Author/Editor		Tomaževič, Tomaž; Ban, Helena; Premru-Sršen, Tanja; Ribič-Pucelj, Martina; Verdenik, Ivan; Vogler, Andrej; Bokal-Vrtačnik, Eda; Virant, Irena; Zorn, Branko; Drobnič, Sašo
Title		Nosečnosti pred in po histeroskopski resekciji pregrad v maternični votlini
Translated title		A survey of pregnancies before and after hysteroscopic treatment of uterine septa
Type		članek
Source		Endoskopska revija
Vol. and No.		Letnik 5, št. 12-13
Publication year		2000
Volume		str. 69-76
Language		slo
Abstract		Study objective. To evaluate reproductive benefits of hysteroscopic transcervical treatment of uterine septa of different stages compared to the pre-treatment structure of pregnancies. Patients and methods. We analysed retrospectively 468 hysteroscopic metroplasties performed by means of a resectoscope during the period 1993 - 1998. The automated Vario Flow system and 5 per cent dextrose were used for uterine distention. Results. The preoperative structure of 574 pregnancies differed significantly from that observed in 282 pregnancies after the operation (P<0.0001). The spontaneous abortion rate fell from 75 to 11% (P<0.0001).Ð, and the share of preterm deliveries in all deliveries dropped from 51 to 11% (P<0.0001). The rate of ectopic pregnancy remained virtually unchanged (7% versus 6%). Perinatal and neonatal data for 177 deliveries in women who underwent metroplasty, recorded in the Perinatal System of Slovenia, did not differ from the data on 354 deliveries in normal controls. The proportion of small, AFS (American Fertility Society) stage VI uterine septa and of 1.5-cm uterine anomalies of AFS stage V (total septa) was 43% and 57%, retrospectively. After hysteroscopic discission of 209 AFS grade 6 uterine septa, the rate of spontaneous abortions among all pregnancies dropped from 77% to 13%, and after 157 discissions of AFS grade V septa from 74% to 13% (P<0.0001). The proportion of preterm deliveries in all deliveries decreased from 56% to 8% (P<0.0001) after metroplasties for minor (AFS grade VI) uterine anomalies, and from 47% to 12% after treatment of major (AFS grade V( uterine septa (P<0.002). Conclusions. The results have confirmed the curative value and the very probable preventive role of this safe and simple endoscopic procedure for the treatment of minor (AFS grade VI) and major (AFS grade V) uterine septa diagnosed by vaginal ultrasound and confirmed by hysteroscopy.
Summary		Izhodišče. Analizirati nosečnosti pred in po histeroskopski transcervikalni resekciji majhnih in večjih pregrad maternice s pomočjo resektoskopa - skupini 5 in 6 po Meriški klasifikaciji za fertilnost in sterilnost (AFS) - s pomočjo resektoskopa. Retrospektivna analiza 468 operacij v letih 1993-1998. Bolniki in metode. Histeroskopsko resekcijo v maternici smo opravili pri 167 bolnicah s pred tem neuspešnimi nosečnostmi in ali s prezgodnjim porodom, pri 121 primarno in 133 sekundarno neplodnih bolnicah. Za distenzijo maternice smo uporabili 5% raztopino glukoze in avtomatizirani distenzijski sistem Vario Flow. Rezultati. Struktura 574 nosečnosti pred operacijo se je statistično pomembno razlikovala od strukture 282 nosečnosti po operaciji (P<0.0001). Delež spontanih splavov se je po operaciji znižal s 75% na 11% (P<0.0001). Delež porodov se je ustrezno povečal. Delež prezgodnjih porodov med vsemi porodi se je statistično pomembno znižal z 51% na 11% (P<0,0001). Deleža ektopičnih nosečnosti med vsemi nosečnostmi pred in po posegu se nista značilno razlikovala: 7 and 6%. Periatalni in neonatalni podatki iz Slovenskega perinatalnega registra se pri 177 ženskah po metroplastiki niso razlikovali od podatkov pri 354 ženskah iz normalne kontrolne skupine. Med operirankami je bilo 43% žensk z manj izrazito pregrado (AFS 6) in 57% žensk z izzrazito pregrado maternične votline - 1,5 cm in več ter popolna pregrada (AFS 5). Delež spontanih splavov med vsemi nosečnostmi se je po 209 discizijah v skupini AFS 6 znižal s 77% na 13% in od 74% na 13% po 157 discizijah v skupini AFS 5 (P<0,0001). Delež prezgodnjega poroda se je po operaciji znižal s 56% na 8% (P<0,0001) v skupini z manj izrazito pregrado (AFS 6) in s 47% na 12% v skupini AFS 5 (š<0,002). Zaključki. Rezultati dokazujejo velik kurativni in preventivni pomen histeroskopske discizije izrazitih (AFS 5) in manj izrazitih (AFS 6) pregrad v maternici.
Descriptors		UTERUS HYSTEROSCOPY PREGNANCY UTERINE DISEASES RETROSPECTIVE STUDIES INFERTILITY, FEMALE ABORTION LABOR, PREMATURE