Intraoperative ultrasound for uterine septum resection: a systematic review and meta-analysis
Septate uterus is one of the most common uterine malformations. Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systemati...
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| Veröffentlicht in: | Archives of gynecology and obstetrics 2024-12, Vol.310 (6), p.3219-3228 |
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| creator | Galati, Giulia Buccilli, Michela Bongiorno, Gina Capri, Oriana Pietrangeli, Daniela Muzii, Ludovico |
| description | Septate uterus is one of the most common uterine malformations. Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systematic review and meta-analysis aims to evaluate whether intraoperative ultrasound monitoring may improve the efficacy of hysteroscopic metroplasty compared to other types of intraoperative monitoring or to unguided resections. An electronic database search was performed to identify articles published until June 15, 2023. Five studies (two randomized clinical trials, two prospective studies and one retrospective cohort study) fulfilled the inclusion criteria. The primary outcome was the rate of residual septum > 10 mm after hysteroscopic metroplasty in the ultrasound (US) monitoring group compared to the rate of residual septum using other types of intraoperative monitoring/no monitoring (control group). The secondary outcomes were any residual septa, surgical time, complications, uterine perforations and reproductive outcomes. Intraoperative ultrasound for uterine septum resection significantly reduced the rate of residual septum > 10 mm and the rate of any residual septa compared to the control group. There was no statistically significant difference in the procedure time between women undergoing intraoperative US monitoring versus the control group. A trend toward reduction of surgical complications was observed in the intraoperative US group compared to the control group. In conclusion, intraoperative ultrasound during metroplasty may reduce the rate of the residual septum with no surgical time differences. Further studies are warranted to understand how this may improve reproductive outcomes. |
| doi_str_mv | 10.1007/s00404-024-07814-6 |
| format | Article |
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Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systematic review and meta-analysis aims to evaluate whether intraoperative ultrasound monitoring may improve the efficacy of hysteroscopic metroplasty compared to other types of intraoperative monitoring or to unguided resections. An electronic database search was performed to identify articles published until June 15, 2023. Five studies (two randomized clinical trials, two prospective studies and one retrospective cohort study) fulfilled the inclusion criteria. The primary outcome was the rate of residual septum > 10 mm after hysteroscopic metroplasty in the ultrasound (US) monitoring group compared to the rate of residual septum using other types of intraoperative monitoring/no monitoring (control group). The secondary outcomes were any residual septa, surgical time, complications, uterine perforations and reproductive outcomes. Intraoperative ultrasound for uterine septum resection significantly reduced the rate of residual septum > 10 mm and the rate of any residual septa compared to the control group. There was no statistically significant difference in the procedure time between women undergoing intraoperative US monitoring versus the control group. A trend toward reduction of surgical complications was observed in the intraoperative US group compared to the control group. In conclusion, intraoperative ultrasound during metroplasty may reduce the rate of the residual septum with no surgical time differences. Further studies are warranted to understand how this may improve reproductive outcomes.</description><identifier>ISSN: 1432-0711</identifier><identifier>ISSN: 0932-0067</identifier><identifier>EISSN: 1432-0711</identifier><identifier>DOI: 10.1007/s00404-024-07814-6</identifier><identifier>PMID: 39549117</identifier><language>eng</language><publisher>Berlin/Heidelberg: Springer Berlin Heidelberg</publisher><subject>Endocrinology ; Female ; Gynecologic Endocrinology and Reproductive Medicine ; Gynecology ; Human Genetics ; Humans ; Hysteroscopy - methods ; Infertility ; Medicine ; Medicine & Public Health ; Monitoring, Intraoperative - methods ; Obstetrics/Perinatology/Midwifery ; Operative Time ; Septate Uterus ; Systematic review ; Ultrasonic imaging ; Ultrasonography ; Urogenital Abnormalities - diagnostic imaging ; Urogenital Abnormalities - surgery ; Uterus ; Uterus - abnormalities ; Uterus - diagnostic imaging ; Uterus - surgery</subject><ispartof>Archives of gynecology and obstetrics, 2024-12, Vol.310 (6), p.3219-3228</ispartof><rights>The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature 2024 Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2024. 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Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systematic review and meta-analysis aims to evaluate whether intraoperative ultrasound monitoring may improve the efficacy of hysteroscopic metroplasty compared to other types of intraoperative monitoring or to unguided resections. An electronic database search was performed to identify articles published until June 15, 2023. Five studies (two randomized clinical trials, two prospective studies and one retrospective cohort study) fulfilled the inclusion criteria. The primary outcome was the rate of residual septum > 10 mm after hysteroscopic metroplasty in the ultrasound (US) monitoring group compared to the rate of residual septum using other types of intraoperative monitoring/no monitoring (control group). The secondary outcomes were any residual septa, surgical time, complications, uterine perforations and reproductive outcomes. Intraoperative ultrasound for uterine septum resection significantly reduced the rate of residual septum > 10 mm and the rate of any residual septa compared to the control group. There was no statistically significant difference in the procedure time between women undergoing intraoperative US monitoring versus the control group. A trend toward reduction of surgical complications was observed in the intraoperative US group compared to the control group. In conclusion, intraoperative ultrasound during metroplasty may reduce the rate of the residual septum with no surgical time differences. Further studies are warranted to understand how this may improve reproductive outcomes.</description><subject>Endocrinology</subject><subject>Female</subject><subject>Gynecologic Endocrinology and Reproductive Medicine</subject><subject>Gynecology</subject><subject>Human Genetics</subject><subject>Humans</subject><subject>Hysteroscopy - methods</subject><subject>Infertility</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Monitoring, Intraoperative - methods</subject><subject>Obstetrics/Perinatology/Midwifery</subject><subject>Operative Time</subject><subject>Septate Uterus</subject><subject>Systematic review</subject><subject>Ultrasonic imaging</subject><subject>Ultrasonography</subject><subject>Urogenital Abnormalities - diagnostic imaging</subject><subject>Urogenital Abnormalities - surgery</subject><subject>Uterus</subject><subject>Uterus - abnormalities</subject><subject>Uterus - diagnostic imaging</subject><subject>Uterus - surgery</subject><issn>1432-0711</issn><issn>0932-0067</issn><issn>1432-0711</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2024</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp9kEtLAzEUhYMoWqt_wIUMuHEzepPJJDPuRHwUCm50KSGd3siUedTcjNJ_b2p94cJASG7ynZObw9gRhzMOoM8JQIJMQcSpCy5TtcVGXGYilpxv_9rvsX2iBQAXRaF22V5W5rLkXI_Y06QL3vZL9DbUr5gMTSypH7p54nqfDAF93WFCuAxDm3gkrELddxeJTWhFAdsoq-L5a41viY2qFoNNbWebFdV0wHacbQgPP9cxe7y5fri6S6f3t5Ory2laiVyF1AkAyLXT0mKldKnnIGYaigIF5GVlY6eA2qFCJx2fKRW_MZMcypwLZR1kY3a68V36_mVACqatqcKmsR32A5mMi1LwMotjzE7-oIt-8LHfNSXzkmsJKlJiQ1W-J_LozNLXrfUrw8Gswzeb8E0M33yEb9ai40_rYdbi_FvylXYEsg1A8ap7Rv_z9j-271hdj0U</recordid><startdate>20241201</startdate><enddate>20241201</enddate><creator>Galati, Giulia</creator><creator>Buccilli, Michela</creator><creator>Bongiorno, Gina</creator><creator>Capri, Oriana</creator><creator>Pietrangeli, Daniela</creator><creator>Muzii, Ludovico</creator><general>Springer Berlin Heidelberg</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-5289-4013</orcidid></search><sort><creationdate>20241201</creationdate><title>Intraoperative ultrasound for uterine septum resection: a systematic review and meta-analysis</title><author>Galati, Giulia ; Buccilli, Michela ; Bongiorno, Gina ; Capri, Oriana ; Pietrangeli, Daniela ; Muzii, Ludovico</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c256t-f200057f74aec6797d02b7088e2059ca1170e7fe6ef4f1b66288b41095126af03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2024</creationdate><topic>Endocrinology</topic><topic>Female</topic><topic>Gynecologic Endocrinology and Reproductive Medicine</topic><topic>Gynecology</topic><topic>Human Genetics</topic><topic>Humans</topic><topic>Hysteroscopy - methods</topic><topic>Infertility</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Monitoring, Intraoperative - methods</topic><topic>Obstetrics/Perinatology/Midwifery</topic><topic>Operative Time</topic><topic>Septate Uterus</topic><topic>Systematic review</topic><topic>Ultrasonic imaging</topic><topic>Ultrasonography</topic><topic>Urogenital Abnormalities - diagnostic imaging</topic><topic>Urogenital Abnormalities - surgery</topic><topic>Uterus</topic><topic>Uterus - abnormalities</topic><topic>Uterus - diagnostic imaging</topic><topic>Uterus - surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Galati, Giulia</creatorcontrib><creatorcontrib>Buccilli, Michela</creatorcontrib><creatorcontrib>Bongiorno, Gina</creatorcontrib><creatorcontrib>Capri, Oriana</creatorcontrib><creatorcontrib>Pietrangeli, Daniela</creatorcontrib><creatorcontrib>Muzii, Ludovico</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Archives of gynecology and obstetrics</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Galati, Giulia</au><au>Buccilli, Michela</au><au>Bongiorno, Gina</au><au>Capri, Oriana</au><au>Pietrangeli, Daniela</au><au>Muzii, Ludovico</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Intraoperative ultrasound for uterine septum resection: a systematic review and meta-analysis</atitle><jtitle>Archives of gynecology and obstetrics</jtitle><stitle>Arch Gynecol Obstet</stitle><addtitle>Arch Gynecol Obstet</addtitle><date>2024-12-01</date><risdate>2024</risdate><volume>310</volume><issue>6</issue><spage>3219</spage><epage>3228</epage><pages>3219-3228</pages><issn>1432-0711</issn><issn>0932-0067</issn><eissn>1432-0711</eissn><abstract>Septate uterus is one of the most common uterine malformations. Recent studies suggest that uterine septa may negatively affect fertility. In cases of recurrent pregnancy loss (RPL) or infertility, hysteroscopic metroplasty has been considered the primary treatment for septate uterus. This systematic review and meta-analysis aims to evaluate whether intraoperative ultrasound monitoring may improve the efficacy of hysteroscopic metroplasty compared to other types of intraoperative monitoring or to unguided resections. An electronic database search was performed to identify articles published until June 15, 2023. Five studies (two randomized clinical trials, two prospective studies and one retrospective cohort study) fulfilled the inclusion criteria. The primary outcome was the rate of residual septum > 10 mm after hysteroscopic metroplasty in the ultrasound (US) monitoring group compared to the rate of residual septum using other types of intraoperative monitoring/no monitoring (control group). The secondary outcomes were any residual septa, surgical time, complications, uterine perforations and reproductive outcomes. Intraoperative ultrasound for uterine septum resection significantly reduced the rate of residual septum > 10 mm and the rate of any residual septa compared to the control group. There was no statistically significant difference in the procedure time between women undergoing intraoperative US monitoring versus the control group. A trend toward reduction of surgical complications was observed in the intraoperative US group compared to the control group. In conclusion, intraoperative ultrasound during metroplasty may reduce the rate of the residual septum with no surgical time differences. Further studies are warranted to understand how this may improve reproductive outcomes.</abstract><cop>Berlin/Heidelberg</cop><pub>Springer Berlin Heidelberg</pub><pmid>39549117</pmid><doi>10.1007/s00404-024-07814-6</doi><tpages>10</tpages><orcidid>https://orcid.org/0000-0002-5289-4013</orcidid></addata></record> |
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| subjects | Endocrinology Female Gynecologic Endocrinology and Reproductive Medicine Gynecology Human Genetics Humans Hysteroscopy - methods Infertility Medicine Medicine & Public Health Monitoring, Intraoperative - methods Obstetrics/Perinatology/Midwifery Operative Time Septate Uterus Systematic review Ultrasonic imaging Ultrasonography Urogenital Abnormalities - diagnostic imaging Urogenital Abnormalities - surgery Uterus Uterus - abnormalities Uterus - diagnostic imaging Uterus - surgery |
| title | Intraoperative ultrasound for uterine septum resection: a systematic review and meta-analysis |
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