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Archives of Gynecology and Obstetrics
Published in: Archives of Gynecology and Obstetrics 5/2021

Open Access 01-05-2021 | Miscarriage | Review

Does hysteroscopic resection of uterine septum improve reproductive outcomes: a systematic review and meta-analysis

Authors: Monica Krishnan, Brenda F. Narice, Bolarinde Ola, Mostafa Metwally

Published in: Archives of Gynecology and Obstetrics | Issue 5/2021

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Abstract

Purpose

Uterine septum in women with subfertility or previous poor reproductive outcomes presents a clinical dilemma. Hysteroscopic septum resection has been previously associated with adverse reproductive outcomes but the evidence remains inconclusive. We aimed to thoroughly and systematically appraise relevant evidence on the impact of hysteroscopically resecting the uterine septum on this cohort of women.

Methods

AMED, BNI, CINAHL, EMBASE, EMCARE, Medline, PsychInfo, PubMed, Cochrane register of controlled trials, Cochrane database of systematic reviews and CINAHL were assessed to April 2020, with no language restriction. Only randomised control trials and comparative studies which evaluated outcomes in women with uterine septum and a history of subfertility and/or poor reproductive outcomes treated by hysteroscopic septum resection against control were included. The primary endpoint was live birth rate, whereas clinical pregnancy, miscarriage, preterm birth and malpresentation rates were secondary outcomes.

Results

Seven studies involving 407 women with hysteroscopic septum resection and 252 with conservative management were included in the meta-analysis. Hysteroscopic septum resection was associated with a lower rate of miscarriage (OR 0.25, 95% CI 0.07–0.88) compared with untreated women. No significant effect was seen on live birth, clinical pregnancy rate or preterm delivery. However, there were fewer malpresentations during labour in the treated group (OR 0.22, 95% CI 0.06–0.73).

Conclusion

Our review found no significant effect of hysteroscopic resection on live birth. However, given the limited evidence available, high-quality randomised controlled trials are recommended before any conclusive clinical guidance can be drawn.
Appendix
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Metadata
Title
Does hysteroscopic resection of uterine septum improve reproductive outcomes: a systematic review and meta-analysis
Authors
Monica Krishnan
Brenda F. Narice
Bolarinde Ola
Mostafa Metwally
Publication date
01-05-2021
Publisher
Springer Berlin Heidelberg
Published in
Archives of Gynecology and Obstetrics / Issue 5/2021
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI
https://doi.org/10.1007/s00404-021-05975-2

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