Author/Editor		Ban, Helena; Tomaževič, Tomaž; Ribič-Pucelj, Martina; Vogler, Andrej; Bokal-Vrtačnik, Eda
Title		Histeroskopska resekcija pregrade - vpliv na nosečnost
Translated title		Hysteroscopic resection of uterine septum - effects on pregnancy
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 2
Publication year		2003
Volume		str. II-73-5
Language		slo
Abstract		Background. In women with spontaneous abortions, preterm deliveries or infertility, septate uterus is often detected on transvaginal ultrasound examination. Since 1993 we have used hysteroscopic resection to correct this anomaly. The aim of this study was to evaluate the effect of the arcuate uterus on the course of pregnancy and its outcome, and the effect of hysteroscopic resection of the arcuate uterus on the prognosis of pregnancy. Patients and methods. Retrospectively we analyzed prospectively collected data. Between 15 February 1993 and 31 December 1999 we performed 760 hysteroscopic resections of the septum at the Department of Obstetrics and Gynecology in Ljubljana. We evaluated the course of pregnancy and its outcome only, therefore we enrolled 241 women, who conceived spontaneously before and after operation. Results. In the group of women with arcuate uterus (n =111) there were 244 pregnancies before hysteroscopic resection. 38 (15.6%) ended with a delivery and 202 (82.8%) with a spontaneous abortion. In the group of women with septate uterus (n = 230) there were 269 pregnancies: 42 deliveries (15.6%) and 224 (83.3%) spontaneous abortions. After hysteroscopic resection there were 109 pregnancies in the women with arcuate uterus: 91 (83.5%) deliveries and 16 (14.7%) spontaneous abortions; in the septate uterus group there were 118 pregnancies: 98 (83.2%) deliveries and 16 (13.5%) spontaneous abortions. In both groups there was a significant improvement in the delivery rate (p < 0.00000). Before resection the preterm delivery rates were significantly higher in both groups (arcuate: 50.0%; septate: 35.1%) than after the resection (arcuate: 11.3%; septate 17.7%). Conclusions. The women with either septate or arcuate uterus are at a higher risk for spontaneous abortion and preterm delivery. Hysteroscopic resection significantly decreases the risk in both groups of women.
Summary		Izhodišča. Pri ženskah s spontanim splavom, prezgodnjim porodom ali pri neplodnih ženskah z vaginalnim ultrazvokom pogosto odkrijemo pregrado v maternici, ki jo od leta 1993 tudi histeroskopsko reseciramo. Zato smo želeli ugotoviti pomen majhne pregrade na potek in izid nosečnosti in poroda ter oceniti vpliv histeroskopske resekcije na napoved izida nosečnosti. Preiskovanke in metode. Retrospektivno smo analizirali prospektivno zbrane podatke. Na Ginekološki kliniki v Ljubljani je bilo med 15. 2. 1993 in 31. 12. 1999 histeroskopsko operiranih 760 žensk zaradi pregrade v maternici. Zanimal nas je samo izid nosečnosti in poroda in ne neplodnost, ki je morebiti tudi povezana s pregrado v maternici. V raziskavo smo zato vključili 241 žensk, ki so tako pred operacijo kot po njej brez težav zanosile. Rezultati. Pred histeroskopsko resekcijo je bilo v skupini 111 žensk z majhno pregrado 244 nosečnosti: 38 (15,6%) je bilo porodov ter 202 (82,8%) spontanih splavov. V skupini 130 žensk z večjo pregrado je bilo 269 nosečnosti: 42 (15,6%) porodov ter 224 (83,3%) spontanih splavov. Po histeroskopski resekciji je bilo v skupini žensk z majhno pregrado 109 nosečnosti: 91 (83,5%) porodov ter 16 (14,7%) spontanih splavov. V skupini žensk z večjimi pregradami pa 218 nosečnosti: 98 (83,2%) porodov ter 16 (13,5%) spontanih splavov. V obeh skupinah je bilo po histeroskopski resekciji značilno več porodov (p < 0 00000). Pred resekcijo je bilo v obeh skupinah značilno več prezgodnjih porodov (50,0% pri majhnih pregradah ter 35,1% pri večjih) po resekciji pa 11,3% ter 17,7%. Zaključki. Tako ženske z večjimi kot z manjšimi pregradami imajo večje tveganje za spontani splav in prezgodnji porod. S histeroskopsko resekcijo pregrade se tveganje v obeh skupinah pomembno zmanjša.
Descriptors		PREGNANCY COMPLICATIONS UTERUS HYSTEROSALPINGOGRAPHY PREGNANCY ABORTION, MISSED HYSTEROSCOPY LABOR, PREMATURE