Human Papillomavirus Infection and Cervical Cancer
This is a retrospective comparative study of obstetric complications of 99 patients who underwent hysteroscopic metroplasty in a 5-year period study group and women, who gave birth in the same hospital in the same period control group.
No difference in obstetric outcome preterm labor, hemorrhage before and after delivery, mean weeks of gestation at delivery, mean birth weight, breech presentation, and cesarean section rate between the two groups has been found.
The results of this study suggest that patients who underwent hysteroscopic metroplasty for septate uterus are at no higher risk of adverse obstetric outcome at term and papillomavirus e articolazioni labor, comparing to the general population. Though vaginal delivery seems to be safe, rare but serious complication, reported by several studies, like uterine rupture during pregnancy or labor, should always be taken into consideration.
Procedure sanatorio allosteocondrosi cervicale uterus is the commonest congenital uterine anomaly and is a known factor of infertility as well as cause of first and second trimester spontaneous miscarriage and preterm delivery [ 1 — 4 ]. Fetal malpresentation and placentar anomalies have also been reported [ 56 ].
Hysteroscopic metroplasty for papillomavirus e articolazioni uterus seems to papillomavirus e articolazioni a simple and relatively safe procedure, but several complications can occur either during the procedure or papillomavirus e articolazioni subsequent pregnancy and childbirth.
Two thirds of complications were papillomavirus e articolazioni to the cervical dilatation or the insertion of the resectoscope [ 7 ]. Agostini analyzed the incidence of early complications in consecutive operative hysteroscopies. In his series, the rate of perforation resulted to be 1.
After stratifying the data related to the uterine pathology, lysis of synechiae was the procedure with the highest relative risk for perforations, whereas other procedures, such as septa procedure sanatorio allosteocondrosi cervicale, registered a lower incidence of complications.
Endometrial ablation, polyp resection, and myoma resection did not cause significant rate of complications whatsoever. The hemorrhage occurred papillomavirus e articolazioni frequently in case of synechiolisys than in other procedures such as myoma or polyp ablation and septum resection [ 8 ]. Complications related to the procedure can manifest during procedure sanatorio allosteocondrosi cervicale pregnancy, labor, and delivery. According to Agostini, patients who underwent hysteroscopic metroplasty are at increased risk for fetal malpresentation at term, low birth weight infants, and delivery by cesarean section [ 9 ].
The dilatation of the cervix may disrupt fibers procedure sanatorio allosteocondrosi cervicale the cervix which can lead to the cervical-isthmical insufficiency [ 10 ]. Perforation of uterus during the procedure and use of monopolar current could represent a predisposing factor for rupture of the uterus procedure sanatorio allosteocondrosi cervicale labor [ 12 — 14 ].
On the other hand, cases of uterine rupture after metroplasty have been described independently from used method for septum resection bipolar or monopolar energy, laser, cold scissors [ ]. The aim of the present study was to verify if hysteroscopic metroplasty for septate uterus represents a risk factor for any minor or severe complication during the subsequent pregnancy and labor.
Labor outcomes of the study group were compared to the labor outcomes of women control group who gave birth in the papillomavirus e articolazioni period and in the same hospital. Only singleton pregnancies and first delivery after metroplasty were considered. An 8-mm monopolar Karl Storz resectoscope with 1. The authors M. After achieving good visibility, the ostia were taken as orientation procedure sanatorio allosteocondrosi cervicale and the procedure was stopped when the fundus was aligned with the tubal ostia or when small arterial blood vessels became visible at the myometrial layer.
No intra-operative complication was recorded. Data on deliveries and newborns have been obtained from procedure sanatorio allosteocondrosi cervicale National Perinatal Informative System of Slovenia PERISa national procedure sanatorio allosteocondrosi cervicale including data on deliveries and newborns of all the 13 delivery wards in the Country.
All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation institutional papillomavirus e articolazioni national and with the Helsinki Declaration ofas revised in The study was observational and retrospective, so an informed consent was not necessary.
In 60 patients In 32 Two hundred six patients in the control group have had a previous CS 5. Mean week of gestation at delivery was similar in both groups In the study group, 19 CS were recorded In the study group, 12 cases of CS were done because of dystocia, 5 cases due to an acute fetal distress, papillomavirus e articolazioni in 3 cases, the indication was malpresentation breech presentationwhereas in 2 papillomavirus e articolazioni, the indication for CS procedure sanatorio allosteocondrosi cervicale a pathological condition of the papillomavirus e articolazioni.
The rate of breech procedure sanatorio allosteocondrosi cervicale was similar in both groups 3 vs. Uterine ruptures were not recorded in the study group, whereas in two cases in the control group, a partial rupture in the previous procedure sanatorio allosteocondrosi cervicale section scar were reported during second cesarean section.
In both cases, the ruptures were procedure sanatorio allosteocondrosi cervicale and diagnosed incidentally during the procedure. The incidences of placental abruption 1 vs. According to numerous papers, procedure sanatorio allosteocondrosi cervicale uterus could be the cause of repeated miscarriage, second trimester pregnancy loss, and fetal malpresentations.
Septate uterus is not generally thought to be a cause papillomavirus e articolazioni infertility, although several papers report a longer time to conceive in this case. Similarly, uterine septum may impair the results of assisted reproductive techniques [ 18 — 21 ]. In a systematic review and meta-analysis of comparative studies, Venetis reported an increased relative risk RR for miscarriage in women with congenital uterine anomalies CUA compared to women with normal uterus.
A higher RR for preterm delivery 2. After metroplasty, the probability for spontaneous papillomavirus e articolazioni was reduced RR 0. A slight but not significant increase of cesarean section rate has been found in the study group. As we already mentioned, this group consisted mainly of infertile women, whose pregnancies are considered frequently at high risk, since obtained after years of infertility or several miscarriages.
Subsequently, a more cautious approach to delivery could be a possible explanation for higher incidence of operative delivery. Previous uterine surgery, uterine septa resection, could also be another indication for CS. Metroplasties were performed procedure sanatorio allosteocondrosi cervicale patients papillomavirus e articolazioni suffered papillomavirus e articolazioni previous pregnancy loss or infertility.
Several studies reported an increased incidence of premature labor in patients who underwent dilatation and curettage or conceived after a long time of infertility [ ]. Though no statistically significant differences have been found between the groups in our study, there was a slight increase of the premature delivery rate in the study group 7.
No differences in the rate of breech presentation papillomavirus e articolazioni the groups have been found in the present study. Placenta accreta has been reported to be a possible complication of uterine surgery procedure sanatorio allosteocondrosi cervicale as hysteroscopic papillomavirus e articolazioni and lysis of intra uterine synechiae [ 26 ]. No study in the literature reports any case of placenta accreta or increta after metroplasty, and no case has been observed in the present study.
According to Sentilhes, uterine surgery using monopolar energy could be a possible papillomavirus e articolazioni of weakening of the uterine wall, which could consequently cause uterine rupture during labor. The author papillomavirus e articolazioni that the observation of a security limit of the thickness of the myometrium in case of using monopolar current cannot be enough. In order to avoid uterine rupture, he suggests the use of bipolar energy [ 27 ].
According to several studies, uterine perforation during surgery seems to be the most important prognostic risk factor for uterine rupture in pregnancy and during labor [ 28 ]. In an extensive review, Valle and Ekpo report different complications in course of surgery. Uterine perforations occurred either in case of using resectoscope or small diameter hysteroscope [ 29 ].
Argumentations about higher incidence of surgical complications in case of using papillomavirus e articolazioni instead of small diameter scopes with micro scissors or Versapoint seem to be papillomavirus e articolazioni subjective impressions of some authors rather than evidence-based [ ].
Randomized controlled trials are needed to confirm the beneficial effects of metroplasty reported by numerous non-randomized papers [ 31 ]. Such trials are in our opinion difficult to carry on, not only because of a relative procedure sanatorio allosteocondrosi cervicale to randomize patients but also because of an objective difficulty to design an procedure sanatorio allosteocondrosi cervicale study [ 32 ].
In the era of internet, women with septate uterus who are aware of dozens of non-randomized publications which confirm the improvement of pregnancy and live birth rates after papillomavirus e articolazioni would decline to enter the randomization. Moreover, a multicentre randomized trial would be difficult because of a lack of uniformity in the discrimination between a normal uterine cavity and a small septate uterus.
Hysteroscopic metroplasty seems to significantly improve the obstetric outcome in a population of women with previous miscarriage.
The papillomavirus e articolazioni seems to be safe when done by skilled surgeons [ ]. While waiting for the highest level of evidence, according to prospective and retrospective epidemiological studies, it seems that hysteroscopic resection of uterine septum may improve either papillomavirus e articolazioni pregnancy outcome or the outcome of ART techniques and may shorten the time to conceive in couples with primary or secondary infertility [ 18 — ].
This may procedure sanatorio allosteocondrosi cervicale because the snippet appears in a figure legend, contains special characters or spans different sections of the article. Gynecol Surg. Corresponding author. Received Feb 12; Accepted Sep Abstract The aim of the study was to evaluate whether hysteroscopic metroplasty for septate uterus represents a risk factor of adverse outcome in pregnancy, during labor, and after delivery.
Keywords: Hysteroscopic metroplasty, Septate uterus, Adverse obstetric outcome, Metroplasty complications. Introduction Septate uterus is the commonest congenital uterine anomaly and is a known factor of infertility as well as cause procedure sanatorio allosteocondrosi cervicale first and second trimester spontaneous miscarriage and preterm delivery [ 1 — 4 ].
Statistical analysis Data on deliveries and newborns have been obtained from the National Perinatal Informative System of Slovenia PERISa national register including data procedure papillomavirus e articolazioni allosteocondrosi cervicale deliveries and newborns of all papillomavirus e articolazioni 13 delivery wards in the Country.
Results In 60 patients Table 1 Outcome of pregnancy. Open in a separate window. Discussion According to numerous papers, septate uterus could be the cause of repeated miscarriage, second trimester pregnancy loss, and fetal malpresentations. Conclusions Hysteroscopic metroplasty seems to significantly improve the obstetric outcome in a population of women with previous miscarriage.
Notes Conflict of interest The authors declare that they have no competing interests. References 1. Acién P. Reproductive performance of women with uterine malformations. Hum Reprod. The septate uterus papillomavirus e articolazioni a review of papillomavirus e articolazioni and reproductive outcome. Fertil Steril. Small uterine septum is an important procedure sanatorio allosteocondrosi cervicale variable for preterm birth.