Page 42 - World Journal of Laparoscopic Surgery

Anshika Lekhi et al
the diagnosis of a suspected bicornuate uterus was REFERENCES
confirmed. Ultimately, the main disadvantage of hyster- 1. Moore KL, Persaud TVN, Torchia MG. The urogenital system.
oscopy is the invasiveness of the procedure which in the Before we are born: essential of embryology and birth defects.
past was usually performed under general anesthetic. 7th ed. Philadelphia (PA): Saunders/Elsevier; 2008. p. 162-189.
Nowadays, hysteroscopy is often performed under 2. Green LK, Harris RE. Uterine anomalies. Frequency of
local anesthetic. diagnosis and associated obstetric complications. Obstet
28
Saravelos et al reviewed the specificity and sensitiv- Gynecol 1976 Apr;47(4):427-429.
ity of different methods in the investigation of patients 3. Rock JA, Schlaff WD. The obstetric consequences of
uterovaginal anomalies. Fertil Steril 1985 May;43(5):681-692.
with uterine malformations. Based on their diagnostic 4. Acien P. Reproductive performance of women with uterine
accuracy, the diagnostic methods were categorized into malformations. Hum Reprod 1993 Jan;8(1):122-126.
four categories: 5. Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simon C,
1. Class Ia: Those that are capable of identifying con- Pellicer A. Reproductive impact of congenital Müllerian
genital uterine anomalies and classifying them into anomalies. Hum Reprod 1997 Oct;12(10):2277-2281.
appropriate subtypes with an accuracy of > 90%. Hys- 6. Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P.
Clinical implications of uterine malformations and hys-
teroscopy plus laparoscopy, HSG, and 3D US belong teroscopic treatment results. Hum Reprod Update 2001
to this class. Mar-Apr;7(2):161-174.
2. Class Ib: Those that are capable of identifying con- 7. Tomazevic T, Ban-Frangez H, Ribic-Pucelj M, Premru-Srsen T,
genital uterine anomalies with an accuracy of > 90% Verdenik I. Small uterine septum is an important risk variable
without being able to classify them into appropriate for preterm birth. Eur J Obstet Gynecol Reprod Biol 2007
Dec;135(2):154-157.
subtypes. Hysteroscopy alone belongs to this class. 8. Simon C, Martinez L, Pardo F, Tortajada M, Pellicer A.
3. Class II: Those that are capable of identifying congeni- Müllerian defects in women with normal reproductive
tal uterine anomalies with an accuracy of < 90%. Ac- outcome. Fertil Steril 1991 Dec;56(6):1192-1193.
cording to the available data, HSG and 2D US belong 9. Makino T, Hara T, Oka C, Toyoshima K, Sugi T, Iwasaki K,
to this class. Umeuchi M, Iizuka R. Survey of 1120 Japanese women with
4. Class III: This includes the investigations whose di- a history of recurrent spontaneous abortions. Eur J Obstet
agnostic accuracy in identifying congenital uterine Gynecol Reprod Biol 1992 Apr 21;44(2):123-130.
anomalies are still not exactly known; MRI belongs 10. Makino T, Umeuchi M, Nakada K, Nozawa S, Iizuka R.
Incidence of congenital uterine anomalies in repeated
to this class. reproductive wastage and prognosis for pregnancy after
They also concluded based on the data derived from metroplasty. Int J Fertil 1992 May-Jun;37(3):167-170.
class Ia and b studies that the prevalence of congenital 11. Clifford K, Rai R, Watson H, Regan L. An informative protocol
uterine anomalies is approximately 6.7% [confidence for the investigation of recurrent miscarriage: preliminary
interval (CI) 95%, 6.0–7.4] in the general/fertile population experience of 500 consecutive cases. Hum Reprod 1994
Jul;9(7):1328-1332.
and 7.3% (CI 95%, 6.7–7.9) in the infertile population. The 12. Acien P. Uterine anomalies and recurrent miscarriage. Infertil
prevalence in the infertile population is similar to that Reprod Med Clin North Am 1996;7:689-719.
of the general/fertile population. However, there seems 13. Homer HA, Li TC, Cooke ID. The septate uterus: a review
to be a higher prevalence of septate uteri in the infertile of management and reproductive outcome. Fertil Steril 2000
population, suggesting an association. 28 Jan;73(1):1-14.
14. Guimaraes Filho HA, Mattar R, Pires CR, Araujo E Jr,
Moron AF, Nardozza LMM. Comparison of hysterosalpingo-
CONCLUSION graphy, hysterosonography and hysteroscopy in evaluation
of the uterine cavity in patients with recurrent pregnancy
Hysteroscopy has revolutionized the uterine morbid- losses. Arch Gynecol Obstet 2006 Aug;274(5):284-288.
ity management globally. Its advantages over tradi- 15. Guimaraes Filho HA, Mattar R, Pires CR, Araujo E Jr,
tional abdominal approach include less morbidity, less Moron AF, Nardozza LMM. Prevalence of uterine defects in
postprocedure pain, reduced hospital stay, thereby habitual abortion patients attended on at a university health
making it a cost-effective procedure. Given its mini- service in Brazil. Arch Gynecol Obstet 2006 Oct;274(6):345-348.
mally invasive approach, there is no scar formation or 16. Heinonen PK, Saarikoski S, Pystyen P. Reproductive
performance of women with uterine anomalies. An evaluation
postoperative adhesion, which allows the maintenance of 182 cases. Acta Obstet Gynecol Scand 1982;61(2):157-162.
of integrity of uterine wall. The recovery time before 17. Colacurci N, De Placido G, Mollo A, Carravetta C,
conception is shortened. Direct visualization of the De Franciscis P. Reproductive outcomes after hysteroscopic
cavity leads to the diagnosis of many uterine anomalies metroplasty. Eur J Obtet Gynecol Reprod Biol 1996 Jun;66(2):
147-150.
which otherwise go unnoticed. These anomalies can 18. Gomel V, Taylor P, Yuzpe AA, Rioux JE, editors. Laparoscopy
not only be diagnosed but also can be managed at the and hysteroscopy in gynecologic practice. Chicago (IL): Year
same time. Book Medical Publishers; 1986. p. 252.
90