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Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study

Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study. Gundabattula S, Marakani L, Yanamandra N, Dasari S, Joseph E, Nirmalan P. Hyderabad, India Website : www.fernandezhospital.com. Introduction. Prevalence of uterine malformation : 4.3%

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Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study

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  1. Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study GundabattulaS, MarakaniL, YanamandraN, DasariS, Joseph E, NirmalanP Hyderabad, India Website : www.fernandezhospital.com

  2. Introduction • Prevalence of uterine malformation : 4.3% • Septate uterus – mean incidence: 35% • Infertility • First and Second trimester loss

  3. Aim • To evaluate the reproductive outcome of septal resection in women with • Infertility • Prior pregnancy losses

  4. Methods • Retrospective study 2003 – 2010 • Data retrieved via electronic database as well as manually through case records • 124 women identified • 74 women (59.7%) – incomplete septum • 50 (40.3%) – complete septum

  5. Procedure • Under general anaesthesia • Septoplasty was performed • 26 FrResectoscope (Karl Storz) with a cutting monopolar electrode • Versapoint Hysteroscopy system (Gynaecare Versapoint) • Septum was divided in upward direction until both tubal ostia were visualised in same plane

  6. Results • Total no. of women : 124 • Mean age : 27 years • Indication • Prior pregnancy losses 52 • Primary infertility (1 – 17 years) 43 • Secondary infertility 21 • Incidental finding 08

  7. Total 124 • Data available 84 • Lost follow up 40 • Conceived 63 • Total pregnancies 98 • Outcome known 92 • Lost to follow up 6

  8. Laparoscopy

  9. First and Second Trimester Miscarriage

  10. Pregnancy rate 59.3% Miscarriage 39.1% Live birth rate 52.2% Infertility Outcome

  11. Cervical cerclage – 41 (33%) • Type • McDonald 35 • Shirodkar 02 • Abdominal 04 • Indication • Prophylactic 37 (4 were abdominal) • Clinically short 03 • Rescue 01

  12. Cervical Cerclage • Post-resection cervical cerclage was done in 33% women • Over three fourths of pregnancies that had cerclage carried pregnancy to term

  13. Discussion • Inadequate septal vascularization • Abnormal placentation • In-coordinated contractility of septum

  14. Summary • This study demonstrates: • Reduction in miscarriage rates • Enhances pregnancy rate in those with infertility • Increases ‘take-home baby’ rate in those with previous miscarriages and infertility

  15. Conclusion • Metroplasty: • Significant improvement in reproductive performance • Outcome of patients with miscarriages is better than those with primary infertility

  16. Thank You

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