COMPARATIVE ANALYSIS OF REPRODUCTIVE OUTCOMES AFTER CLASSICAL HYSTEROSCOPIC METROPLASTY AND A MODIFIED METHOD IN WOMEN WITH RPL-SYNDROM

Authors

DOI:

https://doi.org/10.11603/24116-4944.2024.1.14739

Keywords:

intrauterine septum, hysteroscopic metroplasty, intrauterine adhesions, RPL-syndrome, infertility, miscarriage, mullerian anomalies

Abstract

The aim of the study - to conduct a comparative analysis of reproductive outcomes in women with RPL-syndrome after using modified and traditional electrosurgical hysteroscopic metroplasty.

Materials and Methods. 138 patients with primary miscarriage (RPL-syndrome) and/or premature birth participated in the study. The main group (1st сlinical) consisted of 88 patients with performed hysteroscopic metroplasty according to the proposed modified technique. The comparative group (2nd clinical) consisted of 50 patients who received surgical treatment according to the classical method of GM. The results regarding the onset of pregnancy and their completion were assessed by interviewing during consultations or according to survey data. Statistical analysis of the obtained results was carried out using the program «Primer Biostatistics» (USA).

Results and Discussion. In the main group, compared to the second group, the frequency of spontaneous miscarriages decreased by 3 times, the frequency of spontaneous pregnancies increased by 20%, and the total frequency of pregnancies and live births increased (p<0.05).

Conclusions. The obtained research results indicate the expediency of implementation and use of the modified hysteroscopic metroplasty method.

 

Author Biographies

  • Yu. L. Kalitsynska, Odessa National Medical University

    аспірант, кафедра акушерства та гінекології, Одеський національний медичний університет

  • I. Z. Gladchuk, Odessa National Medical University

    д-р мед. наук, професор, завідувач кафедри акушерства та гінекології Одеського національного медичного університету

References

1. Fascilla, F. D., Resta, L., Cannone, R., De Palma, D., Ceci, O. R., Loizzi, V., ... Bettocchi, S. (2020). Resectoscopic metroplasty with uterine septum excision: a histologic analysis of the uterine septum. Journal of Minimally Invasive Gynecology, 27(6), 1287–1294. DOI: https://doi.org/10.1016/j.jmig.2019.11.019.

2. Amer, M. I., Nageeb, L., Mohammed, W., & Hefny, A. (2018). Histologic features of uterine septum. The Egyptian Journal of Hospital Medicine, 73(2), 5998–6003.

3. Rikken, J. F. W., Verhorstert, K. W. J., Emanuel, M. H., Bongers, M. Y., Spinder, T., Kuchenbecker, W. K. H., ... Goddijn, M. (2020). Septum resection in women with a septate uterus: a cohort study. Human Reproduction, 35(7), 1578–1588. DOI: https://doi.org/10.1093/humrep/dez284.

4. Roy, K. K., Anusha, S. M., Rai, R., Das, A., Zangmo, R., & Singhal, S. A. (2021). Prospective randomized comparative clinical trial of hysteroscopic septal resection using conventional resectoscope versus miniresectoscope. Journal of Human Reproductive Sciences, 14(1), 61–67. DOI: https://doi.org/10.4103/jhrs.JHRS_12_20.

5. Catena, U., Campo, R., Bolomini, G., Moruzzi, M. C., Verdecchia, V., Nardelli, F., ... Testa, A. S. (2021). New approach for T-shaped uterus: Metroplasty with resection of lateral fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-step technique. Facts, Views & Vision in ObGyn, 13(1), 67–71. DOI: https://doi.org/10.52054/FVVO.13.1.003.

6. Practice Committee of the American Society for Reproductive Medicine. (2016). Uterine septum: a guideline. Fertility and Sterility, 106(3), 530–540. DOI: https://doi.org/10.1016/j.fertnstert.2016.05.014.

7. Rikken, J. F. W., Verhorstert, K. W. J., Emanuel, M. H., Bongers, M. Y., Spinder, T., Kuchenbecker, W. K. H., ... Goddijn, M. (2020). Septum resection in women with a septate uterus: a cohort study. Human Reproduction, 35(7), 1578–1588. DOI: https://doi.org/10.1093/humrep/dez284.

8. Rikken, J. F. W., Kowalik, C. R., Emanuel, M. H., Bongers, M. Y., Spinder, T., Jansen, F. W., ... Goddijn, M. (2021). Septum resection versus expectant management in women with a septate uterus: an international multicenter open-label randomized controlled trial. Human Reproduction, 36(5), 1260–1267. DOI: https://doi.org/10.1093/humrep/deab037.

9. National Institute for Health and Care Excellence (NICE). (2015). Hysteroscopic metroplasty of a uterine septum for primary infertility. URL: https://www.nice.org.uk/guidance/ipg509/resources.

10. Bender, A. R., Christiansen, O. B., Elson, J., Kolte, A. M., Lewis, S., Middeldorp, S., ... Goddijn, M. (2018). ESHRE guideline: recurrent pregnancy loss. Human Reproduction Open, 2018(2), hoy004. DOI: https://doi.org/10.1093/hropen/hoy004.

11. Royal College of Obstetricians and Gynaecologists (RCOG). (2011). The investigation and treatment of couples with recurrent first-trimester and second-trimester miscarriage. Green-top Guideline No. 17. URL: https://www.rcog.org.uk/media/3cbgonl0/gtg_17.pdf.

12. Tonguc, E. A., Var, T., & Batioglu, S. (2011). Hysteroscopic metroplasty in patients with a uterine septum and otherwise unexplained infertility. International Journal of Gynecology & Obstetrics, 113(2), 128–130. DOI: https://doi.org/10.1016/j.ijgo.2010.11.023.

13. Krishnan, M., Narice, B. F., Ola, B., & Metwally, M. (2021). Does hysteroscopic resection of uterine septum improve reproductive outcomes: a systematic review and meta-analysis. Archives of Gynecology and Obstetrics, 303(5), 1131–1142. DOI: https://doi.org/10.1007/s00404-021-05975-2.

14. Alvero, R., Burney, R. O., Khorshid, A., Saravanabavanandhan, B., Pier, B. D., Rosalik, K. F., & Schlaff, W. D. (2021). Surgical treatment of the uterine septum to improve reproductive outcomes—to resect or not? Fertility and Sterility, 116(2), 298–305. DOI: https://doi.org/10.1016/j.fertnstert.2021.06.009.

15. Pro zatverdzhennia Standartu medychnoi dopomohy "Ratsionalne zastosuvannia antybakterialnykh i antyfuhalnykh preparativ z likuvalnoiu ta profilaktychnoiu metoiu" [On approval of the Standard of medical care "Rational use of antibacterial and antifungal drugs for therapeutic and prophylactic purposes"]. (2023). Order of the Ministry of Health of Ukraine No. 1513. URL: https://moz.gov.ua/article/ministry-mandates/nakaz-moz-ukraini-vid-23082023-1513-pro-zatverdzhennja-standartu-medichnoi-dopomogi-racionalne-zastosuvannja-antibakterialnih-i-antifungalnih-preparativ-z-likuvalnoju-ta-profilaktichnoju-metoju [in Ukrainian].

16. Turocy, J. M., & Rackow, B. W. (2019). Uterine factor in recurrent pregnancy loss. Seminars in Perinatology, 43(2), 74–79. DOI: https://doi.org/10.1053/j.semperi.2018.12.003.

17. Homer, H. A. (2019). Modern management of recurrent miscarriage. Australian and New Zealand Journal of Obstetrics and Gynaecology, 59(1), 36–44. DOI: https://doi.org/10.1111/ajo.12920.

18. Li, W., Gao, B., Guan, Z., Zhao, X., Huang, H., Zhang, A., & Xu, D. (2021). Hysteroscopic incision of the incomplete uterine septum using 5-French scissors with marking strategies: a modified hysteroscopic technique. Fertility and Sterility, 116, 1423–1425. DOI: https://doi.org/10.1016/j.fertnstert.2021.06.017.

19. Yang, L., Wang, L., Chen, Y., Guo, X., Miao, C., Zhao, Y., ... Zhang, Q. (2021). Cold scissors versus electrosurgery for hysteroscopic adhesiolysis: a meta-analysis. Medicine, 100(17), e25676. DOI: https://doi.org/10.1097/MD.0000000000025676.

20. Fascilla, F. D., Resta, L., Cannone, R., De Palma, D., Ceci, O. R., Loizzi, V., ... Bettocchi, S. (2020). Resectoscopic metroplasty with uterine septum excision: a histologic analysis of the uterine septum. Journal of Minimally Invasive Gynecology, 27(6), 1287–1294. DOI: https://doi.org/10.1016/j.jmig.2019.11.019.

21. Amer, M. I., Nageeb, L., Mohammed, W., & Hefny, A. (2018). Histologic features of uterine septum. The Egyptian Journal of Hospital Medicine, 73(2), 5998–6003.

22. Hladchuk, I. Z., Hryhurko, D. O., & Kalitsynska, Yu. L. (2023). Porivnialnyi analiz efektyvnosti klasychnoi ta modyfikovanoi histeroskopichnoi metroplastyky u zhinok z RPL-syndromom [Comparative analysis of the effectiveness of classical and modified hysteroscopic metroplasty in women with RPL syndrome]. Zbirnyk naukovykh prats Asotsiatsii akusheriv-hinekolohiv Ukrainy – Collection of Scientific Works of the Association of Obstetricians and Gynaecologists of Ukraine, 2(52), 5–10. https://doi.org/10.35278/2664-0767.2(52).2023.298037 [in Ukrainian].

23. Hladchuk, I. Z., Hryhurko, D. O., & Kalitsynska, Yu. L. (2024). Porivnialnyi analiz chastoty pisliaoperatsiinykh vnutrishnomatkovykh synekhii pry klasychnomu sposobi histeroskopichnoi metroplastyky ta modyfikovanomu metodi [Comparative analysis of the incidence of postoperative intrauterine synechiae in the classical method of hysteroscopic metroplasty and the modified method]. Reproduktyvna endokrynolohiia – Reproductive Endocrinology, 71, 33–38. DOI: https://doi.org/10.18370/2309-4117.2024.71.33-38 [in Ukrainian].

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Published

2024-04-15

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Section

OBSTETRICS AND GYNECOLOGY

How to Cite

COMPARATIVE ANALYSIS OF REPRODUCTIVE OUTCOMES AFTER CLASSICAL HYSTEROSCOPIC METROPLASTY AND A MODIFIED METHOD IN WOMEN WITH RPL-SYNDROM. (2024). Actual Problems of Pediatrics, Obstetrics and Gynecology, 1, 16-21. https://doi.org/10.11603/24116-4944.2024.1.14739