ارزیابی نتایج باروری رحم های سپتوم دار اصلاح شده با متروپلاستی هیستروسکوپیک

نوع مقاله: اصیل پژوهشی

نویسندگان

1 استادیار زنان و زایمان، دانشگاه علوم پزشکی

2 Gyneocologist of Obstetrics and Gyneocology, Iran University of Medical Sciences

3 کارورز، دانشگاه علوم پزشکی ایران

چکیده

مقدمه: ناهنجاریهای مادر زادی رحمی ناشی از اخـتلالات اتـصال سیـستم مـولرین شـایع تـرین ناهنجاریهـای
سیستم تناسلی هستند. هدف از این مطالعه ارزیابی نتـایج بررسـی بعـد از متروپلاسـتی ه یـستروسکوپیک در
زنان با رحم سپتوم دار که از نازایی یا سقط راجعه رنج می برند، بود.
روش کار: این مطالعه توصیفی از سال 2003 تا 2004 در بیمارستان رسول اکـرم دانـشگاه ایـران 19 زن در
سنین 21-35سال با نازایی اولیه یا سقط راجعه و رحم سپتوم دار تحـت رزکـسیون هیـستروسکوپیک سـپتوم
قرار گرفتند. همه سپتوم ها با قیچی برداشته و بیماران پیگیری شدند . بیمار در روز اول بعد از عمل و تقریبـا
2 ماه بعد برای نتایج جراحی ویزیت شدند . این ارزیابی به وسیله HSG (هیستروسالپنگوگرافی) انجـام شـد.
مشخصات فردی و نتایج و عوارض جراحی در پرسشنامه جمع آوری و آمار توصیفی با نـرم افـزار آمـاری
 SPSS پردازش گردید.
نتایج: مدت نازایی بیماران بین 2 تا 4 سال و با میانگین 5/4 و انحراف معیار 2 /3 متفاوت بود. میانگین دوره
پیگیری برای 9 زن حدود 3/7 ماه بود که 6 نفر از آنان بین 3-12 ماه بعد از جراحی باردار شدند.
نتیجه گیری: به نظر می رسد که رزکسیون هیستروسکوپیک سپتوم بهبود مشخـصی در نتـایج بـاروری در
زنان با سابقه نازایی و سقط قبلی به همراه دارد. 

کلیدواژه‌ها


عنوان مقاله [English]

The Evaluation of Reproductive Outcome of Septated Uterus Corrected by Hysteroscopic Metroplasty

نویسندگان [English]

  • Mansoreh Vahdat 1
  • Elaheh Sariri 1
  • Ameneh Haghgoo 2
  • Hajar Yousefnejad 3
  • Seyed-Mohammad Fereshtehnejad 3
1 Assistant Professor of Obstetrics and Gyneocology, Iran University of Medical Sciences
2 Gyneocologist of Obstetrics and Gyneocology, Iran University of Medical Sciences
3 Intern, Iran University of Medical Sciences
چکیده [English]

Introduction: Congenital uterine anomalies resulting from mullerian fusion defects are the most common malformations of the reproductive system. The purpose of this study was to evaluate the reproductive outcome after hysteroscopic metroplasty in women with septated uterus who suffer from infertility or recurrent abortion.
Material and Methods: This descriptive study was performed during the period from 2003 to 2004 at Rasul-e-Akram Hospital of Iran Medical University. A total of 19 women (aged 21-35 years) with primary infertility or recurrent abortion and septateuteri underwent hysteroscopic septum resection. All septa were removed with a scissor at 90 and patients were followed up. The patients were seen on the first postoperative day and visited approximately 2 months later for assessment of surgical outcomes. This assesment was accomplished with hysterosalpingography (HSG). Statistical analysis was carried out using SPSS V. 11.5.
Results: The duration of infertility among the patients differed from 2 to 14 years with the mean of 5.4 (SD=3.26) years. The mean follow-up period for 9 women was 7.3 (SD=1.94) months and six of them (66.6%) concived a pregnancy within 3-12 months after the surgery.
Conclusion: It seems that the hysteroscopic septum resection is accompanied by a significant improvement in the reproductive performance of women who suffer from infertility or recurrent abortion.

کلیدواژه‌ها [English]

  • Septated Uterus
  • Primary Infertility
  • HysteroscopicMetroplasty
  • RecurrentAbortion
1. Pabuccu R, Gomel V. Reproductive outcome after hysteroscopic metroplasty in women with
septate uterus and otherwise unexplained infertility. Fertile Steril 2002; 81(6):1675-1678.
2. Grimbizis G, Camus M, Clasen K. Hysteroscopic septum resection in patients with recurrent
abortions or infertility. Human Reprod1998;13(5):1188-1193.
3. Brau P, Grau FV, Pons RM. Is hysterosalpangography able to diagnose all uterine
malformations correctly? European Journal of Radiol 2005; 53: 274-279.
4. Acien P. Incidence of mullerian defects in fertile and infertile women. Hum Reprod 1997; 12:
1372-6.
5. Pellicer A. Shall we operate on mullerian defects? An introduction to the debate. Hum Reprod
1997;12: 1371-1372.
6. Heinonen KP, Saarikoski S, Postynen P. Reproductive performance of women with uterine
anomalies. Acta Obstet Gynecol Scand 1982; 61: 157-162.
7. Buttram CV. Mullerian anomalies and their management. Fertile Steril 1983;40: 159-163.
8. Patton PE, Novy MJ, Lee DM. The diagnosis and reproductive outcome after surgical treatment
of the complete septate uterus, duplicated cervix and vaginal septum. Am J of Obstet and Gyn
2004; 190:1669-78.
9. Mc Shane MP, Reilly JR, Schiff I. Pregnancy outcome following Tompkins metroplasty. Fertil
Introduction: Congenital uterine anomalies resulting from mullerian fusion defects are the
most common malformations of the reproductive system. The purpose of this study was to
evaluate the reproductive outcome after hysteroscopic metroplasty in women with septated
uterus who suffer from infertility or recurrent abortion.
Material and Methods: This descriptive study was performed during the period from 2003
to 2004 at Rasul-e-Akram Hospital of Iran Medical University. A total of 19 women (aged
21-35 years) with primary infertility or recurrent abortion and septate uteri underwent
hysteroscopic septum resection. All septa were removed with a scissor at 90◦
 and patients
were followed up. The patients were seen on the first postoperative day and visited
approximately 2 months later for assessment of surgical outcomes. This assesment was
accomplished with hysterosalpingography (HSG). Statistical analysis was carried out using
SPSS V. 11.5.
Results: The duration of infertility among the patients differed from 2 to 14 years with the
mean of 5.4 (SD=3.26) years. The mean follow-up period for 9 women was 7.3 (SD=1.94)
months and six of them (66.6%) concived a pregnancy within 3-12 months after the surgery.
Conclusion: It seems that the hysteroscopic septum resection is accompanied by a
significant improvement in the reproductive performance of women who suffer from
infertility or recurrent abortion.
 
Keywords: Septated Uterus, Primary Infertility, Hysteroscopic Metroplasty, Recurrent
Abortion
Abstract 
♦ Mansoreh Vahdat, MD, et al
112
Steril 1983; 175: 85-89.
10. Fedele L, Bianchi S. Hysteroscopic metroplasty for septate uterus. Obstet Gyneol Clin N Am
1995; 22:473-489.
11. Perino A, Schtaff DW. The Obstetric consequences of uterovaginal anomalies. Fertil Steril
1985;43:681-691.
12. Goldenberg M, Sivan E, Sharabi Z. Reproductive outcome following hysteroscopic
management of intrauterine septum and adhesions. Hum Reprod 1995;10:2663-2665.
13. Fedele L, Arcaini L, Parazzini F. Reproductive prognosis after hysteroscopic metroplasty in 102
women, life-table analysis. Fertil Sterile 1993;59:768-72.
14. Rock JA, Thaompson JD. The linde 's operative gynecology, 8th ed .phildelphia: LippincottRaven;
1997.
15. Buttram VC, Gibbons WE. Mullerian anomalies: a proposed classification (an analysis of 144
cases). Fertil Steril 1979;32:40-6.
16. Jacobsen IJ, Decherney A. Results of conventional and hysteroscopic surgery. Hum Reprod
1997;12:1376-1381.
17. Perino A, Mengaclia L, Hamou J. Hysteroscopy for metroplasty of uterine septs: report of 24
cases. Fertil Steril 1987;48:321-3.
18. Fedele L, Bianchi S, Marchini M. Ultrastructural aspects of endometrium in infertile women
with septate uterus. Fertil Steril 1996;65:750-2.
19. Marcus S, Al-Shawaf T, Brinsden P. The obstetric outcome of in vitro fertilization and embryo
transfer in women with congenital uterine malformation. Am J Obstet Gyn 1996;175:85-89.
20. Fayes JA. Comparision between abdominal and hysteroscopic metroplasty. Obstet Gyn
1986;63:399-403.
21. Daly DC, Mailer D, Soto-Albors C. Hysteroscopic metroplasty: six year 's experience. Obstet
Gyn 1989; 73:201-5.
22. Roch JA, Murphy AA, Cooper WH 4th. Resectoscopic techniques for the lysis of a class V:
complete uterine septum. Fertil Steril 1987;48:495-6.
23. Vercellini P, Ragni G, Trespidi L, Oldani S, Panazza S, Crosignani PG. A modified technique
for correction of the complete septate uterus. Acta Obstet Gyn Scand 1996;73:425-8.
24. Romer T, Lober R. Hysteroscopic correction of a complete septate uterus using a bolloon
technique. Hum Reprod 1997;12:478-9.
25. Nagel TC. Metroplasty of the class Va uterus Italian style (abstract O-284). Fifty-seventh
Annual Meeting of the American Society for Reproductive Medicine October 20-25,
2001.p.S107.
26. Valle RF. Hysteroscopic treatment of complete uterine septum with septate servix (abstract
VS72.1). Acta Obstet Gyn Scand 1997;76(Suppl.167):12.
27. Donnez J, Nisolle M. Endoscopic laser treatment of uterine malformations. Hum Repord 1997;
12: 1381-7.