Open access uterine reconstruction
Metroplasty is indicated when the anomaly cannot be corrected hysteroscopically: with a bicornuate uterus with two bodies and repeated pregnancy losses, a thick septum extending to the fundus, when combined with other open operations. The surgeon dissects the fundus of the uterus in the transverse direction, opens both cavities, excises the septum or connects the horns and sutures the uterus layer by layer in the longitudinal direction, forming a single cavity of normal volume; the patency of the pipes is checked. The operation significantly increases the chances of a full-term pregnancy (up to 70–80%), but leaves a scar requiring a cesarean section. Before surgery, other causes of miscarriage (genetics, hormones, thrombophilia) must be excluded.
Indications
- intrauterine septum (complete or incomplete) with recurrent miscarriage, infertility, unsuccessful IVF;
- septum identified during pregnancy planning and examination (by doctor’s decision);
- bicornuate uterus, T-shaped uterus, complex anomalies with miscarriage (metroplasty);
- combination of septum with polyps, synechiae, fibroids.
Uterine abnormalities and pregnancy
The intrauterine septum is the most common anomaly of the uterus: it is poorly supplied with blood, and implantation on it leads to miscarriages in 60–80% of cases, premature birth and abnormal position of the fetus. Hysteroscopic incision of the septum eliminates the problem without incisions, and the miscarriage rate is reduced from 80 to 10-15%. A bicornuate uterus (two horns with a common or separate body) in case of repeated pregnancy losses is corrected by metroplasty - open union of the horns into a single cavity. The diagnosis is clarified by 3D ultrasound or MRI and hysteroscopy with laparoscopy to distinguish the septum from a bicornuate uterus.
