INFLUENCE OF HYSTEROSCOPIC METROPLASTY ON APPEARANCE, ONGOING AND OUTCOME OF PREGNANCY

Cilj rada. Usavršavanjem dijagnostike, posebice ultrazvučnih i endoskopskih metoda, omogućeno je uspješno otkrivanje poremećaja u spajanju Müllerovih cijevi s posljedičnim stvaranjem septuma uterusa različite dužine i lokalizacije. Ovi poremećaji su združeni s lošim reprodukcijskim ishodom i povećanim rizikom za majku. Cilj rada je bio analizirati¬ uspješnost histeroskopske metroplastike u nastanku, tijeku i ishodu trudnoće. Ispitanice i metode rada. Skupina od 410 ispitanica s trudnoćom nastalom poslije histeroskopske metroplastike, sa srednjom vrijednosti životne dobi od 31,4 godine i srednjom vrijednosti trajanja neplodnosti 5,3 godine, podijeljena je u dvije podskupine: 1) s primarnom neplodnošću 178 i 2) sa sekundarnom neplodnošću 232 bolesnice. Rezultati. Prije histeroskopske metroplastike stopa rađanja je bila 7,6% (31 porod), sa stopom preživljenja 5,4% i perinatalnim mortalitetom 32,3%. Stopa spontanih pobačaja je bila 72,8% (169 bolesnica), od 1 do 9 po bolesnici. Ukupni broj spontanih pobačaja iznosio je 360, odnosno 86,1% od ukupnog broja 418 trudnoća ili 2,1 pobačaj po bolesnici. Stopa izvanmaternične trudnoće je bila 10,8% (25 bolesnica). U 178 ispitanica nije došlo do trudnoće unatoč poduzetom višegodišnjem liječenju neplodnosti. Poslije histeroskopske metroplastike stopa po¬roda je signifikatno porasla i dostigla 75,8%. S druge strane, stopa spontanih pobačaja je signifikantno pala na 10,4%. Stopa perinatalnog mortaliteta je pala na 2,2%, dok je stopa izvanmaternične trudnoće pala na 3,9%. Trudnoća u tijeku je 8,5%. Zaključak. Incizijom septuma kavuma uterusa postiže se poboljšanje uvjeta za implantaciju i razvoj trudnoće. Nakon histeroskopske metroplastike signifikantno raste stopa poroda, od 7,6% prije na 75,8% poslije operacije. U isto vrijeme, stopa spontanih pobačaja pala je od 72,8% prije histeroskopske metroplastike na 10,4% poslije operacije.Objective. Ultrasound diagnostics and hysteroscopic technique made a hughe progress in accurate detection of failure of fusion of the Müllerian ducts and failure of resorption of the intervening septum, which are occuring during embryologic development from 6 to 20 weeks and result in formation of uterine septa of variable lengths and positions. These congenital uterine malformations are associated with poor reproductive outome and an increased risk for mother. Hysteroscopic metroplasty is minimally invasive procedure allowing safe technique for incision of the septum. The objective was to analyze the successfulness of the hysteroscopic metroplasty in the appearance, ongoing and outcome of the pregnancy. Material and methods. The group of 410 patients with pregnancy after hysteroscopic metroplasty was evaluated.¬ The mean age of patients was 31.4 years. The mean infertile interval was 5.3 years. Before hysteroscopic metroplasty 232 patients were referred with history of pregnancy loss or complications of pregnancy. Infertility was the main complaint in 178 patients. Results. Before hysteroscopic metroplasty delivery rate in the group of 232 patients with secondary infertility¬ was 7.6%, perinatal mortality rate 32.3% and spontaneous abortion rate 72.8%; total number of miscarriagies was 360, its number ranged 1–9 in studied 169 patients. Ectopic pregnancy rate was 10.8% (25 patients). In spite of the treatment lasting several years there were no pregnancies in the group of 178 patients. After hysteroscopic metroplasty, delivery rate increased significantly and reached 75.8%. Ongoing pregnancy rate is 8.5%. On the other hand, spontaneous abortion rate decreased significantly and dropped to 10.4%. Ectopic pregnancy rate decreased to 3.9%. Perinatal mortality decreased to 2.2%. Conclusion. Pregnancy capacity of the uterine cavity is enlarged by hysteroscopic incision of the septum. Conditions for implantation and embryo development are improved. Hysteroscopic metroplasty significantly increased delivery rate, from 7.6% before to 75.8% after the procedure. Rate od spontaneous abortions decreased¬ from 72.8% before operation to 10.4% and ectopic pregnancy rate from 10.8% to 3.9%