Postoperative management of hysteroscopic metroplasty for patients with septate and T-shaped uteri.

Objectives: The study aimed to evaluate the efficacy of hormone treatment, barrier gel and their combined application following hysteroscopic metroplasty in women with septate (U2) and T-shaped uteri (U1a).

Material and methods: Hysteroscopic uterine septum resection was performed in 236 patients with U2, while lateral metroplasty was conducted in 191 patients with U1a. After surgery, 56 women with U2 and 58 women with U1a received hormone therapy (HT). Cross-linked hyaluronic acid (cHA) gel was applied to 54 women with U2 and 37 with U1a. Combined therapy (CT) using both HT and cHA gel was implemented for 48 women with U2 and 33 with U1a. Postoperative treatment was not performed in corresponding control groups. Reproductive outcomes were evaluated within 18 ± 6 months postoperatively.

Results: Compared to the control group, the clinical pregnancy rate was significantly higher in the U2-HT, U2-cHA and U2-CT groups, as well as in the U1a-HT and U1a-CT groups (p < 0.05). The miscarriage rate was significantly lower in the U2-cHA and U2-CT groups (p < 0.05). The live birth rate was significantly higher in the U2-cHA and U2-CT groups (p < 0.05). A second-look hysteroscopy revealed intrauterine adhesions in U2-HT (9%) and its respective control group (33%), as well as in the U1a control group (18%).

Conclusions: Hysteroscopic metroplasty enhances reproductive outcomes in women with septate and T-shaped uteri. Postoperative treatment is necessary to prevent the development of intrauterine adhesions.