Metroplasty and fetal survival.

During the period 1973-83, metroplasty for infertility was performed in 20 cases of symmetric uterine malformation. Apart from a vaginal septum in 2 cases, no other genital malformations were noted. A modified Jones & Jones technique was performed in 16 cases. 3 were unified a.m. Tompkins and 1 a.m. Strassman. No operative complications were noted. Prior to operation, 19 of the 20 women were pregnant, 46 times in all. Of these, 40 ended in spontaneous abortion, 5 in preterm birth, of which 2 infants survived, and 1 in birth at term. Postoperatively, 17 of the 20 women became pregnant, 22 times in all, and of these, 3 ended in spontaneous abortion and 19 with live infants born at term. The metroplasty changed the fetal survival rate from 6.5% prior to operation, to 86.4% after the operation. Pregnancy occurred 15 months, on average, after the operation. Only a few minor complications occurred during the pregnancies. Cesarean section was performed electively in 13 cases and acutely in 3 cases. A vaginal delivery occurred in the last 3 cases. There were only a few abnormal presentations and all the infants were born at term with a mean weight of 3,400 g. Metroplasty seems to be an operation which clearly improves fetal survival rate in women with both symmetric uterine malformations and a history of habitual abortions and/or preterm births. Subsequent pregnancies are not associated with any increased risk of complications.