Balloon technique for hysteroscopic correction of a complete septate uterus.

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This document describes a technique for hysteroscopically correcting a complete uterine septum using a balloon catheter. It presents data on 6 patients who underwent the procedure. The technique involves using a balloon catheter to dissect the septum while sparing the cervical septum. Procedure times ranged from 20-50 minutes. Postoperative outcomes included term pregnancies for 4 of the 6 patients. The balloon technique offers the advantage of sparing the cervical septum during septum dissection.

Health & Medicine

Hysteroscopic correction of septate uterus

Figure 1. Balloon technique for hysteroscopic correction of a complete septate uterus.

Table I. Pre-, intra- and postoperative data for six patients with complete uterine septum

Age Past history Time of Postoperative pregnancy
(years) surgery (min)

23 Primary infertility; 50 Term pregnancy
longitudinal vaginal septum (Caesarean section)
28 Recurrent abortion 30 Term pregnancy
(three abortions)
30 One abortion
One preterm birth 25 –
23 Primary infertility,
longitudinal vaginal septum 25 –
31 Recurrent abortions 30 Term pregnancy
(three abortions)
24 Secondary infertility 20 –
(one abortion)

at 16 weeks gestation. Because of the prophylactic cervical uterus and septate vagina: report of a previously undescribed Mullerian¨
anomaly. Hum. Reprod., 11, 218–219.
suture, the advantage of this technique of spared cervical Daly, D.C., Tohan, N., Walters, C. et al. (1983) Hysteroscopic resection of
incision could not be clearly demonstrated. Although Vercellini the uterine septum in the presence of a septate cervix. Fertil. Steril., 39,
et al. (1989) could not show a positive effect of IUD insertion 560–563.
and postoperative oestrogen administration, we used these two Ludmir, J., Samuels, P., Brooks, S. and Mennuti, M.T. (1990) Pregnancy
outcome of patients with uncorrected uterine anomalies managed in a high-
adjuvants with good results for the prevention of intrauterine risk obstetric setting. Obstet. Gynecol., 75, 906–910.
adhesions after septal dissection. Perino, A., Chianchiano, N., Simonaro, C. and Cittadini, E. (1995) Endoscopic
The described balloon technique offers the possibility of management of a case of complete septate uterus. Hum. Reprod., 10,
2171–2173.
sparing the cervical septum during septum dissection in patients Rock, I. A., Murphy, A.A. and Cooper IV, W.H. (1987) Resectoscopic
with a complete uterine septum. The good clinical results of techniques for the lysis of a class V: complete uterine septum. Fertil. Steril.,
our procedure lead us to favour this technique. Because a 48, 495–496.
complete uterine septum is such a rare uterine malformation, Salle, B., Sergeant, P., Gaucherand, P., et al. (1996) Transvaginal
hysterosonographic evaluation of septate uteri: a preliminary report. Hum.
a deﬁnitive recommendation can be given only after a random- Reprod., 11, 1004–1007.
ized multicentre study. In all cases of a uterine septum, an Vercellini, P., Fedele, L., Arcaini, L. et al. (1989) Value of intrauterine
indication for dissection must be critically proven because, even device insertion and estrogen administration after hysteroscopic metroplasty.
J. Reprod. Med., 34, 447–450.
without intervention, term pregnancies have been reported. Vercellini, P., Ragni, G., Trespidi, L. et al. (1994) A modiﬁed technique for
correction of the complete septate uterus. Acta Obstet. Gynecol. Scand.,
73, 425–428.
References
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secondary to tubal ligation, tubal pregnancies and intrauterine adhesions.
Fertil. Steril., 49, 944–955.
Balasch, J., Moreno, E., Martinez-Roman, S. et al. (1996) Septate uterus with
cervical duplication and longitudinal vaginal septum: a report of three new
cases. Eur. J. Obstet. Gynecol. Reprod. Biol., 65, 241–243
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Balloon technique for hysteroscopic correction of a complete septate uterus.

1. Hysteroscopic correction of septate uterus Figure 1. Balloon technique for hysteroscopic correction of a complete septate uterus. Table I. Pre-, intra- and postoperative data for six patients with complete uterine septum Age Past history Time of Postoperative pregnancy (years) surgery (min) 23 Primary infertility; 50 Term pregnancy longitudinal vaginal septum (Caesarean section) 28 Recurrent abortion 30 Term pregnancy (three abortions) 30 One abortion One preterm birth 25 – 23 Primary infertility, longitudinal vaginal septum 25 – 31 Recurrent abortions 30 Term pregnancy (three abortions) 24 Secondary infertility 20 – (one abortion) at 16 weeks gestation. Because of the prophylactic cervical uterus and septate vagina: report of a previously undescribed Mullerian¨ anomaly. Hum. Reprod., 11, 218–219. suture, the advantage of this technique of spared cervical Daly, D.C., Tohan, N., Walters, C. et al. (1983) Hysteroscopic resection of incision could not be clearly demonstrated. Although Vercellini the uterine septum in the presence of a septate cervix. Fertil. Steril., 39, et al. (1989) could not show a positive effect of IUD insertion 560–563. and postoperative oestrogen administration, we used these two Ludmir, J., Samuels, P., Brooks, S. and Mennuti, M.T. (1990) Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high- adjuvants with good results for the prevention of intrauterine risk obstetric setting. Obstet. Gynecol., 75, 906–910. adhesions after septal dissection. Perino, A., Chianchiano, N., Simonaro, C. and Cittadini, E. (1995) Endoscopic The described balloon technique offers the possibility of management of a case of complete septate uterus. Hum. Reprod., 10, 2171–2173. sparing the cervical septum during septum dissection in patients Rock, I. A., Murphy, A.A. and Cooper IV, W.H. (1987) Resectoscopic with a complete uterine septum. The good clinical results of techniques for the lysis of a class V: complete uterine septum. Fertil. Steril., our procedure lead us to favour this technique. Because a 48, 495–496. complete uterine septum is such a rare uterine malformation, Salle, B., Sergeant, P., Gaucherand, P., et al. (1996) Transvaginal hysterosonographic evaluation of septate uteri: a preliminary report. Hum. a definitive recommendation can be given only after a random- Reprod., 11, 1004–1007. ized multicentre study. In all cases of a uterine septum, an Vercellini, P., Fedele, L., Arcaini, L. et al. (1989) Value of intrauterine indication for dissection must be critically proven because, even device insertion and estrogen administration after hysteroscopic metroplasty. J. Reprod. Med., 34, 447–450. without intervention, term pregnancies have been reported. Vercellini, P., Ragni, G., Trespidi, L. et al. (1994) A modified technique for correction of the complete septate uterus. Acta Obstet. Gynecol. Scand., 73, 425–428. References American Fertility Society (1988) The American Fertility Society Received on October 14, 1996; accepted on January 7, 1997 classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies and intrauterine adhesions. Fertil. Steril., 49, 944–955. Balasch, J., Moreno, E., Martinez-Roman, S. et al. (1996) Septate uterus with cervical duplication and longitudinal vaginal septum: a report of three new cases. Eur. J. Obstet. Gynecol. Reprod. Biol., 65, 241–243 Candiani, M., Busacca, M., Natale, A. and Sambruni, I. (1996) Bicervical 479

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