P-531 Effectiveness and safety of uterine septum division: An updated systematic review and meta-analysis
Bibliographic record
Abstract
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
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".