mullerian anomalies. Prevalence and reproductive implications. J Reprod Med 1995;40(10):684-8.
- Venetis CA, Papadopoulos SP, Campo R, Gordts S, Tarlatzis BC, Grimbizis GF. Clinical implications of congenital uterine anomalies: A meta-analysis of comparative studies. Reprod BioMed Online 2014;29(6):665-83.
- Mollo A, De Franciscis P, Colacurci N, et al. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: A prospective controlled trial. Fertil Steril 2009;91(6):2628-31.
- Acien P. Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 1997;12(7):1372-6.
- Hollett-Caines J, Vilos GA, Abu-Rafea B, Ahmad R. Fertility and pregnancy outcomes following hysteroscopic septum division. J Obstet Gynaecol Can 2006;28(2):156-9.
- Wang JH, Kai-Hong X, Lin J, Chen XZ. Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility. Fertil Steril 2009;91(6):2643-9.
- Valle RF. Hysteroscopic treatment of partial and complete uterine septum. Int J Fertil Menopausal Stud 1995;41(3):310-5.
- March CM, Israel R. Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 1987;156(4):834-42.
- Rutstein SO, Shah IH. Infecundity, Infertility, and Childlessness in Developing Countries. DHS Comparative Reports No. 9. Maryland; ORC Macro and the World Health Organisation 2004.
- Nicolini U, Bellotti M, Bonazzi B, Zamberletti D, Candiani GB. Can ultrasound be used to screen uterine malformations? Fertil Steril 1987;47(1):89-93.
- Bermejo C, Martínez Ten P, Cantarero R, et al. Three‐dimensional ultrasound in the diagnosis of Müllerian duct anomalies and concordance with magnetic resonance imaging. Ultrasound Obstet Gynecol 2010;35(5):593-601.
- Fedele L, Dorta M, Brioschi D, Massari C, Candiani GB. Magnetic resonance evaluation of double uteri. Obstet Gynecol 1989;74(6):844-7.
- Salim R, Woelfer B, Backos M, Regan L, Jurkovic D. Reproducibility of three‐dimensional ultrasound diagnosis of congenital uterine anomalies. Ultrasound Obstet Gynecol 2003;1(6):578-82.
- Raga F, Bonilla-Musoles F, Blanes J. Osborne NG. Congenital Müllerian anomalies: Diagnostic accuracy of three-dimensional ultrasound. Fertil Steril 1996;65(3):523-8.
- Ghirardi V, Bizzarri N, Remorgida V, Venturini PL, Ferrero S. Intraoperative transrectal ultrasonography for hysteroscopic metroplasty: Feasibility and safety. J Minim Invasive Gynecol 2015;22(5):884-8.
- Vigoureux S, Fernandez H, Capmas P, Levaillant J-M, Legendre G. Assessment of abdominal ultrasound guidance in hysteroscopic metroplasty. J Minim Invasive Gynecol 2016;23(1):78-83.
- Malik R, Rizwan S, Rizk B. Resection of uterine septum using the myosure tissue removal system. J Minim Invasive Gynecol 2015;6(22):S123.
- Homer HA, Li T-C, Cooke ID. The septate uterus: A review of management and reproductive outcome. Fertil Steril 2000;73(1):1-14.
- Cararach M, Penella J, Ubeda A, Labastida R. Hysteroscopic incision of the septate uterus: Scissors versus resectoscope. Hum Reprod 1994;9(1):87-9.
- Fedele L, Arcaini L, Parazzini F, Vercellini P, Di Nola G. Reproductive prognosis after hysteroscopic metroplasty in 102 women: Life-table analysis. Fertil Steril 1993;59(4):768-72.
- Nouri K, Ott J, Huber JC, Fischer E-M, Stögbauer L, Tempfer CB. Reproductive outcome after hysteroscopic septoplasty in patients with septate uterus-a retrospective cohort study and systematic review of the literature. Reprod Biol Endocrinol 2010;21(8)52.
- Sentilhes L, Sergent F, Roman H, Verspyck E, Marpeau L. Late complications of operative hysteroscopy: Predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol 2005;120(2):134-8.
There are 31 citations in total.
Details
| Primary Language | English |
|---|---|
| Subjects | Health Care Administration |
| Journal Section | Research Articles |
| Authors | |
| Publication Date | September 14, 2018 |
| Submission Date | May 20, 2017 |
| Published in Issue | Year 2018Volume: 57 Issue: 3 |
