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Frontiers in Surgery 2022Although the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in... (Review)
Review
OBJECTIVE
Although the randomized controlled trial (RCT) of the efficacy of hysteroscopic resection in women with uterine septum has not shown any significant correlation in recent research, motivation for deeper study remains insufficient. In this study, the objective was to determine pregnancy-related outcomes, along with adverse obstetric outcomes, following hysteroscopic resection and also to determine whether women with hysteroscopic resection bear the same outcomes as women with normal uterine cavities.
SEARCH METHODS
From January 1995 to February 2022, a systematic literature review was conducted to identify all studies published concerning the gestation outcomes of women with and without hysteroscopic resection while comparing the gestation outcomes of women after hysteroscopic resection and with a normal uterine cavity. Our primary outcome was the live birth rate (LBR). The secondary outcomes were term delivery, preterm delivery, spontaneous miscarriage, malpresentation, cesarean section, and other adverse obstetric outcomes.
RESULTS
22 studies were included in this meta-analysis. The control groups of 14 studies were treated women, and the control groups of the other 8 studies were patients bearing a normal uterine cavity. Hysteroscopic resection was related to a higher rate of term delivery (OR = 2.26, 95% CI, 1.26-4.05), and a lower rate of spontaneous abortion (OR = 0.50, 95% CI, 0.27-0.93), and a lower rate of malpresentation (OR = 0.31, 95% CI, 0.19-0.50). Nevertheless, in comparison with the normal uterus group, the rates of preterm birth, cesarean section, and postpartum hemorrhage after resection did not return to normal levels.
CONCLUSION
Hysteroscopic resection can effectively reduce the risk of abortion and malpresentation in patients possessing a uterine septum while increasing the term delivery rate. Although well-designed RCTs should confirm our meta-analysis, it still bears recommending to patients.
PubMed: 35832500
DOI: 10.3389/fsurg.2022.889696 -
Journal of Clinical Medicine Jun 2022Objective: we performed a systematic review/meta-analysis to evaluate the impact of septate uterus and hysteroscopic metroplasty on pregnancy rate-(PR), live birth... (Review)
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.
PubMed: 35743362
DOI: 10.3390/jcm11123290 -
Genes Dec 2021Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest...
Patent Foramen Ovale (PFO) is a common postnatal defect of cardiac atrial septation. A certain degree of familial aggregation has been reported. Animal studies suggest the involvement of the Notch pathway and other cardiac transcription factors (GATA4, TBX20, NKX2-5) in Foramen Ovale closure. This review evaluates the contribution of genetic alterations in PFO development. We systematically reviewed studies that assessed rare and common variants in subjects with PFO. The protocol was registered with PROSPERO and followed MOOSE guidelines. We systematically searched English studies reporting rates of variants in PFO subjects until the 30th of June 2021. Among 1231 studies, we included four studies: two of them assessed the gene, the remaining reported variants of chromosome 4q25 and the S377G variant, respectively. We did not find any variant associated with PFO, except for the rs2200733 variant of chromosome 4q25 in atrial fibrillation patients. Despite the scarceness of evidence so far, animal studies and other studies that did not fulfil the criteria to be included in the review indicate a robust genetic background in PFO. More research is needed on the genetic determinants of PFO.
Topics: Animals; Foramen Ovale, Patent; GATA4 Transcription Factor; Homeobox Protein Nkx-2.5; Humans; Risk Factors
PubMed: 34946902
DOI: 10.3390/genes12121953 -
Obstetrics and Gynecology Jan 2022To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3... (Meta-Analysis)
Meta-Analysis
Obstetric Complications in Women With Congenital Uterine Anomalies According to the 2013 European Society of Human Reproduction and Embryology and the European Society for Gynaecological Endoscopy Classification: A Systematic Review and Meta-analysis.
OBJECTIVE
To assess the risk for obstetric complications in women with congenital uterine anomalies and the risk in each main class of uterine anomaly (U2 [septate], U3 [bicorporeal], U4 [hemi-uterus]), based on the 2013 classification by the ESHRE (European Society of Human Reproduction and Embryology) and the ESGE (European Society for Gynaecological Endoscopy).
DATA SOURCES
MEDLINE, Scopus, and ClinicalTrials.gov were searched from inception until January 2021. The reference list of all included articles and previous systematic reviews were also screened to identify potential additional articles.
METHODS OF STUDY SELECTION
Comparative and noncomparative studies that investigated the obstetric outcomes of women with any type of known congenital uterine anomaly were considered eligible for inclusion. Screening and eligibility assessment was performed independently by two reviewers.
TABULATION, INTEGRATION, AND RESULTS
Forty-seven studies were included. The quality of included comparative studies was assessed using the Newcastle-Ottawa Quality Assessment Scale. Odds ratios (ORs), pooled proportions of each obstetric outcome, and 95% CIs were calculated in RevMan and Stata accordingly, using random effects models. Congenital uterine anomalies were associated with increased risk of preterm birth (OR 3.89, 95% CI 3.11-4.88); cervical insufficiency (OR 15.13, 95% CI 11.74-19.50); prelabor rupture of membranes (OR 2.48, 95% CI 1.38-4.48); fetal malpresentation (OR 11.11, 95% CI 5.74-21.49); fetal growth restriction (OR 3.75, 95% CI 1.88-7.46); placental abruption (OR 5.21, 95% CI 3.34-8.13); placenta previa (OR 4.00, 95% CI 1.87-8.56); placental retention (OR 1.71, 95% CI 1.16-2.52); and cesarean birth (OR 4.52, 95% CI 2.19-9.31); when compared with those without anomalies. Pooled estimated risks were 25% for preterm birth, 40% for fetal malpresentation, 64% for cesarean birth, 12% for prelabor rupture of membranes, 15% for fetal growth restriction, 4% for placental abruption, 5% for preeclampsia, 13% for cervical insufficiency, and 2% for placenta previa. Classes U2 (septate), U3 (bicorporeal), and U4 (hemi-uterus) were also associated independently with preterm birth, fetal malpresentation, cesarean birth, and placental abruption.
CONCLUSION
Congenital uterine anomalies are associated with obstetric complications across all examined ESHRE and ESGE classifications.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO, CRD42021244487.
Topics: Delivery, Obstetric; Europe; Female; Gynecology; Humans; Obstetrics; Pregnancy; Pregnancy Complications; Societies, Medical; Urogenital Abnormalities; Uterus
PubMed: 34856567
DOI: 10.1097/AOG.0000000000004627 -
Journal of Minimally Invasive Gynecology Apr 2022The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
The aim of this systematic review with meta-analysis is to evaluate the impact of hysteroscopic metroplasty on adverse reproductive outcomes such as miscarriage, preterm birth, and fetal malpresentation in patients with history of infertility or previous poor obstetrical outcomes.
DATA SOURCES
A systematic electronic search from inception each database up to April 2021 including the following databases was conducted: PubMed-MEDLINE, EMBASE, Web of Science, The Cochrane Library, the CGF Specialized Register of Controlled Trials, Google Scholar, and trial registries. A combination of the following keywords was used: uterine septum, septate uterus, congenital uterine malformation, class 2 uterus, class V uterus, metroplasty, hysteroscopic, pregnancy, clinical pregnancy, ongoing pregnancy, miscarriage, live birth, preterm birth, cesarean section, 'cesarean delivery, and fetal malpresentation.
METHODS OF STUDY SELECTION
Studies comparing reproductive outcomes between women undergoing hysteroscopic resection of the uterine septum and those with expectant management were included. Eligible population consisted of infertile women, women with poor obstetrical history, or women without previous pregnancy failures and a diagnosis of septate uterus.
TABULATION, INTEGRATION, AND RESULTS
The systematic electronic search retrieved 1076 studies; after elimination of duplicates, 688 titles and abstracts were screened, and 55 were assessed for eligibility. Eleven studies were included in the quantitative synthesis: one randomized controlled trial and 10 observational studies involving reproductive outcomes from 1589 patients with either complete or partial uterine septum. The pooled OR for miscarriage was 0.45, (95% CI, 0.22-0.90). When the analysis was performed considering subgroups according to the type of septum, pooled OR in complete septum subgroup was 0.16 (95% CI, 0.03-0.78), OR = 0.36 (95% CI, 0.19-0.71) in the partial septum subgroup and 0.58 (95% CI, 0.20-1.67) in those studies not differentiating between complete or partial septum. No significant differences were found between the 2 groups in OR of clinical pregnancy, term live birth, or risk of cesarean delivery. There was a significant decrease in the frequency of preterm birth in patients who underwent partial septum resection (OR = 0.30, 95% CI, 0.11-0.79). This difference was detected neither in patients with complete septum nor in studies not differentiating between partial or complete septum. The risk of fetal malpresentation was also significantly reduced (OR = 0.32, 95% CI, 0.16-0.65).
CONCLUSION
The results of the present meta-analysis support that hysteroscopic metroplasty is effective in reducing the risk of miscarriage in patients with complete or partial uterine septum, although these data should be confirmed with a well-designed randomized controlled trial.
Topics: Abortion, Spontaneous; Cesarean Section; Female; Humans; Hysteroscopy; Infant, Newborn; Infertility, Female; Pregnancy; Premature Birth; Uterus
PubMed: 34648934
DOI: 10.1016/j.jmig.2021.10.001 -
World Neurosurgery Jun 2021The current treatment options for chronic subdural hematoma (CSDH) include burr hole drainage, twist drill drainage, and craniotomy with or without postoperative...
BACKGROUND
The current treatment options for chronic subdural hematoma (CSDH) include burr hole drainage, twist drill drainage, and craniotomy with or without postoperative catheter drainage. Although generally effective, these treatments have continued to be complicated by recurrence, especially in partially hemolyzed or septated hematomas. Recently, interest in the use of fibrinolytic agents as an adjunct to surgical treatment to address this limitation has been increasing. We conducted a systematic review, focusing on the efficacy and safety profile of fibrinolytic agents and compared the different fibrinolytic agents.
METHODS
The PubMed, EMBASE, CINAHL Plus, and Cochrane Library databases were searched for trials relevant to fibrinolytic administration in the treatment of CSDH. The findings are reported in accordance with the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. The data from 1702 subjects from 6 retrospective observational studies were qualitatively analyzed. In addition, we included 11 case series and reports for discussion.
RESULTS
For 1449 patients, the use of urokinase or tissue plasminogen activator improved hematoma drainage and shortened the hospital stay (7.04 days), with an overall hematoma recurrence rate of 1.59%. The incidence of infection, seizure, and intracranial bleeding was 3.18%, 0.80%, and 0.41%, respectively, which compared favorably with previously reported findings for surgical drainage without the use of fibrinolytic agents.
CONCLUSIONS
The routine use of intrathecal urokinase and tissue plasminogen activator could be a new direction in the management of CSDH. Conclusive clinical evidence is lacking, however, and further prospective controlled studies are warranted to confirm the benefit and safety of this treatment strategy and to identify the optimal agent and dosing regimen.
Topics: Chemotherapy, Adjuvant; Craniotomy; Fibrinolytic Agents; Hematoma, Subdural, Chronic; Humans; Injections, Spinal; Tissue Plasminogen Activator; Urokinase-Type Plasminogen Activator
PubMed: 33722722
DOI: 10.1016/j.wneu.2021.03.029 -
American Journal of Medical Genetics.... Jan 2021This objective of this systematic review was to estimate live birth rate and explore prognostic indicators in fetuses with 45,X karyotype and a posterior cystic hygroma...
This objective of this systematic review was to estimate live birth rate and explore prognostic indicators in fetuses with 45,X karyotype and a posterior cystic hygroma (CH). Electronic databases were searched and studies reporting pregnancy outcomes (termination, spontaneous abortion, demise, or live birth) for fetuses with 45,X karyotype and a CH diagnosed on ultrasound were included. For cases of survival, CH characteristics, presence of hydrops fetalis, or concomitant anomalies, delivery details, and postnatal outcomes were summarized. A total of 95 studies, including 535 cases, met inclusion criteria: 285 (53.3%) pregnancies were terminated, 72 (13.5%) had spontaneous abortion or demise, 164 (30.7%) had unspecified pregnancy failure, and 14 (2.6%) were live births. Among live births with data available, all CH measured 2-7 cm, more than half were septate, and almost all regressed in size or eventually disappeared. Hydrops fetalis was noted in five cases. Of the eight live births with neonatal outcomes available, three neonates died shortly after birth and five survived past the neonatal period. This review suggests that diagnosis of CH in a 45,X fetus is associated with an estimated live birth rate of 2.6%, but only 1% survive to infancy. Prognosis appears to improve with CH regression.
Topics: Chromosome Aberrations; Female; Fetus; Humans; Infant, Newborn; Karyotype; Karyotyping; Lymphangioma, Cystic; Pregnancy; Pregnancy Outcome; Prognosis; Ultrasonography, Prenatal
PubMed: 33026168
DOI: 10.1002/ajmg.a.61902 -
Minerva Ginecologica Feb 2020Hysteroscopic septoplasty is a safe and routinely used procedure for the treatment of septate uterus. The aim of this paper is to determine which hysteroscopic technique... (Comparative Study)
Comparative Study
INTRODUCTION
Hysteroscopic septoplasty is a safe and routinely used procedure for the treatment of septate uterus. The aim of this paper is to determine which hysteroscopic technique (scissors, monopolar/bipolar diathermy) is superior for post-treatment reproductive outcome.
EVIDENCE ACQUISITION
Two different hysteroscopic septoplasty instruments (scissors and monopolar/bipolar diathermy) were compared, focusing on the pregnancy outcome. In addition, all published studies and reviews regarding pregnancy outcomes that occurred after operative hysteroscopy using different techniques (bipolar, monopolar electrodes, resectoscope, VERSAPOINT™ [Ethicon LLC] and scissors) were reviewed. Dichotomous analysis, with use of the Mantel-Haenszel method, was performed for all five outcomes, with fixed effect analysis model and odds ratio (OR) as the effect measure. Analysis details included totals and subtotals with 95% confidence interval. The Multinomial CI package for the R statistical language was also used.
EVIDENCE SYNTHESIS
Out of 26 full-text articles available in the literature, two studies were finally selected as eligible, with a total number of 125 patients. Pregnancy rate for scissors was 88.8% and for resectoscope was 75.6% (OR: 2.13, I2=29%; P=0.23). Delivery rate for scissors was 78.1% and for resectoscope was 75.0% (OR: 1.29, I2=0%; P=0.53). Miscarriage rate for scissors was 21.8% and for resectoscope was 27.1% (OR: 0.78, I2=0%; P=0.53). Preterm delivery rate for scissors was 6.2% and for resectoscope was 6.7% (OR: 0.85, I2=0%; P=0.94). Term delivery rate for scissors was 71.8% and for resectoscope was 66.1% (OR: 1.32, I2=0%; P=0.47). The lack of evidence in literature regarding the potential influence in the reproductive outcome of the instrument used when performing a hysteroscopy to treat a septate uterus became radically clear.
CONCLUSIONS
No statistically significant differences were observed in reproductive outcomes between women treated for septate uterus using resectoscope or scissors.
Topics: Abortion, Spontaneous; Confidence Intervals; Diathermy; Female; Humans; Hysteroscopy; Odds Ratio; Pregnancy; Pregnancy Outcome; Pregnancy Rate; Premature Birth; Surgical Instruments; Term Birth; Treatment Outcome; Uterus
PubMed: 32153162
DOI: 10.23736/S0026-4784.20.04444-5 -
BJOG : An International Journal of... Sep 2019Little is known about the pathophysiology underlying the increased risk for impaired reproductive outcomes in women with a septate uterus.
BACKGROUND
Little is known about the pathophysiology underlying the increased risk for impaired reproductive outcomes in women with a septate uterus.
OBJECTIVES
We explored the available evidence on the pathophysiology of the septate uterus in an attempt to find a biological basis for these effects.
SEARCH STRATEGY
We performed a systematic literature search in OVID MEDLINE and OVID EMBASE from inception to January 2018.
SELECTION CRITERIA
We selected studies that investigated the pathophysiology of the septate uterus. Case reports or reviews without original data were excluded.
DATA COLLECTION AND ANALYSIS
Two reviewers independently evaluated potentially eligible papers.
MAIN RESULTS
Thirty-eight studies were included for analysis. The overall findings were that the intrauterine septum consists of endometrium and myometrium similar to the uterine wall. All five imaging studies that evaluated vascularity found that most of the intrauterine septa were vascularised. Histological studies found that the intrauterine septum consisted of myometrium and was covered by endometrium (n = 9). The endometrium covering the septum showed differences in histological composition in four studies and in gene expression in three studies compared with the normal uterine wall.
CONCLUSIONS
We found no clear biological basis for the impaired reproductive outcomes in women with a septate uterus. Either the gross anatomy of the septum itself or differences in histology or gene expression of the septum could account for the increased risk of reproductive waste observed after implantation in the septum.
TWEETABLE ABSTRACT
In women with a septate uterus differences in histology or gene expression could account for impaired reproductive outcome.
Topics: Abortion, Habitual; Female; Humans; Hysteroscopy; Infertility; Pregnancy; Uterine Diseases; Uterus
PubMed: 31004459
DOI: 10.1111/1471-0528.15798 -
Pancreas Oct 2018The evidence on the ability of radiological tests to predict a specific diagnosis and also their aptitude in identifying pathological markers indicative of malignancy in...
The evidence on the ability of radiological tests to predict a specific diagnosis and also their aptitude in identifying pathological markers indicative of malignancy in cystic lesions of the pancreas remains inconclusive. We conducted a systematic review on MEDLINE for the use of computed tomography (CT), magnetic resonance imaging, and positron emission tomography/CT (PET/CT) in the diagnosis and characterization of these cysts. The accuracy of CT scan for reaching a specific diagnosis was 39% to 61.4%, whereas its accuracy for differentiating benign from malignant lesions was 61.9% to 80%. Magnetic resonance imaging showed a better accuracy in identifying a specific diagnosis of 50% to 86%, whereas its accuracy in differentiating benign from malignant lesions was 55.6% to 87%. The use of magnetic resonance imaging was superior to CT scan in identifying septations, mural nodules, and ductal communication. The sensitivity of PET/CT in diagnosing malignancy was 85.7% to 100% with a reported accuracy of 88% to 95%. The evidence gathered from this review suggests that the adequacy of CT imaging in full characterization of pancreatic cysts is suboptimal, and therefore a low threshold for supplementary imaging is advised. The use of PET/CT should be considered in high-risk patients with equivocal findings.
Topics: Diagnosis, Differential; Humans; Magnetic Resonance Imaging; Pancreas; Pancreatic Cyst; Pancreatic Neoplasms; Positron Emission Tomography Computed Tomography; Reproducibility of Results; Sensitivity and Specificity; Tomography, X-Ray Computed
PubMed: 30199486
DOI: 10.1097/MPA.0000000000001134