Literature Review Article
No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus: a prospective study. Gergolet M, Campo R, Verdenik I, Suster NK, Gordts S, Gianaroli L. Reprod Biomed Online 2012; 24 576-82.
Dr. John Preston Parry, M.D., M.P.H.
Patients with previous adverse obstetrical outcomes in the setting of a septate and subseptate uteri are anxious about subsequent pregnancy. There has been controversy as to whether subtle distortions of the endometrial cavity adversely affect reproductive outcome, but multiple recent papers suggest this to be the case. The authors pose the question as to whether repair of these more subtle distortions resulted in normal probability for live birth with subsequent conception after previous first trimester loss. These authors defined an arcuate uterus as one with a <1.5 cm depression below the interostial line and a subseptate uterus as >1.5 cm. Among patients with septate uteri, 96 underwent metroplasty and stratification, with 72 being characterized as having a subseptate uterus and 24 as having an arcuate uterus. Prior to surgery, 82.1% of pregnancies in patients with a subseptate uterus resulted in miscarriage, but afterwards the rate was 14%. For patients with arcuate uterus, 94.9% of pregnancies prior to metroplasty resulted in miscarriage, but only 11.1% of pregnancies after surgery were nonviable. Of note, the authors do not address potential selection bias in enrollment.) The authors conclude that the debate surrounding the precise classification of uteri as arcuate or septate may be moot if untreated reproductive outcomes are similar and intervention offers comparable benefit. Patients with Mullerian anomalies amenable to hysteroscopic metroplasty can be reassured that restoration of normal anatomic dimensions is likely to be associated with favorable obstetrical outcomes in a subsequent pregnancy.
Dr. Steven Lindheim, M.D.
This prospective study found no difference in reproductive outcome before or after hysteroscopic resection between septate and arcuate uterus thus a difference in classification of these two types of congenital anomalies may not be necessary. It may be time to review the current classification system and update as new clinical data become available.
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.