Reproductive outcome after hysteroscopic metroplasty in patients with infertility and recurrent pregnancy loss.

INTRODUCTION: Patients with uterine malformations have decreased reproductive potential and an unfavourable reproductive outcome starting even from the first pregnancy. Patients with untreated uterine malformations have a term delivery rate of 40%-65%. Hysteroscopic metroplasty is a standard, safe and minimally invasive method for treatment of uterine malformations, which provides a normal uterine cavity in patients with hysteroscopically correctible types of uterine malformations. The aim of the study was to analyse the variables associated with reproductive outcome before and after hysteroscopic metroplasty. MATERIAL AND METHODS: We analysed the variables determining reproductive outcome after 216 interventions with hysteroscopic metroplasty in 202 patients which were done at the University Obstetrics and Gynecology Clinic in Skopje during a three-year period, from 01.01.2006 to 31.12.2008. Patients were divided into three groups: patients with recurrent pregnancy loss, patients with secondary infertility and foetal loss and patients with primary infertility. The follow-up period lasted for two years (24 months). Statistical analysis was performed using the Chi-square test and p<0.05 was considered to be statistically significant. RESULTS: During the follow-up period of two years after hysteroscopic metroplasty there were a total of 113 pregnancies, of which 46 belonged to the group of primary infertility. Analysis of the reproductive outcome of those patients (compared before and after hysteroscopic metroplasty) showed a significant (p<0.05) decrease in the abortion rate from 89.6% to 12.4%, as well as an increase of term delivery rate from 1.4% to 74.4%. In the group of preterm deliveries there was a rise from 9% to 13.2%, which was not significant. The group of primary infertility had a pregnancy rate of 36%. CONCLUSION: Hysteroscopic metroplasty significantly improves the reproductive outcome in patients with surgically correctible uterine malformation.

Comparison between ultrasound (US) and macrodisection measurements of human foetal kidney.

Development of the foetal human kidney runs through a series of continual and mutually dependent changes during which the kidney obtains its morphological and functional maturity. In recent times, there has been a significant improvement in intrauterine observations of the normal growth and development of the foetus, as well as of anomalies in the development of foetal organs. Ultrasound measurement of foetal kidney dimensions provides monitoring of the normal growth and development since the anomalies in the growth are most strikingly expressed in changes in the kidney dimensions. Kidney size in relation to gestational age was determined by 60 Ultra Sound photos of 60 intrauteral foetuses of both sexes and macrodisectional measurements of 60 foetuses post mortem with gestational ages from 18 to 31 weeks. The renal volume was calculated from the outer kidney diameters using the volume formula for an ellipsoid. The results were statistically analyzed. Student's t-test and Mann-Whithney U Test were applied. The examinations have shown that the kidney is an organ that undergoes complicated changes during embryonic development. Therefore, knowledge of these measurements may contribute to earlier diagnosis of a variety of abnormalities.