الفهرس 
Anomalies of the reproductive genital tractOnly 14 pages are availabe for public view
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Abstract
Incomplete resorption of the mullerian duct during embryogenesis leads to mullerian anomalies that result in uterine defect which may alter the reproductive outcomes of the patients.
Septate uterus is the most frequent congenital malformation of the female reproductive tract. It is a mullerian anomaly resulting from incomplete resorption of paramesonephric ducts during the eleventh week of fetal development. Its frequency is difficult to determine because of different classification methods.
The frequency of septate uterus was estimated to be 5% among the general population. The anomaly accounts for 9% to 23% of genital malformations and 35% of uterine malformations. It is associated with various types of reproductive failure, including recurrent miscarriage, late abortion, and preterm delivery. No relationship has been shown between infertility and septate uterus.
Uterine septum resection by a hysteroscopy approach has been proved to be beneficial with significant improvement in pregnancy rates post procedure as well as shorter operating and hospitalization periods, reduced risk of post-operative pelvic adhesions, low morbidity and an increased rate of vaginal delivery.
The aim of the study was to evaluate the obstetric outcomes following hysteroscopic resection of uterine septum and its effects on live birth rates, rate of term pregnancies and fecundity in women who prior to the procedure suffered from infertility and on the rate of spontaneous miscarriages and to detect the complications of the procedure.
Ninety-nine Egyptian women were included in this retrospective – Case series study which performed at the Early Cancer Detection & Gyn Endoscopy Unit (ECD&GEU)-Ain Shams Maternity Hospital- Ain Shams University. All women were presented with uterine septum and underwent hysteroscopic septectomy.
The following data were fulfilled:
Personal history: Occupation (employed – un-employed).
Obstetric history: Parity, number of living children, mode of delivery, date of the last delivery, miscarriage, preterm labor.
All cases had done 2D U/S or 3D ultrasound or hysteronsalpingogram.
Diagnostic hysteroscopy was made prior to septum resection and pregnancy following the procedure was part of the ‘‘after septum resection’’ group.
Methodology of septectomy: was performed using uni-polar or scissor with normal saline as the distension medium either in office or under general anesthesia.
Type of the septum detected during the hysteroscopy: partial or complete.
Complication: perforation, excessive bleeding, fluid overload or thermal injury.
A second look hysteroscopy was performed in order to evaluate the uterine cavity before trial of conception (if needed).
Following pregnancy: Full term, preterm, miscarriage or no-pregnancy.
Results of this study showed that:
• Mean age of the included cases was (26.2±5.2).
• Most of the cases were multiparous (72%).
• Previous abortion was more than half of the risk factors among cases.
• Complete septum was less than tenth of the total number of cases, while partial septum was found in about 90% of the cases.
• Regarding the septectomy methods, Scissors was the most frequent method (68.7%), while Unipolar was in less than one third of the studied cases (29%).
• Regarding the further interventions, septal removal was the most intervention; was in less than one tenth of the studied cases, intra Uterine Balloon was in (3%) and intra Uterine Device was in (1%).
• Regarding the obstetric outcomes before and after hysteroscopic septectomy:
There was significant difference (increase) between pregnancy before and after septectomy.
There was significant difference (decrease) between cerclage before and after septectomy.
There was significant difference (decrease) between miscarriage before and after septectomy.
There was no significant difference (decrease) between preterm delivery before and after septectomy.
There was significant difference (increase) between full term before and after septectomy.
There was significant difference (increase) between viable neonate before and after septectomy.
There was significant difference (decrease) between cesarean delivery before and after septectomy, while significant increase between vaginal delivery before and after septectomy.
There was significant difference (decrease) between curettage before and after septectomy.
Regarding complications of hysteroscopy: only one case (0.9%) had PID, treated by antibiotics for 2 weeks and then she returned again with good endometrium and no symptoms or signs of infection.