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SUMMARYThis study was conducted on 20 patients with uterine septum diagnosed clinically and by endovaginal sonogarphy hysterosalpingography, hysteroscopically to assess the role of the hysteroscope in diagnosis and treatment of this condition.In this study, every case was subjected to full history taking, including personal, menstrual, obstetric and sexual history. The main complaint was identified in most of the group as being repeated pregnancy wastage occurred in 35% of cases primary infertility 25% of cases; premature labour in 15% of cases, peri-natal mortalies in 10% of cases while interactable dysmenorrhoea found in 10% of cases, irregular uterine bleeding was found in 5% of the cases.Complete physical examination of all patients was performed in the outpatient clinic and included general and pelvic examination; endovaginal sonography was performed for every case to detect the extent and width of the septum, hysterosalpingogaphy was performed for every case and those showed any lesion rather than intra-uterine septum were excluded from this study.Hysteroscopic examination of the uterine cavity was done for every case to confirm the hysterographic diagnosis of the septum. There were some differences between results obtained by hysteroscope, endovaginal sonography and those of hysterograms regarding the actual length and width of the uterine septum.In the proliferative phase of the menstrual cycle, both of the hysteroscope and the abdominal laparoscope were used to resect the septum. Early complications during the operation and remote complications after the procedure were minimal and confined to intra-uterine bleeding in three cases with thick septum; bimanual compression was sufficient to control this bleeding.Copper-T (380) intra- uterine device was inserted in every case to minimize the risk of developing postoperative adhesions for two months.Hysterosalpingography was performed after two months for every case after removal of the loop to determine the shape of the uterine cavity. In four cases only, remenant of septum was noticed and needed another sitting to be removed completely.Follow-up of the cases showed satisfactory gestational outcome results, among 5 cases presented with repeated abortions, 4 of them got pregnant during the time of this study, 2 out of these cases gave birth to normal infants through spontaneous vaginal delivery; 1 case required caesarean section while the last one got repeated abortion.As regards the five cases of primary infertility 2 of these cases got pregnant one of them after I.V. trial and the other case after induction of ovulation. While the last 3 cases failed to get pregnant due to sever pelvic adhesions in 2 of them and a male factor in the third one.Only one reached full term and delivered caesarean section but the other case aborted.As regards the 2 cases of repeated premature labours one case reached full term and delivered vaginally.As regards the case of perinatal mortality reached full term and delivered vaginally.As regards the cases presented with dysmenorrhoea, irregular uterine bleeding, marked improvement of such symptoms was noticed in this study.CONCLUSION? Hysteroscopy is a safe and effective modality in diagnosis of uterine septae and useful to define the extent and the thickness of the uterine septum.? Hysteroscopic resection is an excellent treatment for uterine septae.? Hysteroscopic resection represent a reasonable alternative to metroplasty (the surgical management of the septum).? Hysteroscopic resection is more acceptable to the patient as it is associated with rapid recovery and little inconvenience and associated with a high degree of success and low rate of complications.? Two essential points to avoid the complications during the hysteroscopic resection.• Careful patient selection.• Good training and under standing the equipment used.? Endovaginal sonography permit non-invasive differentiation of uterine anomalies and can spare women diagnostic laparascopy, promoting cost-effective diagnosis.? Hysterosalpingography it is an excellent diagnostic tool for revealing anomalies in the reproductive system? Laparoscopy it is of major importance in determining whether the patients has a bicornuate uterus or septate uterus during operative hysteroscopy was used to assess myometrial thickness during the procedure to obtain an optimal resection and avoid or promptly identify a uterine perforation and visualization of the transilluminated uterine fundus in addition the laparoscope can be used to identify and treat factors that may affect fertility such as pelvic adhesion and endometriosis? From the foregoing data we conclude that the hysteroscope can be considered as a very important and useful method in diagnosis and treatment of the uterine septum.
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