The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum

Literature Review Article

The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Patton P, Novy M, Lee D, Hickok L., Am Jour Ob Gyn 01 Jun 2004; 190(6): 1669-75. 

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

This is a retrospective review of 16 patients exhibiting septate uterus, duplicate cervix, and a longitudinal vaginal septum. None were correctly diagnosed prior to referral, with the most common misdiagnosis being uterus didelphys. The most common presenting complaint in nulliparous patients was dyspareunia (n=7) and in parous patients was pregnancy loss (n=7). Final diagnoses were made using MRI or a combination of hysterosalpingography and ultrasound. Fourteen patients underwent hysteroscopy and laparoscopy. This allowed for confirmation of anatomic findings along with hysteroscopic resection of the septum. Hysteroscopic resection was successful in 11 patients. The three patients who failed hysteroscopic management, along with two patients chosen for primary intervention by laparotomy, underwent a modified Tompkins metroplasty. Of the 14 patients who attempted pregnancy, 12 conceived. There were 17 pregnancies and 14 live births. Combined first trimester spontaneous abortion rate was 17.6%, with remaining pregnancies extending to the third trimester or term delivery. Nine of twelve pregnancies in the hysteroscopy group resulted in third trimester or term deliveries (75%), while five of five pregnancies in the laparotomy group delivered in the third trimester or at term (100%). 
 

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

This study highlights the difficulty in making the correct diagnosis in patients with congenital anomalies of the reproductive tract. Since some Mullerian defects are associated with minimal obstetric risk while others can impact significantly on reproductive outcomes, it is of paramount importance to identify and select those patients who would benefit from surgical management. 

 

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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