Unfortunately, there is no foolproof method for gauging whether the incision has been made far enough or whether a residual septum will result, possibly requiring additional surgery, versus extending the incision too far into the myometrium and increasing the risk of subsequent uterine rupture.
Perhaps the most difficult aspect of the procedure is the determination of the end point.
there are now several case reports of uterine rupture after prior hysteroscopic resection. Interestingly, they include cases in which no electrosurgery was used and no evidence of uterine perforation was found at the time of surgery.
Given these reports, it is advisable to monitor patients who have undergone prior uterine surgery with a heightened sense of concern during labor.
Propst et al. noted a complication rate of 9.5% for uterine septum resection.
A follow-up examination should be performed 1 month to 2 months after the procedure; ultrasonography, HSG, and hysteroscopy are reasonable approaches.
more than one procedure may be required to completely restore the cavity to normal.
patients with a previous hysteroscopic metroplasty for septate uterus are at increased risk for fetal malpresentation at term, low birth weight infants, and caesarean delivery. Therefore, these patients should be informed of these risks before delivery.
After hysteroscopic treatment, results were markedly improved, with 81% of patients achieving pregnancy; of these, 83% were term, 7% were preterm but viable, and only 12% ended in first-trimester losses.
Overall, due to the ease and low morbidity associated with hysteroscopic metroplasty for a septate uterus, as well as its demonstrated association with improved obstetric outcomes, this procedure should be considered in infertile women with a septate uterus prior to advanced fertility treatment.
Oh, laparoscopy blogs.
May I never hear or even read the term “pregnancy wastage” again.