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Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research

Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literatur...

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Autores principales: Noventa, Marco, Spagnol, Giulia, Marchetti, Matteo, Saccardi, Carlo, Bonaldo, Giulio, Laganà, Antonio Simone, Cavallin, Francesco, Andrisani, Alessandra, Ambrosini, Guido, Vitale, Salvatore Giovanni, Pacheco, Luis Alonso, Haimovich, Sergio, Di Spiezio Sardo, Attilio, Carugno, Jose, Scioscia, Marco, Garzon, Simone, Bettocchi, Stefano, Buzzaccarini, Giovanni, Tozzi, Roberto, Vitagliano, Amerigo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224595/
https://www.ncbi.nlm.nih.gov/pubmed/35743362
http://dx.doi.org/10.3390/jcm11123290
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author Noventa, Marco
Spagnol, Giulia
Marchetti, Matteo
Saccardi, Carlo
Bonaldo, Giulio
Laganà, Antonio Simone
Cavallin, Francesco
Andrisani, Alessandra
Ambrosini, Guido
Vitale, Salvatore Giovanni
Pacheco, Luis Alonso
Haimovich, Sergio
Di Spiezio Sardo, Attilio
Carugno, Jose
Scioscia, Marco
Garzon, Simone
Bettocchi, Stefano
Buzzaccarini, Giovanni
Tozzi, Roberto
Vitagliano, Amerigo
author_facet Noventa, Marco
Spagnol, Giulia
Marchetti, Matteo
Saccardi, Carlo
Bonaldo, Giulio
Laganà, Antonio Simone
Cavallin, Francesco
Andrisani, Alessandra
Ambrosini, Guido
Vitale, Salvatore Giovanni
Pacheco, Luis Alonso
Haimovich, Sergio
Di Spiezio Sardo, Attilio
Carugno, Jose
Scioscia, Marco
Garzon, Simone
Bettocchi, Stefano
Buzzaccarini, Giovanni
Tozzi, Roberto
Vitagliano, Amerigo
author_sort Noventa, Marco
collection PubMed
description Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27–0.76; p < 0.0001; and OR 0.21, 95% CI 0.12–0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90–6.36; p < 0.0001; OR 2.56, 95% CI 1.52–4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49–2.49; p = 0.82 and OR 0.81, 95% CI 0.35–1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21–1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02–0.04; p < 0.000 and OR 0.05, 95% CI 0.03–0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA.
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spelling pubmed-92245952022-06-24 Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research Noventa, Marco Spagnol, Giulia Marchetti, Matteo Saccardi, Carlo Bonaldo, Giulio Laganà, Antonio Simone Cavallin, Francesco Andrisani, Alessandra Ambrosini, Guido Vitale, Salvatore Giovanni Pacheco, Luis Alonso Haimovich, Sergio Di Spiezio Sardo, Attilio Carugno, Jose Scioscia, Marco Garzon, Simone Bettocchi, Stefano Buzzaccarini, Giovanni Tozzi, Roberto Vitagliano, Amerigo J Clin Med Systematic Review Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth rate-(LBR), spontaneous abortion-(SA) and preterm labor (PL) in infertile/recurrent miscarriage-(RM) patients. Data sources: a literature search of relevant papers was conducted using electronic bibliographic databases (Medline, Scopus, Embase, Science direct). Study eligibility criteria: we included in this meta-analysis all types of observational studies that evaluated the clinical impact of the uterine septum and its resection (hysteroscopic metroplasty) on reproductive and obstetrics outcomes. The population included were patients with a diagnosis of infertility or recurrent pregnancy loss. Study appraisal and synthesis methods: outcomes were evaluated according to three subgroups: (i) Women with untreated uterine septum versus women without septum (controls); (ii) Women with treated uterine septum versus women with untreated septum (controls); (iii) Women before and after septum removal. Odds ratios (OR) with 95% confidence intervals (CI) were calculated for the outcome measures. A p-value < 0.05 was considered statistically significant. Subgroup analysis was performed according to the depth of the septum. Sources of heterogeneity were explored by meta-regression analysis according to specific features: assisted reproductive technology/spontaneous conception, study design and quality of papers included Results: data from 38 studies were extracted. (i) septum versus no septum: a lower PR and LBR were associated with septate uterus vs. controls (OR 0.45, 95% CI 0.27–0.76; p < 0.0001; and OR 0.21, 95% CI 0.12–0.39; p < 0.0001); a higher proportion of SA and PL was associated with septate uterus vs. controls (OR 4.29, 95% CI 2.90–6.36; p < 0.0001; OR 2.56, 95% CI 1.52–4.31; p = 0.0004). (ii) treated versus untreated septum: PR and PL were not different in removed vs. unremoved septum(OR 1.10, 95% CI 0.49–2.49; p = 0.82 and OR 0.81, 95% CI 0.35–1.86; p = 0.62); a lower proportion of SA was associated with removed vs. unremoved septum (OR 0.47, 95% CI 0.21–1.04; p = 0.001); (iii) before-after septum removal: the proportion of LBR was higher after the removal of septum (OR 49.58, 95% CI 29.93–82.13; p < 0.0001) and the proportion of SA and PL was lower after the removal of the septum (OR 0.02, 95% CI 0.02–0.04; p < 0.000 and OR 0.05, 95% CI 0.03–0.08; p < 0.0001) Conclusions: the results show the detrimental effect of the uterine septum on PR, LBR, SA and PL. Its treatment reduces the rate of SA. MDPI 2022-06-08 /pmc/articles/PMC9224595/ /pubmed/35743362 http://dx.doi.org/10.3390/jcm11123290 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Systematic Review
Noventa, Marco
Spagnol, Giulia
Marchetti, Matteo
Saccardi, Carlo
Bonaldo, Giulio
Laganà, Antonio Simone
Cavallin, Francesco
Andrisani, Alessandra
Ambrosini, Guido
Vitale, Salvatore Giovanni
Pacheco, Luis Alonso
Haimovich, Sergio
Di Spiezio Sardo, Attilio
Carugno, Jose
Scioscia, Marco
Garzon, Simone
Bettocchi, Stefano
Buzzaccarini, Giovanni
Tozzi, Roberto
Vitagliano, Amerigo
Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title_full Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title_fullStr Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title_full_unstemmed Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title_short Uterine Septum with or without Hysteroscopic Metroplasty: Impact on Fertility and Obstetrical Outcomes—A Systematic Review and Meta-Analysis of Observational Research
title_sort uterine septum with or without hysteroscopic metroplasty: impact on fertility and obstetrical outcomes—a systematic review and meta-analysis of observational research
topic Systematic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9224595/
https://www.ncbi.nlm.nih.gov/pubmed/35743362
http://dx.doi.org/10.3390/jcm11123290
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