The National Institute for Health and Care Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on Hysteroscopic metroplasty of a uterine septum for recurrent miscarriage, in January 2015.
A septate uterus is a type of congenital uterine anomaly, in which the inside of the uterus is divided by a muscular or fibrous wall, called the septum. The septum may be partial or complete, extending as far as the cervix. It is more common in women with infertility and in women with repeated miscarriage and may therefore be one cause of this problem.
Surgical removal of the septum (metroplasty) is usually considered for women who have a septate uterus and repeated adverse reproductive outcomes, including miscarriage and preterm delivery. Metroplasty has also been used to manage primary infertility but the causal relationship between this problem and the presence of a uterine septum is less clear.
Surgery was traditionally done by a transabdominal approach. A hysteroscopic approach aims to reduce morbidity and shorten the recovery period. Unlike transabdominal metroplasty, caesarean section is not mandatory for patients who conceive after hysteroscopic metroplasty.
The OPCS-4 code for hysteroscopic metroplasty is:
Q17.5 Endoscopic metroplasty
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account, and specifically any special arrangements relating to the introduction of new interventional procedures. The guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties. Providers should ensure that governance structures are in place to review, authorise and monitor the introduction of new devices and procedures.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.