P-531 Effectiveness and safety of uterine septum division: An updated systematic review and meta-analysis
Notice bibliographique
Résumé
Abstract Study question To evaluate whether division of uterine septum improves reproductive outcome as compared to no intervention and is a safe procedure. Summary answer While septal division doesn’t seem to improve live birth and clinical pregnancy rates or reduce miscarriage rates, it has improved preterm birth and malpresentation rates. What is known already Septate uteri are common congenital uterine malformations and are seen in about 1% of women. While most women with septate uterus have normal reproductive outcome, studies have reported increased risk of adverse reproductive outcome including miscarriages in women with septate uterus. Hysteroscopic metroplasty or hysteroscopic transcervical division of the uterine septum has been regularly done with an intention to improve the outcome, although evidence on its effectiveness is conflicting. A systematic review of controlled studies done in 2014 has shown a potential benefit, but later studies including a recent randomized controlled trial (RCT) has shown no benefit. Study design, size, duration In this systematic review and meta-analysis, Medline and Cochrane Library databases were searched from commencement to December 2022. We identified 13 eligible studies of which 12 were non-randomised controlled studies and one RCT, comprising 1855 women. Participants/materials, setting, methods We included comparative studies of septal division versus non-intervention in women having septate uterus with a history of infertility or recurrent miscarriage. The outcomes assessed were live birth, clinical pregnancy, miscarriage, preterm birth, malpresentation and complications. The Newcastle-Ottawa Quality Assessment Scale was used for quality assessment. Statistical analysis was performed using Review Manager 5.4.1 software. Pooled odds ratios (OR) with 95% confidence intervals (CI) were computed using random effects models. Main results and the role of chance The live birth rates were similar for the septal division and non-intervention groups (OR: 1.48; 95% CI 0.86-2.56). The clinical pregnancy rates (OR: 1.24; 95% CI 0.64-2.39) and miscarriage rates (OR: 0.61; 95% CI 0.35-1.06) were also similar. The preterm birth rates (OR: 0.67; 95% CI 0.47-0.95) and malpresentation at birth (OR: 0.34; 95% CI 0.23-0.53) were lower in patients managed surgically. The complication rates were reported in four studies and were ranging between 2.6% and 9.4% with the main reported complication being uterine perforation. Limitations, reasons for caution While the review included comparative studies, only one was RCT. High level of heterogeneity between studies was observed. Many had different inclusion and/ or exclusion criteria and used different diagnostic modalities and criteria. Wider implications of the findings The findings of our review help in counselling women seeking septal division, particularly of lack of benefit in improving live birth rates or reducing miscarriage, but may reduce preterm births and malpresentation. Due to the heterogeneity of the included studies and low-quality evidence, large multicentre RCTs are warranted. Trial registration number not applicable
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,000 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».