Objective  To retrospectively analyze the pregnancy outcomes of patients with different pregnancy histories or different mediastinal types after hysteroscopic tanscervical resection of septum (TCRS).

Methods  A total of 145 patients with uterine septum who underwent hysteroscopic TCRS in The Third Affiliated Hospital of Zhengzhou University from January 2018 to January 2021 were selected as the study subjects. The patients were followed up for 3 to 24 months, and the surgical effects and pregnancy were observed and compared.

Result  119 (82.07%) patients achieved pregnancy after surgery, and the total number of pregnancies was 132. Compared with before surgery, the number of pregnancies and live births increased, and the cumulative number of pregnancies and abortions decreased, the difference was statistically significant (P<0.05). In the infertility group, 25 (65.79%) patients achieved pregnancy after surgery, but 13 (34.21%) were still infertile, and the difference was statistically significant compared with that before surgery (P<0.01). The abortion rate of patients in the previous pregnancy group and the adverse pregnancy history group decreased, and the live birth rate of the two groups increased (P<0.05). Patients with complete uterine septum were more likely to have infertility than those with incomplete uterine septum before surgery (P<0.001). After surgery, the abortion rates of the complete uterine septum group and the incomplete uterine septum group decreased, and the live birth rates increased, and the differences were statistically significant (P<0.001). The results of Logistic regression analysis showed that age was an independent risk factor for postoperative secondary infertility [OR=4.796, 95%CI (1.916, 12.007), P<0.001].

Conclusion  The hysteroscopic TCRS is a safe and minimally invasive surgical manner that can improve pregnancy outcomes. For patients with septate uterus who have fertility requirements, this operation can improve pregnancy rate and live birth rate.

1.Troiano RN. Magnetic resonance imaging of mullerian duct anomalies of the uterus[J]. Top Magn Reson Imaging, 2003, 14(4): 269-279. DOI: 10.1097/00002142-200308000-00002.

2.Venetis CA, Papadopoulos SP, Campo R, et al. Clinical implications of congenital uterine anomalies: a meta-analysis of comparative studies[J]. Reprod Biomed Online, 2014, 29(6): 665-683. DOI: 10.1016/j.rbmo.2014.09.006.

3.赵雪燕, 李卫民, 徐云, 等. 156例宫腔镜下子宫纵隔切除术后的生殖预后[J]. 中国妇产科临床杂志, 2022, 23(1): 38-41. [Zhao XY, Li WM, Xu Y, et al. Reproductive prognosis of 156 cases of hysteroscopic transcervical resection of septum[J]. Chinese Journal of Clinical Obstetrics and Gynecology, 2022, 23(1): 38-41.] DOI: 10.13390/j.issn.1672-1861.2022.01.012.

4.谢幸, 孔北华, 段涛. 妇产科学（第9版）[M]．北京：人民卫生出版社, 2018: 274-275. [Xie X, Kong BH, Duan T. Obstetrics and gynecology (9th ed)[M]. Beijing: People's Medical Publishing House, 2018: 274-275.]

5.The American Fertility Society classifications of adnexal adhesions, distal tubal occlusion, tubal occlusion secondary to tubal ligation, tubal pregnancies, mullerian anomalies and intrauterine adhesions[J]. Fertil Steril, 1988, 49(6): 944-955. DOI: 10.1016/s0015-0282(16)59942-7.

6.姚桔芳, 付向红. 88例女性继发性不孕病因分析[J]. 中国性科学, 2014, 23(5): 77-79. [Yao JF, Fu XH. Etiological analysis of 88 cases of female secondary infertility[J]. Chinese Journal of Human Sexuality, 2014, 23(5): 77-79.] DOI: 10.3969/j.issn.1672-1993.2014.05.029.

7.Practice Committee of the American Society for Reproductive Medicine. Uterine septum: a guideline[J]. Fertil Steril. 2016, 106(3): 530-540. DOI: 10.1016/j.fertnstert.2016.05.014.

8.Kroener L, Wang ET, Pisarska MD. Predisposing factors to abnormal first trimester placentation and the impact on fetal outcomes[J]. Semin Reprod Med, 2016, 34(1): 27-35. DOI: 10.1055/s-0035-1570029.

9.赵子辰, 邓姗, 陈娜, 等. 宫腔镜下子宫纵隔切除术后生育结局分析[J]. 中国实用妇科与产科杂志, 2022, 38(3): 327-330. [Zhao ZC, Deng S, Chen N, et al. Analysis of reproductive outcomes after hysteroscopic transcervical resection of uterine septum[J]. Chinese Journal of Practical Gynecology and Obstetrics,, 2012, 38(3): 327-330.] DOI: 10.19538/j.fk2022030116.

10.肖菊花, 罗烨, 易迎春. 三维超声成像对先天性子宫发育异常的诊断价值[J]. 实用临床医学, 2023, 24(1): 59-62. [Xiao JH, Luo Y, Yi YC. Diagnostic value of three-dimensional ultrasound in congenital uterine dysplasia[J]. Practical Clinical Medicine, 2023, 24(1): 59-62.] DOI: 10.13764/j.cnki.lcsy.2023.01.017.

11.黎少琴. 宫腔镜下子宫纵隔切除术治疗子宫纵隔畸形不孕的疗效观察[J]. 中国合理用药探索, 2018, 15(8): 48-50. [Li SQ. Observation on efficacy of hysteroscopic uterine mediastinal resection for the treatment of infertility caused by uterine mediastinal malformation[J]. China Licensed Pharmacist, 2018, 15(8): 48-50.] DOI: 10.3969/j.issn.2096-3327.2018.08.015.

12.马宁, 黄晓武, 周巧云, 等. 宫腔镜子宫纵隔冷刀手术与电切术对子宫内膜影响的对比研究[J]. 国际生殖健康/计划生育杂志, 2017, 36(3): 204-207. [Ma N, Huang XW, Zhou QY, et al. Comparative study on endometrium reepithelialization after surgery of uterine septum using hysteroscopic scissors and resectoscope[J]. Journal of International Reproductive Health/Family Planning, 2017, 36(3): 204-207.] DOI: 10.3969/j.issn.1674-1889.2017.03.006.

13.赵雪燕, 冯力民. 子宫纵隔手术的近期、远期并发症及生殖预后[J]. 国际妇产科学杂志, 2017, 44(3): 252-256. [Zhao XY, Feng LM. Short, long-term complications and reproductive outcome of transcervical resection of septum[J]. Journal of International Obstetrics and Gynecology, 2017, 44(3): 252-256.] DOI: 10.3969/j.issn.1674-1870.2017.03.003.

14.Rousseau L, Brichant G, Timmermans M, et al. Daily practice management of septate uterus: reproductive outcome after septoplasty[J]. Facts Views Vis Obgyn, 2021, 13(3): 253-259. DOI: 10.52054/FVVO.13.3.032.

15.Wang Z, An J, Su Y, et al. Reproductive outcome of a complete septate uterus after hysteroscopic metroplasty[J]. J Int Med Res, 2020, 48(3): 300060519893836. DOI: 10.1177/0300060519893836.

16.Bendifallah S, Faivre E, Legendre G, et al. Metroplasty for AFS Class V and VI septate uterus in patients with infertility or miscarriage: reproductive outcomes study[J]. J Minim Invasive Gynecol, 2013, 20(2): 178-184. DOI: 10.1016/j.jmig.2012.11.002.

17.Kenda Šuster N, Gergolet M. Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor?[J]. Gynecol Surg, 2016, 13: 37-41. DOI: 10.1007/s10397-015-0916-2.

18.Rikken JFW, Kowalik CR, Emanuel MH, et al. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial[J]. Hum Reprod, 2021, 36(5): 1260-1267. DOI: 10.1093/humrep/deab037.