Obstetric outcome before and after metroplasty in women with uterine anomalies.

A review of 49 patients with uterine anomalies was made to determine the relationship of anomalies to infertility, to obstetric outcome, and to indications for surgical reconstruction (metroplasty). For 41 of the 49 patients with obstetric histories, the overall pregnancy wastage was 72%, with bicornuate and septate patients having 85 to 90% wastage. The 28% of pregnancies that were successful were largely accounted for by patients with didelphic anomalies. It was found that infertility was an uncommon problem in these patients and it should rarely be an indication for metroplasty. In 21 patients properly selected for metroplasty because of repeat pregnancy loss, the obstetric outcome improved from 7% successful pregnancies before surgery to 75% postoperatively. Patients with septate or bicornuate anomalies were found to be poor obstetric performers and likely candidates for repair, while patients with didelphic anomalies achieved obstetric satisfaction without surgical intervention.