Hysteroscopic metroplasty of the complete uterine septum, duplicate cervix and vaginal septum

Literature Review Article

Hysteroscopic metroplasty of the complete uterine septum, duplicate cervix and vaginal septum. Parsanezhad M, Alborzi S, Zarei A, Dehbashi S, Shirazi L, Rajaeefard A, Schmidt E. Fertility and Sterility 01 May 2006; 85(5): 1473-7. 

Review
Kelly E. Peacock, M.D., Charlotte, NC

The authors performed a prospective, randomized, controlled trial on 28 women with complete uterine septum, duplicate cervix and vaginal septum. All patients underwent hysterosalpingogram, ultrasound, and MRI to confirm diagnosis. Procedures were performed by one of two surgeons. Patients were randomized into two groups. Group A underwent resection of vaginal septum and hysteroscopic metroplasty (HMP) along with resection of the cervical portion of the septum. Group B underwent resection of the vaginal septum and HMP with preservation of the cervical septum. Baseline characteristics of the two groups were similar. Operative time was significantly less in group A (36 min) compared to group B (73 min). Total distention media volume and distention media deficit was significantly less in group A than group B. Though not statistically significant, there was a higher complication rate in group B compared to A. Three patients had an estimated blood loss greater than 150 mL and two of these patients endured a perforation. There were two incidences of pulmonary edema in group B. Postoperatively, there were no significant differences in abortion, premature, or term delivery rates. There was a 100% pregnancy rate in both groups, with an 87% neonatal survival rate in group A and 85% neonatal survival rate in group B. There were no diagnoses of cervical incompetence, though four patients in group A and two patients in group B received a cerclage. There was a significantly higher rate of cesarean section in group B.
 

Comments 
Steven R. Lindheim, M.D., Dept Ob/Gyn, Univ of Wisconsin
Meike L. Uhler, M.D., Fertility Center of Illinois

Adolescent patients who present with pain require prompt and accurate diagnosis. Careful pelvic examination can reveal hematocolpos due to an obstructive reproductive tract anomaly. This article illustrates that the frequency of these disorders is higher than previously reported. Proper imaging studies to permit timely diagnosis followed by surgical correction are essential.

 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.

 

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