Importance To date, a comprehensive review on the safety and effectiveness of hysteroscopic metroplasty for T-shaped uterus is still missing. Objective To provide a robust synthesis of the available studies investigating reproductive outcomes after hysteroscopic metroplasty for T-shaped uterus. Evidence Acquisition We performed a systematic review and meta-analysis (CRD42019143291), using the proportion method with 95% confidence interval (CI). Statistical heterogeneity was assessed by Higgins test (I-2). Results We included 11 cohort studies embedding 937 women who underwent hysteroscopic metroplasty. After surgery, the pooled percentage of live birth was 44.54% (95% CI, 36.12%-53.12%;I-2= 46.22%) and 56.88% (95% CI, 46.48%-66.98%;I-2= 36.38%) in women with primary infertility and recurrent miscarriage, respectively. In women with recurrent miscarriage, the pooled proportion of miscarriage was 21.46% (95% CI, 15.09%-28.61%;I-2= 30.18%). The pooled clinical pregnancy proportion in women with primary infertility was 57.19% (95% CI, 43.83%-70.03%;I-2= 77.81%). The pooled rate of surgical complications was 0.65% (95% CI, 0.20%-1.33%;I-2= 11.44%). Conclusions The hysteroscopic correction of T-shaped uteri was associated with high live birth rate and low miscarriage rate, both in case of primary infertility and recurrent miscarriage. Relevance Hysteroscopic metroplasty can be considered a safe and effective strategy to improve reproductive outcomes in case of T-shaped uterus. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be better able to identify and diagnose T-shaped uterus; explain the epidemiological data regarding reproductive outcomes in cases of untreated T-shaped uterus; and describe the technique and outcomes of hysteroscopic metroplasty for T-shaped uterus, both in case of primary infertility and recurrent miscarriage.
Hysteroscopic Metroplasty for T-Shaped Uterus: A Systematic Review and Meta-analysis of Reproductive Outcomes
Vitagliano, Amerigo
2020-01-01
Abstract
Importance To date, a comprehensive review on the safety and effectiveness of hysteroscopic metroplasty for T-shaped uterus is still missing. Objective To provide a robust synthesis of the available studies investigating reproductive outcomes after hysteroscopic metroplasty for T-shaped uterus. Evidence Acquisition We performed a systematic review and meta-analysis (CRD42019143291), using the proportion method with 95% confidence interval (CI). Statistical heterogeneity was assessed by Higgins test (I-2). Results We included 11 cohort studies embedding 937 women who underwent hysteroscopic metroplasty. After surgery, the pooled percentage of live birth was 44.54% (95% CI, 36.12%-53.12%;I-2= 46.22%) and 56.88% (95% CI, 46.48%-66.98%;I-2= 36.38%) in women with primary infertility and recurrent miscarriage, respectively. In women with recurrent miscarriage, the pooled proportion of miscarriage was 21.46% (95% CI, 15.09%-28.61%;I-2= 30.18%). The pooled clinical pregnancy proportion in women with primary infertility was 57.19% (95% CI, 43.83%-70.03%;I-2= 77.81%). The pooled rate of surgical complications was 0.65% (95% CI, 0.20%-1.33%;I-2= 11.44%). Conclusions The hysteroscopic correction of T-shaped uteri was associated with high live birth rate and low miscarriage rate, both in case of primary infertility and recurrent miscarriage. Relevance Hysteroscopic metroplasty can be considered a safe and effective strategy to improve reproductive outcomes in case of T-shaped uterus. Target Audience Obstetricians and gynecologists, family physicians. Learning Objectives After participating in this activity, the learner should be better able to identify and diagnose T-shaped uterus; explain the epidemiological data regarding reproductive outcomes in cases of untreated T-shaped uterus; and describe the technique and outcomes of hysteroscopic metroplasty for T-shaped uterus, both in case of primary infertility and recurrent miscarriage.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
