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Hysteroscopic correction of septate uterus




Figure 1. Balloon technique for hysteroscopic correction of a complete septate uterus.



                         Table I. Pre-, intra- and postoperative data for six patients with complete uterine septum

                         Age                 Past history                         Time of                      Postoperative pregnancy
                         (years)                                                  surgery (min)

                         23                  Primary infertility;                 50                           Term pregnancy
                                             longitudinal vaginal septum                                       (Caesarean section)
                         28                  Recurrent abortion                   30                           Term pregnancy
                                             (three abortions)
                         30                  One abortion
                                             One preterm birth                    25                           –
                         23                  Primary infertility,
                                             longitudinal vaginal septum          25                           –
                         31                  Recurrent abortions                  30                           Term pregnancy
                                             (three abortions)
                         24                  Secondary infertility                20                           –
                                             (one abortion)



at 16 weeks gestation. Because of the prophylactic cervical                          uterus and septate vagina: report of a previously undescribed Mullerian¨
                                                                                     anomaly. Hum. Reprod., 11, 218–219.
suture, the advantage of this technique of spared cervical                         Daly, D.C., Tohan, N., Walters, C. et al. (1983) Hysteroscopic resection of
incision could not be clearly demonstrated. Although Vercellini                      the uterine septum in the presence of a septate cervix. Fertil. Steril., 39,
et al. (1989) could not show a positive effect of IUD insertion                      560–563.
and postoperative oestrogen administration, we used these two                      Ludmir, J., Samuels, P., Brooks, S. and Mennuti, M.T. (1990) Pregnancy
                                                                                     outcome of patients with uncorrected uterine anomalies managed in a high-
adjuvants with good results for the prevention of intrauterine                       risk obstetric setting. Obstet. Gynecol., 75, 906–910.
adhesions after septal dissection.                                                 Perino, A., Chianchiano, N., Simonaro, C. and Cittadini, E. (1995) Endoscopic
   The described balloon technique offers the possibility of                         management of a case of complete septate uterus. Hum. Reprod., 10,
                                                                                     2171–2173.
sparing the cervical septum during septum dissection in patients                   Rock, I. A., Murphy, A.A. and Cooper IV, W.H. (1987) Resectoscopic
with a complete uterine septum. The good clinical results of                         techniques for the lysis of a class V: complete uterine septum. Fertil. Steril.,
our procedure lead us to favour this technique. Because a                            48, 495–496.
complete uterine septum is such a rare uterine malformation,                       Salle, B., Sergeant, P., Gaucherand, P., et al. (1996) Transvaginal
                                                                                     hysterosonographic evaluation of septate uteri: a preliminary report. Hum.
a definitive recommendation can be given only after a random-                         Reprod., 11, 1004–1007.
ized multicentre study. In all cases of a uterine septum, an                       Vercellini, P., Fedele, L., Arcaini, L. et al. (1989) Value of intrauterine
indication for dissection must be critically proven because, even                    device insertion and estrogen administration after hysteroscopic metroplasty.
                                                                                     J. Reprod. Med., 34, 447–450.
without intervention, term pregnancies have been reported.                         Vercellini, P., Ragni, G., Trespidi, L. et al. (1994) A modified technique for
                                                                                     correction of the complete septate uterus. Acta Obstet. Gynecol. Scand.,
                                                                                     73, 425–428.
References
American Fertility Society (1988) The American Fertility Society                   Received on October 14, 1996; accepted on January 7, 1997
  classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion
  secondary to tubal ligation, tubal pregnancies and intrauterine adhesions.
  Fertil. Steril., 49, 944–955.
Balasch, J., Moreno, E., Martinez-Roman, S. et al. (1996) Septate uterus with
  cervical duplication and longitudinal vaginal septum: a report of three new
  cases. Eur. J. Obstet. Gynecol. Reprod. Biol., 65, 241–243
Candiani, M., Busacca, M., Natale, A. and Sambruni, I. (1996) Bicervical

                                                                                                                                                                479

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Balloon technique for hysteroscopic correction of a complete septate uterus.

  • 1. Hysteroscopic correction of septate uterus Figure 1. Balloon technique for hysteroscopic correction of a complete septate uterus. Table I. Pre-, intra- and postoperative data for six patients with complete uterine septum Age Past history Time of Postoperative pregnancy (years) surgery (min) 23 Primary infertility; 50 Term pregnancy longitudinal vaginal septum (Caesarean section) 28 Recurrent abortion 30 Term pregnancy (three abortions) 30 One abortion One preterm birth 25 – 23 Primary infertility, longitudinal vaginal septum 25 – 31 Recurrent abortions 30 Term pregnancy (three abortions) 24 Secondary infertility 20 – (one abortion) at 16 weeks gestation. Because of the prophylactic cervical uterus and septate vagina: report of a previously undescribed Mullerian¨ anomaly. Hum. Reprod., 11, 218–219. suture, the advantage of this technique of spared cervical Daly, D.C., Tohan, N., Walters, C. et al. (1983) Hysteroscopic resection of incision could not be clearly demonstrated. Although Vercellini the uterine septum in the presence of a septate cervix. Fertil. Steril., 39, et al. (1989) could not show a positive effect of IUD insertion 560–563. and postoperative oestrogen administration, we used these two Ludmir, J., Samuels, P., Brooks, S. and Mennuti, M.T. (1990) Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high- adjuvants with good results for the prevention of intrauterine risk obstetric setting. Obstet. Gynecol., 75, 906–910. adhesions after septal dissection. Perino, A., Chianchiano, N., Simonaro, C. and Cittadini, E. (1995) Endoscopic The described balloon technique offers the possibility of management of a case of complete septate uterus. Hum. Reprod., 10, 2171–2173. sparing the cervical septum during septum dissection in patients Rock, I. A., Murphy, A.A. and Cooper IV, W.H. (1987) Resectoscopic with a complete uterine septum. The good clinical results of techniques for the lysis of a class V: complete uterine septum. Fertil. Steril., our procedure lead us to favour this technique. Because a 48, 495–496. complete uterine septum is such a rare uterine malformation, Salle, B., Sergeant, P., Gaucherand, P., et al. (1996) Transvaginal hysterosonographic evaluation of septate uteri: a preliminary report. Hum. a definitive recommendation can be given only after a random- Reprod., 11, 1004–1007. ized multicentre study. In all cases of a uterine septum, an Vercellini, P., Fedele, L., Arcaini, L. et al. (1989) Value of intrauterine indication for dissection must be critically proven because, even device insertion and estrogen administration after hysteroscopic metroplasty. J. Reprod. Med., 34, 447–450. without intervention, term pregnancies have been reported. Vercellini, P., Ragni, G., Trespidi, L. et al. (1994) A modified technique for correction of the complete septate uterus. Acta Obstet. Gynecol. Scand., 73, 425–428. References American Fertility Society (1988) The American Fertility Society Received on October 14, 1996; accepted on January 7, 1997 classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies and intrauterine adhesions. Fertil. Steril., 49, 944–955. Balasch, J., Moreno, E., Martinez-Roman, S. et al. (1996) Septate uterus with cervical duplication and longitudinal vaginal septum: a report of three new cases. Eur. J. Obstet. Gynecol. Reprod. Biol., 65, 241–243 Candiani, M., Busacca, M., Natale, A. and Sambruni, I. (1996) Bicervical 479