The influence of different methods of hysteroscopic metroplasty using a bipolar resectoscope on the restoration of reproductive function in women with a septate uterus

Abstract

Uterine septum is the most common congenital anomaly of the uterus, accounting for 35% of all diagnosed malformations. Data on the effectiveness of restoring reproductive function in women with a septate uterus after hysteroscopic metroplasty are contradictory, there are no data on the comparison of reproductive results after removal and dissection of the septum using a bipolar hysteroresectoscope. The purpose of the study was to assess the effectiveness of reproductive function recovery after dissection and removal of the uterine septum using a bipolar hysteroresectoscope. Material and methods. 78 patients of group B with uterine septum, reproductive failure, bipolar hysteroscopic metroplasty were under observation. Among the examined patients, 39 suffered from miscarriage and 39 suffered from infertility. 37 women of the BI group underwent hysteroscopic bipolar dissection of the uterine septum; 41 women of the BII group underwent hysteroscopic bipolar resection of the septum. Results and their discussion. Within 2 years after metroplasty, pregnancy occurred in 86.49% of women in the BI group and in 100% of women in the BII group (p>0.05); the specific weight of miscarriages was 9.38% and 0.00%, respectively (p>0.05); childbirth - 58.88% and 70.97% (p>0.05); premature births – 17.65% and 6.45% (p>0.05); term deliveries - 38.24% and 64.52% (p<0.04, SD 0.34 [0.12-0.93]). In women with initial infertility, pregnancy occurred in 61.54% of women in the BI group (n=13) within 2 years after the operation, in 69.23% in the BII group (n=13) (p>0.05); the specific weight of miscarriages was 25.00% and 22.22%, respectively (p>0.05); childbirth - 75.00% and 77.78% (p>0.05); premature births – 12.50% and 11.00% (p>0.05); term deliveries - 62.50% and 66.67% (p>0.05). Analysis of recovery of reproductive function 2 years after surgery in women with initial miscarriage showed that 90.48% of women in the BI group became pregnant, 94.44% in the BII group (p>0.05); the specific weight of miscarriages was 31.58% and 11.76%, respectively (p>0.05); childbirth - 68.42% and 88.24% (p>0.05); premature births – 26.32% and 5.88% (p>0.05); term deliveries - 42.11% and 82.35% (p<0.02, SD 0.16 [0.03-0.73]). Conclusions. The use of the technique of removal of the uterine septum during bipolar hysteroresectoscopy compared to the technique of its dissection in women with a septate uterus and reproductive failure leads to a probable increase in the termination of pregnancy by term delivery both in the general group and in the group of patients with initial miscarriage.