Clinical implications of uterine malformations and hysteroscopic treatment results

Uterine malformations consist of a group of miscellaneous congenital anomalies of the female genital system. Their mean prevalence in the general population and in the population of fertile women is similar to4.3%, in infertile patients similar to3.5% and in patients with recurrent pregnancy losses similar to 13%. Septate uterus is the commonest uterine anomaly with a mean incidence of similar to 35% followed by bicornuate uterus (similar to 25%) and arcuate uterus (similar to 20%). It seems that malformed uterus and especially septate uterus is not an infertility factor in itself. However, it may have a part in the delayed natural conception of women with mainly secondary infertility. On the other hand, patients with uterine malformations seem to have an impaired pregnancy outcome even as early as their first pregnancy. Overall term delivery rates in patients with untreated uterine malformations are only similar to 50% and obstetric complications are more frequent. Unicornuate and didelphys uterus have term delivery rates of similar to 45%, and the pregnancy outcome of patients with untreated bicornuate and septate uterus is also poor with term delivery rates of only similar to 40%. Arcuate uterus is associated with a slightly better but still impaired pregnancy outcome with term delivery rates of similar to 65%. Women who have undergone hysteroscopic septum resection and have been reported in the different series comprise a highly selected group of symptomatic patients with term delivery and live birth rates of only similar to5%. Hysteroscopic treatment seems to restore an almost normal prognosis for the outcome of their pregnancies with term delivery rates of similar to 75% and live birth rates of similar to 85%. It seems, therefore, that hysteroscopic septum resection can be applied as a therapeutic procedure in cases of symptomatic patients but also as a prophylactic procedure in asymptomatic patients in order to improve their chances for a successful delivery.