Office hysteroscopic metroplasty: three "diagnostic criteria" to differentiate between septate and bicornuate uteri

STUDY OBJECTIVE: To evaluate the benefits of adopting 3 simple “diagnostic criteria” in the differential diagnosis between septate and bicornuate uteri, and the relative treatment by hysteroscopy in an office setting. DESIGN: Prospective clinical study (Canadian Task Force classification III). SETTING: University-affiliated hospital. PATIENTS: Two hundred-sixty patients with a hysteroscopic diagnosis of a double uterine cavity were enrolled. INTERVENTIONS: Office hysteroscopic metroplasty was performed without analgesia or anesthesia using 5F scissors. MEASUREMENTS AND MAIN RESULTS: The presence of vascularized tissue, sensitive innervation, and the appearance of the tissue at the incision of a supposed septum during an office hysteroscopic procedure were the criteria used to differentiate a septate from a bicornuate uterus. In 93.1% of the cases, office hysteroscopic metroplasty was successfully performed during the same diagnostic procedure. In 15 of 18 patients scheduled for laparoscopic control of the uterine anatomy, the suspicion of a bicornuate uterus was confirmed. Hysteroscopic follow-up at 3 months showed a regular uterine cavity with a fundal notch less than 1 cm. CONCLUSION: The study demonstrates the possibility of obtaining complete, safe removal of uterine septae in most cases by office hysteroscopy confirmation, using mechanical instruments, in an office setting. This was achieved by relating the diagnosis and treatment to simple anatomic and physiologic diagnostic criteria.