Hysteroscopic metroplasty of a uterine septum for recurrent miscarriage

A non‑randomised comparative study of 78 women with a partial septate uterus and a history of recurrent miscarriage reported miscarriage rates of 22% (8 out of 37) after hysteroscopic metroplasty and 50% (9 out of 18) with expectant management (p<0.05), at a mean follow‑up of 11 months. A non‑randomised comparative study of 48 women with a septate uterus and a history of recurrent miscarriage reported miscarriage rates for the first pregnancy after enrolment of 18% (4 out of 22) after hysteroscopic metroplasty and 64% (9 out of 14) with expectant management (p<0.001), at a mean follow‑up of 36 months. A case series of 973 women with a septate uterus and a history of recurrent miscarriage or infertility reported the pregnancy outcomes of 344 women after hysteroscopic metroplasty: 78% (268 out of 344) of women reached term, 14% (48 out of 344) of women miscarried before 12 weeks' gestation, 4% (14 out of 344) of women miscarried after 12 weeks' gestation and 14 women were still pregnant at the close of the study (follow‑up period not reported). A case series of 170 women with a partial or complete septate uterus and a history of recurrent miscarriage, preterm delivery or infertility reported that before hysteroscopic metroplasty, 92% (332 out of 363) of pregnancies ended in miscarriage compared with 13% (24 out of 186) of pregnancies after hysteroscopic metroplasty (p=0.02), at a mean follow‑up of 29 months.

A review of 2,528 women (37 studies) with a septate uterus and a history of recurrent miscarriage, infertility, spontaneous abortion or preterm delivery, that included a meta‑analysis of 2,074 women (29 studies) reported a live birth rate of 50% after hysteroscopic metroplasty (95% confidence interval [CI] 43 to 57; 19 studies, n=1,525; follow‑up period not reported). A case series of 246 women with a septate uterus and a history of recurrent miscarriage or infertility reported a live birth rate after hysteroscopic metroplasty of 60% (71 out of 129) in women with a history of recurrent miscarriage, at a mean follow‑up of 37 months; there were 11 ongoing pregnancies at the close of the study.

The non‑randomised comparative study of 78 women with a partial septate uterus and a history of recurrent miscarriage reported preterm delivery in 5% (2 out of 37) of pregnancies in women treated by hysteroscopic metroplasty and 28% (5 out of 18) in women managed expectantly (p<0.05). The non‑randomised comparative study of 48 women with a septate uterus and a history of recurrent miscarriage reported preterm delivery in 5% (1 out of 22) of pregnancies after hysteroscopic metroplasty and 7% (1 out of 14) with expectant management, for the first pregnancy after enrolment (p value not stated). The case series of 170 women with a partial or complete septate uterus and a history of recurrent miscarriage, preterm delivery or infertility reported preterm delivery in 6% (22 out of 363) of pregnancies before hysteroscopic metroplasty compared with 8% (14 out of 186) of pregnancies after hysteroscopic metroplasty (p=0.12). The case series of 246 women with a septate uterus and a history of recurrent miscarriage or infertility reported a preterm delivery rate after hysteroscopic metroplasty of 11% (14 out of 129) of pregnancies in women with a history of recurrent miscarriage.

The specialist advisers listed the key efficacy outcomes as a normal‑sized uterine cavity, pregnancy rate, reduced miscarriage rate and increased live birth rate.