II-183
Posterji
SPONTANA ZANOSITEV PO HISTEROSKOPSKI
METROPLASTIKI
SPONTANEOUS CONCEPTION AFTER HYSTEROSCOPIC METROPLASTY
Marco Gergolet, Sergej Pušnar
Ginekološki oddelek, Ginekološko porodniška služba, Splošna bolnišnica »dr. Franc Derganc«, 5290 Šempeter pri Gorici
Ključne besede: septum maternice; neplodnost
Izvleček – Izhodišča. Prirojene nepravilnosti maternice so lah-
ko vzrok neplodnosti in spontanega splava v prvem trimeseč-
ju nosečnosti. Preverili smo, ali histeroskopska resekcija ma-
ternice s pregrado pozitivno vpliva na poldnost.
Materiali in metode. V obdobju marec 2000 do maj 2002 smo
pri 31 bolnicah s pregrado v maternici opravili histeroskop-
sko resekcijo pregrade in ugotavljali časovni presledek do za-
nositve po metroplastiki. Izključili smo bolnice z obojestran-
skim tubarnim dejavnikom in moško neplodnostjo, ter bolni-
ce, ki po metroplastiki niso želele zanositi. Ugotavljali smo čas
v mesecih od želje po zanositvi do operacije oziroma obdobje
od zadnjega spontanega splava pred metroplastiko in čas v
mesecih do spontane zanositve po metroplastiki. Operativne
posege smo opravili z 8-milimetrskim resektoskopom Aescu-
lap. Za distenzijo maternične votline smo uporabili 5-odstot-
no glukozno razstopino in Vario FlowTM, ki omogoča ob do-
bri distenizji hkrati kontrolo uravnoteženosti uporabljene te-
kočine.
Rezultati. 23 bolnic je spontano zanosilo (74,2%). Dve sta za-
nosili dvakrat, ena je po spontanem splavu ponovno sponta-
no zanosila in donosila dvojčke, druga je ponovno spontano
zanosila po tubarni nosečnosti. Srednja starost žensk, ki so
zanosile, je bila 31,4 leta, žensk, ki niso zanosile, pa 31,43 leta
(n.s.), BMI je bil 20,56 oz. 20,89 (n.s.).
Povprečno obdobje izpostavljenosti pred metroplastiko je
bilo pri bolnicah, ki so po posegu zanosile, 15,8 meseca (SE =
8,01), po metroplastiki pa 5,09 meseca (SE = 3,29) p =
0,000001.
Zaključki. Histeroskopska resekcija pregrade lahko bistveno
skrajša čas do spontane zanositve.
Key words: uterine septum; infertility
Abstract – Background. Congenital uterine anomalies may
be associated with infertility and first trimester spontaneous
pregnancy loss. Aim of the present study was to verify whe-
ther hysteroscopic metroplasty could be advantageous in treat-
ment of infertility.
Materials and methods. Thirty one patients who underwent
hysteroscopic metroplasty for uterine septum during the pe-
riod from March 2000 to May 2002 were reviewed for subse-
quent spontaneous conception. From the study were exclu-
ded cases with male factor of infertility, bilateral tubal factor
and patients with septum uteri who did not want to conceive
after the metroplasty. We compared the lengthiness in months
of pregnancy seeking before metroplasty or before the spon-
taneous abortion which carried to metroplasty and time in
months needed to conceive after the metroplasty. All the me-
troplastys have been done with an 8 mm Aesculap operative
hysteroscope. A Vario Flow TM automated gravitation system
was used to assure good uterine distention with a real time
fluid deficit control.
Results. Twenty three women became pregnant (74.2%). Two
of them two times, one after an ectopic pregnancy, one after a
spontaneous miscarriage for a total of 25 pregnancies The
average age of women that conceived after metroplasty was
31, 4, the average age of those who did not conceive was 31.43
(n.s.), BMI was 20.56 vs. 20, 89 (n.s.).
The expectation time for achieving pregnancy before metro-
plasty was 15.8 months (SE = 8.01) and after operation was
5.09 months (SE = 3.29), p = 0,000001.
Conclusions. Hysteroscopic metroplasty can significantly im-
prove spontaneous conception.
ZDRAV VESTN 2003; 72: II-183–204