Hysteroscopic metroplasty of a uterine septum for recurrent miscarriage

2 Indications and current treatments

2.1 A uterine septum is a congenital anomaly (present from birth). The septum is a muscular or fibrous wall that divides the inside of the uterus, creating 2 cavities (a septate uterus). The septum may be complete or incomplete. It is more common in women with primary infertility and in women who have had repeated miscarriages, and may therefore be one cause of these problems.

2.2 Surgical removal of the septum (metroplasty) is usually considered for women who have a septate uterus in association with repeated adverse reproductive outcomes, including recurrent miscarriage (usually defined as 3 or more miscarriages in a row) and preterm delivery. Metroplasty is also used to manage primary infertility but the causal relationship between this problem and the presence of a uterine septum is less certain.

2.3 Metroplasty 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.