Pregnancy after Tompkins metroplasty for Robert's uterus.

Two patients of early adolescence age presented with medically resistant primary dysmenorrhoea. Imaging (MRI scan) confirmed an asymmetric uterine septum with a unilaterally obstructed horn with haematometra. Laparotomy and Tompkins metroplasty was performed to unify the uterine cavity in each case, a technique not used for this condition before. Dysmenorrhoea resolved postoperatively. One patient got pregnant spontaneously 3.5 years later and was delivered by emergency caesarean section at 36 weeks of gestation. There are five reported cases of pregnancy after treatment for a Robert's uterus, none after Tompkins metroplasty. Primary dysmenorrhoea needs investigation with imaging when it does not respond to simple medical treatment. Resection of the septum hysteroscopically or via a laparotomy and a hysterotomy have been reported before, but Tompkins metroplasty offers the advantage of using the uterine septal tissue in the repair rather than resecting it. This is especially relevant if the septum is thick.