L’hystéroplastie dˈagrandissement : à propos des résultats

The DiethylstilBbestrol (DES) is a synthetic estrogen which was prescribed from 1941 onwards for the prevention of miscarriage. As well as a possible risk of cancer, another side effect of this treatment was the possible of abnormality of the genitalia in the female issue of the prescribed user. Apart from possibly having a hypoplasic uterus, the patient is also prone, in the case where she has an undersized uterus, to having a much narrower than normal cavity. Consequently there is a tendency for an excess of muscle tissue on the uterus walls. This can be observed on an RMN. The most significant characteristics of this abnormality are: constriction rings around the proximal uterine segment, a T shaped uterus, uterus with an arched based. The idea of the plastic enlargement operation is to widen the cavity by making careful incisions on the excess muscle tissue located on the uterus wall. The objective of this is to obtain a triangular shaped cavity taking care though not to weaken the walls themselves. 51 patients were treated. We observed 31 pregnancies (49%) after 16 months with 25 ungoing pregnancies. Generally the anatomic results are excellent but it's difficult to measure the functional results or the success rate in future pregnancies. The reason for this is the enlarging of the cavity alone does not guarantee successful fertility. There are other problems to take in to account e.g. implantation, miscarriage and premature labor. There are risks with this operation: placenta percreta, a possible rupture of the uterus, though this can happen at any time with DES patients. This operation can only be recommended once a thorough examination of the patient has been made. It is not advisable with a patient who has a hypoplasic cavity in a hypoplasic uterus (hysterometry < 4 cm). This operation should never be done as a first course of action but it can be recommended above all if the patient has a constriction ring: as a sole reason for infertility; where infertility has been diagnosed and unsuccessfully treated; and an unexplained failure of ART, and where the patient has unexplained repeated miscarriages.