Uterine surgery by operative hysteroscopy

Uterine anomalies are found in 10-15% of women with repeated pregnancy loss; Uterine malformations and benign tumors are common causes of abortions, premature labour and abnormal fetal presentation in some cases. One-third of patients with habitual abortion have a septated or subseptated uterus, and two-thirds of pregnancies in women with duplicated uterus progress to term. Mullerian fusion defects and submucous fibroid may cause poor implantation or ineffective maternal blood supply to the placental site of the developing pregnancy. When these abnormalities were evaluated in infertile patients or in habitual abortions, traditionally the abdominal correction (Jones, Strassman, Tompkins etc.) were used traditionally. These procedures require incision of abdominal and uterine walls in general anesthesia with relative long hospitalization and recovery. The new endoscopic procedure; hysteroscopy is used not only to evaluate the type and size of Mullerian fusion defects but also to treat this malformation. The uterine septum is transsectable, via this elegant method, without injury of abdominal wall and healthy uterine wall musculature. After a traditional abdominal metroplasty there is no other choice other than the cesarean section to prevent rupture of the uterus, but after hysteroscopic septotomy the vaginal delivery is possible and the uterine rupture rarity. (C) 1997 Elsevier Science Ireland Ltd.