Hysteroscopic metroplasty: six years' experience.

Seventy patients who underwent hysteroscopic metroplasty for uterine septa during a 6-year period were reviewed for subsequent gynecologic problems and obstetric outcome. Complete follow-up was obtained for 1 year in 60 patients and through the first pregnancy in 64. The 70 patients were divided into three groups based on obstetric history prior to surgery: 1) 40 with only first-trimester losses, 2) 15 whose histories included second-trimester losses or premature delivery, and 3) 15 with primary infertility. Long-term follow-up indicated no significant gynecologic abnormalities. Comparison of preoperative and postoperative obstetric outcomes indicated the following: 1) Hysteroscopic metroplasty was very effective in treating patients with septa and a history of first-trimester abortion; 2) patients with first-trimester loss and either second-trimester abortion or preterm birth benefited from metroplasty but were still at risk for preterm labor; and 3) hysteroscopic metroplasty does not "cure" unexplained infertility. When compared with abdominal metroplasty for efficacy, morbidity, and cost, hysteroscopic metroplasty appears to be the treatment of choice in patients with uterine septa associated with pregnancy loss. Those patients with a history of second-trimester loss and third-trimester preterm delivery continue to require close monitoring in subsequent pregnancies.