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. 2017 Jan 17;1(1):CD008576.
doi: 10.1002/14651858.CD008576.pub4.

Septum resection for women of reproductive age with a septate uterus

Judith Fw Rikken  1 , Claudia R Kowalik  2 , Mark H Emanuel  3 , Ben Willem J Mol  4 , Fulco Van der Veen  5 , Madelon van Wely  5 , Mariëtte Goddijn  6
Affiliations

Septum resection for women of reproductive age with a septate uterus

Judith Fw Rikken et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Women with a septate uterus are at increased risk for subfertility, recurrent miscarriage, and preterm birth. Restoration of the anatomy of the uterus by hysteroscopic septum resection is an established intervention. This treatment has been assessed mainly in retrospective cohort studies, which suggested a positive effect on pregnancy outcomes. The major flaw in these studies is the before/after design, which will always favour the tested intervention.

Objectives: To determine whether hysteroscopic septum resection in women of reproductive age with a septate uterus improves live birth rates and to assess the safety of this procedure.

Search methods: We searched the Cochrane Gynaecology and Fertility Group Specialised Register (inception to May 2016), the Cochrane Central Register of Controlled Trials (CENTRAL CRSO) (inception to May 2016), MEDLINE (1946 to May 2016), Embase (1974 to May 2016), PsycINFO (1806 to May 2016), and CINAHL database (1982 to May 2016). We also searched trial registers for ongoing and registered trials, reference lists, the Cochrane Library, unpublished dissertations and theses, conference abstracts, OpenGrey, LILACS, PubMed, and Google.

Selection criteria: We planned to include randomised controlled trials that assessed the effect on reproductive outcomes and the safety of hysteroscopic septum resection in women of reproductive age with a septate uterus.

Data collection and analysis: If there had been studies to include, two review authors would have independently selected studies, assessed trial risk of bias, and extracted data. They would also have contacted study authors for additional information.

Main results: As in the 2011 version of this review, we identified no randomised controlled trials for inclusion in this update.

Authors' conclusions: Hysteroscopic septum resection in women of reproductive age with a septate uterus is performed worldwide to improve reproductive outcomes. At present, there is no evidence to support the surgical procedure in these women. Randomised controlled trials are urgently needed. Two trials are currently underway.

PubMed Disclaimer

Conflict of interest statement

The authors of this review are conducting a trial: TRUST (The Randomised Uterine Septum Transsection Trial). In this study, women with recurrent miscarriage or subfertility and a septate uterus are being randomised between surgical intervention (hysteroscopic metroplasty) and expectant management.

Mark Emanuel has received consultancy fees and royalties from Smith & Nephew Endoscopy and holds patents for hysteroscopic morcellation and tubal patency foam ultrasonography testing.

For the version of this Cochrane review published in 2017, Mark Emanuel declared that he holds patents for hysteroscopic morcellation and tubal patency foam ultrasonography testing. These conflicts were declared prior to publication and applied during the period that the review was in preparation.

Clarification statement added from the Co‐ordinating Editor Professor Cindy Farquhar on 25 February 2020: this review was found by the Cochrane Funding Arbiters, post‐publication, to be noncompliant with theCochrane conflict of interest policy, which includes the relevant parts of theCochrane commercial sponsorship policy.In line with the policy, Dr Emanuel cannot be an author on the review while holding patents relevant to the topic of this review. We expect it will be updated by 25 February 2021. The update will have a majority of authors and lead author free of conflicts."

Figures

1
1
The ESHRE/ESGE classification system for female genital congenital anomalies (Grimbizis 2013).
2
2
Study flow diagram.
See this image and copyright information in PMC

Update of

References

References to ongoing studies

ISRCTN28960271 {unpublished data only}
    1. ISRCTN28960271. Pilot randomised controlled trial of hysteroscopic septal resection [Assessment of hysteroscopic metroplasty in women with a uterine septum and a history of miscarriage: a randomised controlled trial]. isrctn.com/ISRCTN28960271 (date applied 6 January 2015).
NTR1676 {unpublished data only}
    1. NTR1676. The Randomised Uterine Septum Transsection Trial [The Randomised Uterine Septum Transsection Trial]. trialregister.nl/trialreg/admin/rctview.asp?TC=1676 (date registered 18 February 2009).

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References to other published versions of this review

Kowalik 2011
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