Laparoscopic metroplasty in bicornuate and didelphic uteri: feasibility and outcome.

PURPOSE: To report the outcomes of laparoscopic metroplasty in bicornuate and didelphic uteri. METHODS: This observational study includes 26 women with double uterine cavities (22 bicornuate and 4 didelphic uteri) with history of recurrent pregnancy loss undergoing laparoscopic metroplasty, second-look laparoscopy and hysteroscopy between 2008 and 2013 in University and Private hospital (Shiraz, Iran). The feasibility of laparoscopic metroplasty, appropriateness of the uterine cavity upon second-look laparoscopy, pregnancy outcome and live birth rate (within at least 12 month follow-up) were evaluated. RESULT(S): All patients had a unified and acceptable uterine cavity in second-look operation. Minimal pelvic adhesions in eight cases and subseptum of uterus in seven patients were detected which were removed by laparoscopy and resectoscopy, respectively. Out of 14 patients who could be followed for one year for pregnancy occurrence 12 patients had conception. Out of them nine term pregnancies with normal pregnancy and delivery outcomes were reported. These women delivered nine live neonates through the cesarean section. Three patients had pregnancy loss (2 early pregnancy losses and one with preterm delivery). Two patients decided to postpone conception due to personal reasons. CONCLUSION(S): Laparoscopic metroplasty by developing single uterine cavity with a suitable volume and minimal adhesion formation can be a substitute for laparotomy technique. However, more long-term studies should be done on larger sample size to confirm its positive effects on the pregnancy outcomes.

Double versus single cervical cerclage for patients with recurrent pregnancy loss: a randomized clinical trial.

AIM: To compare the effectiveness of the double cervical cerclage method versus the single method in women with recurrent second-trimester delivery. METHOD: In this randomized clinical trial, we included 33 singleton pregnancies suffering from recurrent second-trimester pregnancy loss (≥2 consecutive fetal loss during second-trimester or with a history of unsuccessful procedures utilizing the McDonald method), due to cervical incompetence. Patients were randomly assigned to undergo either the classic McDonald method (n = 14) or the double cerclage method (n = 19). The successful pregnancy rate and gestational age at delivery was also compared between the two groups. RESULTS: The two study groups were comparable regarding their baseline characteristics. The successful pregnancy rate did not differ significantly between those who underwent the double cerclage method or the classic McDonald cerclage method (100% vs 85.7%; P = 0.172). In the same way, the preterm delivery rate (<34 weeks of gestation) was comparable between the two study groups (10.5% vs 35.7%; P = 0.106). Those undergoing the double cerclage method had longer gestational duration (37.2 ± 2.6 vs 34.3 ± 3.8 weeks; P = 0.016). CONCLUSION: The double cervical cerclage method seems to provide better cervical support, as compared with the classic McDonald cerclage method, in those suffering from recurrent pregnancy loss, due to cervical incompetence.