Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment.

STUDY
OBJECTIVE: To evaluate reproductive performance in women with a confirmed uterine anomaly treated by abdominal or hysteroscopic metroplasty, or by no surgical procedure.
DESIGN: Retrospective study.
SETTING: A university hospital. PATIENTS: Four hundred four women with uterine anomaly, of whom 247 had complete or partial septate uterus or partial bicornuate uterus.
INTERVENTIONS: Hysteroscopic metroplasty was performed in 32 patients with septate or subseptate uterus. Twenty women underwent abdominal metroplasty (Jones or Tompkins procedure) and 140 had no operative treatment.
MEASUREMENTS AND MAIN RESULTS: Fetal survival improved from 13% to 91% after hysteroscopic metroplasty and from 3% to 86% after the abdominal procedure. A living child was born in 67% of 264 pregnancies in 116 women with septate uterus with no surgical treatment. When 19 patients with hysteroscopic metroplasty were matched by age, gravidity, and type of uterine anomaly with 19 women not subjected to metroplasty, the rates were 86% and 68%, respectively (p = 0.089).
CONCLUSIONS: Hysteroscopic metroplasty has replaced abdominal metroplasty in the treatment of septate uterus. It improves the fetal survival rate in women with repeated miscarriage. It does not enhance pregnancy rates in infertile women with septate uterus, but as a minimally invasive uterine repair, it may be carried out before assisted reproduction. Pregnancy in the septate uterus can also progress without any surgical treatment. Metroplasty seems to prevent breech delivery and to decrease the cesarean section rate, which are potential benefits.