1. Reproductive Outcome Following Resection of Uterine Septum : A Retrospective Study Gundabattula S, Marakani L, Yanamandra N, Dasari S, Joseph E, Nirmalan P Hyderabad, India Website : www.fernandezhospital.com

2. Introduction  Prevalence of uterine malformation : 4.3%  Septate uterus – mean incidence : 35% – Infertility – First and Second trimester loss

3. Aim  To evaluate the reproductive outcome of septal resection in women with – Infertility – Prior pregnancy losses

4. Methods  Retrospective study 2003 – 2010  Data retrieved via electronic database as well as manually through case records  124 women identified – 74 women (59.7%) – incomplete septum – 50 (40.3%) – complete septum

5. Procedure  Under general anaesthesia  Septoplasty was performed – 26 Fr Resectoscope (Karl Storz) with a cutting monopolar electrode – Versapoint Hysteroscopy system (Gynaecare Versapoint)  Septum was divided in upward direction until both tubal ostia were visualised in same plane

6. Results  Total no. of women : 124  Mean age : 27 years  Indication – Prior pregnancy losses52 – Primary infertility (1 – 17 years)43 – Secondary infertility21 – Incidental finding08

7. Total 124 Lost follow up 40 Data available 84 Conceived 63 Total pregnancies 98 Lost to follow up 6 Outcome known 92

8. Pre-operative Imaging 80 had ultrasound Normal study49 Subseptum2 Complete septum8 Bicornuate uterus9 Hypoplastic uterus2 Inconclusive10

9. Laparoscopy Not performed24 - Laparotomy x 1 - Caesarean section x 1 Performed100

10. Miscarriage + / - Secondary Infertility

11. First and Second Trimester Miscarriage Pre- resection 169(%) Post resection 92(%) 1 st trimester 102 (60.4) 18 (21.1) 2 nd trimester 55 (32.5) 13 (15.2) Take home baby 3 (1.8) 56 (60.8)

12. First and Second Trimester Miscarriage

13. Infertility Outcome  Pregnancy rate 59.3%  Miscarriage 39.1%  Live birth rate 52.2%

14. Pre-resection (169) Post resection (92) p Value No. of pregnancies 16992 1 st trimester miscarriage 102 (60%) 18 (19%) p< 0.001 2 nd trimester miscarriage 55 (32%) 13 (14%) p= 0.002

15. Pre resection 169 (%) Post resection 92 (%) p Value Term pregnancy 2 (1.2) 50 (54.34) p< 0.001 IUFD /NND 7 (5.3) 3 (3.6) p= 0.75 Live birth 7 (4.1) 57 (61.9) p< 0.001 Take home baby 3 (1.8) 56 (60.8) p< 0.001

16. Cervical cerclage – 41 (33%)  Type – McDonald 35 – Shirodkar02 – Abdominal04  Indication – Prophylactic37 (4 were abdominal) – Clinically short03 – Rescue01

17. Cervical Cerclage  Post-resection cervical cerclage was done in 33% women  Over three fourths of pregnancies that had cerclage carried pregnancy to term

18. Author No. of patients Pre resection Post resection Bakas 201268 Preg rate 44% Live birth 37% Misc rate 17% Selvaraj 201026 Primary infertility Pai 200972 Primary infertility Preg rate 45%

19. Author No. of patients Pre resection Post resection Hicock 200040 Preg loss 77% Uncomplic del 6.5% Preg loss 18% Uncomplic del 77% Goldenberg 199547 Preg loss 87% Primary infertility 36 Preg loss 44% Preg rate 63% Fernandez Hospital 124 Preg loss 93 I ry infertility 41 Preg loss 32% Preg rate 75%

20. Study No. of Patients I ry Infertility (%) Miscarriage +/- II ry infertilty (%) Preg Rate Misc Rate Live Birth Preg Rate Misc Rate Live Birth Ayas 2011181441742771567 Nouri 201064752550681949 Selvaraj 20102632336863367 Mollo 200944394.534--- Saygili-Yilmaz 2002361251675 1675 Fernandez Hospital124593952853364

21. Discussion Study No. of Patients (%) Primary Infertility (%) Preg Rate Misc Rate Live Birth Ayas 2011181441742 Nouri 201064752550 Selvaraj 201019 / 26 6 (32) 2 (33) 4 (6) Mollo 200944 17 (39) 2 (4.5) 15 (34) Saygili-Yilmaz 2002193 / 361 45 (25) 29 (16) 135 (75) Fernandez Hospital study124593952

22. Discussion Study No. of Patients (%) Miscarriage + / - Sec. infertilty (%) Preg Rate Misc Rate Live Birth Ayas 2011181771567 Nouri 201064681949 Selvaraj 201019 / 26 6 (86) 2 (33) 4 (67) Mollo 200944--- Saygili-Yilmaz 2002193 / 361135 (75)29 (16)135 (75) Fernandez Hospital study124 853364

23. Discussion  Inadequate septal vascularization  Abnormal placentation  In-coordinated contractility of septum

24. Summary  This study demonstrates: – Reduction in miscarriage rates – Enhances pregnancy rate in those with infertility – Increases ‘take-home baby’ rate in those with previous miscarriages and infertility

25. Conclusion  Metroplasty: – Significant improvement in reproductive performance – Outcome of patients with miscarriages is better than those with primary infertility

26. Thank You