ISSN: 2148-8274 / E-ISSN: 2587-0084
, Türk Üreme Tıbbı ve Cerrahisi
Dergisi

Turkish Journal of Reproductive Medicine and Surgery

Dernek Sitesi
Kayıtlı İndexler
ORİJİNAL ARAŞTIRMALAR

Uterin Septumlu Olgularda Histeroskopik Septum İnsizyonu Sonrası Gebelik Sonuçları
Pregnancy Results Following Hysteroscopic Septum Incision in Cases with Uterine Septum
Received Date : 08 Dec 2020
Accepted Date : 13 Jan 2021
Available Online : 03 Feb 2021
Doi: 10.24074/tjrms.2020-80478 - Makale Dili: TR
TJRMS. 2020;4(2):53-8
ÖZET
Amaç: Bu çalışmanın amacı, tekrarlayan gebelik kaybı öyküsü olan veya primer infertilite tanısı ile başvuran ve eş zamanlı uterin septum tespit edilen olgularda histeroskopik septum insizyonu sonrası gebelik sonuçlarının retrospektif olarak incelenmesidir. Gereç ve Yöntemler: Çukurova Üniversitesi Tıp Fakültesi Kadın Hastalıkları ve Doğum Kliniği İnfertilite Polikliniğine primer infertilite veya tekrarlayan gebelik kaybı nedeniyle başvuran ve histerosalpingografide uterin septum tespit edilen 76 hasta çalışmaya dahil edildi. 27 hasta primer infertil, 49 hasta tekrarlayan gebelik kaybı öyküsü olan grupta idi. Tüm olgulara genel anestezi altında laparoskopi eşliğinde histeroskopik septum insizyonu operasyonu uygulandı. Postoperatif takip süresi 18 ± 8 ay olarak alındı. Her iki grup operasyon öncesi ve sonrası toplam gebelik sayısı, toplam abortus ile preterm ve term doğum sayısı, kümülatif canlı doğum oranları, doğum şekilleri, kontrol HSG’leri ve reopere olabilme olasılıkları açısından karşılaştırıldı. Bulgular: Elli-beş (% 72,4) hastanın komplet, 21 (% 27,6) hastanın inkomplet septumu mevcuttu. Operasyon sonrası 76 hastanın 55 (% 72,4)’i gebe kaldı, toplam gebelik sayısı 79 idi. Bunun 14 (% 17,8)’ü spontan abortus, 12 (% 15,2)’si preterm doğum, 53 (% 67)’ü term doğum olarak tespit edildi. Operasyon öncesi % 3,4 olan kümülatif canlı doğum oranının operasyon sonrası % 70’ e yükseldiği saptandı. Sonuç: Uterin septumların histeroskopik insizyonu kolay uygulanabilir ve etkin bir yöntemdir. Özellikle tekrarlayan gebelik kaybı öyküsü olan hastalarda operasyonun başarısı primer infertil olan hastalara göre daha fazladır.
ABSTRACT
Objective: The aim of this study is to retrospectively examine the pregnancy outcomes after hysteroscopic septum incision in cases with a history of recurrent pregnancy loss or a diagnosis of primary infertility and in whom uterine septum is detected. Material and Methods: Seventysix patients who were admitted to the Infertility Outpatient Clinic of Çukurova University Faculty of Medicine due to primary infertility or recurrent pregnancy loss and who had uterine septum detected in hysterosalphingography were included in the study. 27 patients were in the primary infertile group, 49 patients were in the group with a history of recurrent pregnancy loss. A laparoscopy-guided hysteroscopic septum incision was performed under general anesthesia. Postoperative follow-up period was taken as 18 ± 8 months. Both groups were compared in terms of pre- and postoperative total pregnancy numbers, total abortus, preterm, term births, cumulative live birth rates, delivery types, control HSGs and their reoperation. Results: Fifty-five (72.4%) patients had complete septum and 21 (27.6%) patients had incomplete septum. 55 (72.4%) of 76 patients became pregnant after the operation, the total number of pregnancies was 79. Of these, 14 (17.8%) were found as spontaneous abortion, 12 (15.2%) as preterm delivery, and 53 (67%) as term delivery. The cumulative live birth rate, which was 3.4% before the operation, increased to 70% after the operation. Conclusion: Hysteroscopic incision of the uterine septum is an easy and effective method. Especially in patients with a history of recurrent pregnancy loss, the success of the operation is higher than in patients with primary infertility.
REFERANSLAR
  1. Giacomucci E, Bellavia E, Sandri F, Farina A, Scagliarini G. Term delivery rate after hysteroscopic metroplasty in patients with recurrent spontaneous abortion and T-shaped, arcuate and septate uterus. Gynecol Obstet Invest. 2011;71(3):183-8.[Crossref] [PubMed] 
  2. Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761-71.[Crossref] [PubMed] [PMC] 
  3. Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161-74.[Crossref] [PubMed] 
  4. Rikken J, Leeuwis-Fedorovich NE, Letteboer S, Emanuel MH, Limpens J, van der Veen F, et al. The pathophysiology of the septate uterus: a systematic review. BJOG. 2019;126(10):1192-9.[Crossref] [PubMed] 
  5. Heinonen PK. Complete septate uterus with longitudinal vaginal septum. Fertil Steril. 2006;85(3):700-5.[Crossref] [PubMed] 
  6. Fedele L, Bianchi S, Marchini M, Franchi D, Tozzi L, Dorta M. Ultrastructural aspects of endometrium in infertile women with septate uterus. Fertil Steril. 1996;65(4):750-2.[Crossref] 
  7. Burchell RC, Creed F, Rasoulpour M, Whitcomb M. Vascular anatomy of the human uterus and pregnancy wastage. Br J Obstet Gynaecol. 1978;85(9):698-706.[Crossref] [PubMed] 
  8. Homer HA, Li TC, Cooke ID. The septate uterus: a review of management and reproductive outcome. Fertil Steril. 2000;73(1):1-14.[Crossref] 
  9. Rikken JF, Kowalik CR, Emanuel MH, Mol BW, Van der Veen F, van Wely M, et al. Septum resection for women of reproductive age with a septate uterus. Cochrane Database Syst Rev. 2017;1(1):Cd008576.[Crossref] [PubMed] [PMC] 
  10. Fedele L, Arcaini L, Parazzini F, Vercellini P, Di Nola G. Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis. Fertil Steril. 1993;59(4):768-72.[Crossref] 
  11. Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, Devroey P. Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod. 1998;13(5):1188-93.[Crossref] [PubMed] 
  12. Wang X, Hou H, Yu Q. Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol. Medicine (Baltimore). 2019;98(30):e16623.[Crossref] [PubMed] [PMC] 
  13. Rikken JFW, Verhorstert KWJ, Emanuel MH, Bongers MY, Spinder T, Kuchenbecker W, et al. Septum resection in women with a septate uterus: a cohort study. Hum Reprod. 2020;35(7):1578-88.[Crossref] [PubMed] [PMC] 
  14. Fedele L, Bianchi S, Marchini M, Mezzopane R, Di Nola G, Tozzi L. Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod. 1996;11(4):727-9.[Crossref] [PubMed] 
  15. Pabuccu R, Pabuccu EG, Gomel V. Reproductive outcomes of patients with T-Shaped and septate uterus following metroplasty: an observational study. Facts Views Vis Obgyn. 2020;11(4):317-21.
  16. Işıkalan MM, Yeniçeri H, Toprak E, Güleroğlu FY, Acar A. Effect of previous cesarean sections on second-trimester uterine artery Doppler. J Obstet Gynaecol Res. 2020;46(9): 1766-71.[Crossref] [PubMed] 
  17. Bulbul R, Isikalan MM, Acar A. Maternal outcomes of conservative surgery in women with postpartum hemorrhage caused by abnormally invasive placenta. Ann Med Res 2020;27(5):1448-52.[Crossref]