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Surgical Endoscopy

, Volume 18, Issue 12, pp 1782–1784 | Cite as

Hysteroscopy in the evaluation of patients with recurrent pregnancy loss: a cohort study in a primary care population

  • G. VentoliniEmail author
  • M. Zhang
  • J. Gruber
Original article

Abstract

Background

The purpose of this study was to determine the prevalence of structural uterine defects (SUD) in patients with recurrent pregnancy loss (RPL) attending a large family medicine practice and to determine the effectiveness of the therapeutic intervention.

Methods

This prospective cohort study from October 1995 to October 1998 included 23 patients aged 23 to 35 years (mean, 28.1) with an otherwise unexplained history of three or more 1st- or 2nd-trimester miscarriages and no live births. None of the couples were tobacco or alcohol users, all of them and had normal cytogenetic examinations and testing. Their jobs were unrelated to chemical handling. All patients had a complete history taken and underwent physical examination and hysteroscopy with directed biopsy. They had normal values for complete blood count, sedimentation rate, urinalysis and culture (gonorrhea, Chlamydia, syphilis, hepatitis B, HIV), lupus anticoagulant, anticardiolipin antibodies, spermiogram, progesterone, and pelvic ultrasound.

Results

Fourteen patients (60.9%) had a normal hysteroscopy (with biopsies). Nine patients (39.1 %) had SUD, as follows: Five patients (21.8%) had intrauterine adhesions, two patients (8.7%) had a septated uterus, one patient (4.3%) had submucosal myoma, and one patient (4.3%) had multiple factors. After appropriate therapy of the SUD, seven patients (77.8%) achieved successful pregnancy and two patients (22.2%) had recurrent miscarriage. In the normal hysteroscopy group, eight patients (57.1%) had recurrent miscarriages, two patients (14.3%) had infertility, and four patients (28.6%) achieved successful pregnancy with no further therapy.

Conclusions

The prevalence of SUD in our studied population was 39.1 %. After appropriate treatment, the rate of live-birth pregnancies in these patients was 77.8%. Because SUD are the most treatable cause of RPL, these patients should be identified early after other potential causes of RPL are eliminated.

Keywords

Hysteroscopy Recurrent pregnancy loss Structual uterine defects Miscarriage Family medicine practice 

References

  1. 1.
    Alborzi, S, Dehbashi, S, Parsanezhad, ME 2002Differential diagnosis of septate and bicornuate uterus by sonohysterography eliminates the need for laparoscopyFertil Steril78176178CrossRefPubMedGoogle Scholar
  2. 2.
    Barranger, E, Gervaise, A, Doumere, S, Fernandez, H 2002Reproductive performance after hysteroscopic metroplasty in the hypoplastic uterus: a study of 29 casesBr J Obstet Gynaecol10913311334CrossRefGoogle Scholar
  3. 3.
    Choe, JK, Baggish, MS 1992Hysteroscopic treatment of septate uterus with neodymium-YAG laserFertil Steril578184CrossRefPubMedGoogle Scholar
  4. 4.
    Donnez, J, Nisolle, M 1997Endoscopic laser treatment of uterine malformationsHum Reprod1213811387CrossRefPubMedGoogle Scholar
  5. 5.
    Garbin, O, Ohl, J, Bettahar-Lebugle, K, Dellenbach, P 1998Hysteroscopic metroplasty in diethylstilboestrol-exposed and hypoplastic uterus: a report on 24 casesHum Reprod1327512755CrossRefPubMedGoogle Scholar
  6. 6.
    Goldberg, JM, Falcone, T, Attaran, M 1997Sonohysterographic evaluation of uterine abnormalities noted on hysterosalpingographyHum Reprod1221512153CrossRefPubMedGoogle Scholar
  7. 7.
    Homer, HA, Li, TC, Cooke, ID 2002The septate uterus: a review of management and reproductive outcomeFertil Steril73114CrossRefGoogle Scholar
  8. 8.
    Keltz, MD, Olive, DL, Kim, AH, Arici, A 1997Sonohysterography for screening in recurrent pregnancy lossFertil Steril67670674CrossRefPubMedGoogle Scholar
  9. 9.
    Lee, RM, Silver, RM 2000Recurrent pregnancy loss: summary and clinical recommendationsReorid Med18433440Google Scholar
  10. 10.
    Nagel, TC, Malo, JW 1993Hysteroscopic metroplasty in the diethylstilbestrol-exposed uterus and similar nonfusion anomalies: effects on subsequent reproductive performance; a preliminary reportFertil Steril59502506CrossRefPubMedGoogle Scholar
  11. 11.
    Pabuccu, R, Atay, V, Orhon, E, Urman, B, Ergun, A 1997Hysteroscopic treatment of intrauterine adhesions is safe and effective in the restoration of normal menstruation and fertilityFertil Steril6811411143CrossRefPubMedGoogle Scholar
  12. 12.
    Patton, PE 1994Anatomic uterine defectsClin Obstet Gynecol37705721CrossRefPubMedGoogle Scholar
  13. 13.
    Plouffe, L,Jr, White, EW, Tho, SP, Sweet, CS, Layman, LC, Whitman, GF, McDonough, PG 1992Etiologic factors of recurrent abortion and subsequent reproductive performance of couples: have we made any progress in the past ten years?Am J Obstet Gynecol23339348Google Scholar
  14. 14.
    Preutthipan, S, Linasmita, V 2001Reproductive outcome following hysteroscopic treatment of the septate uterus: a result of 28 cases at Ramathibodi HospitalMed Assoc Thai84166170Google Scholar
  15. 15.
    Propst, AM, Hill, JA,3rd 2000Anatomic factors associated with recurrent pregnancy lossSemin Reprod Med18341350CrossRefPubMedGoogle Scholar
  16. 16.
    Daya, S (ed) 1996Recurrent miscarriageInfertil Reprod Med North AM7645870Google Scholar
  17. 17.
    Seidman, DS, Ben-Rafael, Z, Bider, D, Recabi, K, Mashiach, S 1991The role of cervical cerclage in the management of uterine anomaliesSurg Gynecol Obstet173384386PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  1. 1.Department of Obstetrics and GynecologyWright State University School of MedicineDaytonUSA

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