Authors' objectives:

To assess the efficacy and safety of metroplasty for uterine enlargement to treat uterine abnormalities following exposure to diethylstilbestrol (DES).

Authors' results and conclusions: Definition. Metroplasty for uterine enlargement is a surgical procedure to restore the size and shape of the uterine cavity to improve the patient's reproductive potential. It is occasionally offered to patients with uterine abnormalities following in utero exposure to DES. Studies selected: 4 uncontrolled retrospective studies. Efficacy. There were no comparative studies which would have allowed assessment of its actual efficacy in fertility disorders related to in utero exposure to DES. Safety. Two cases of placenta acreta and 2 cases of postoperative adhesions were reported in one of the studies selected. Metroplasty for uterine enlargement causes endometrial and myometrial scarring. All uterine surgery exposes the patient to the risk of perioperative uterine perforation and to the risk of uterine rupture during labour. These events have been reported in patients exposed to DES in utero, who were pregnant but had not had surgery. Vaginal deliveries are only possible if the pelvis is large enough for the baby's head, and they need close clinical and cardiotocographic monitoring. Advice of the working group: Metroplasty - should not be performed routinely, as patients who have been exposed to DES in utero and who have substantial uterine abnormalities have still been able to carry a pregnancy to term; - is not the first choice of procedure in patients with no history of infertility and/or major problems in pregnancy; - is not a solution for all the fertility problems experienced by patients exposed to DES in utero; - should only be considered after the couple has undergone a full fertility workup, and the best possible level of fertility has been achieved; - should be performed by a surgeon with sufficient experience of hysteroscopy.

Authors' recommendations: Efficacy and safety. Comparative studies need to be encouraged, e.g. case-control studies in patients who have been clearly informed about all the uncertainties relating to the technique. Further studies are needed, both basic research into the pathophysiological mechanisms and abnormalities related to DES, as well as clinical trials to investigate the hypothesis of reduced endometrial blood flow.

Authors' methods: Review

Project Status: Completed

URL for project: http://www.has-sante.fr/

Year Published: 2003

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: France

Organisation Name: L'Agence Nationale d'Accreditation d'Evaluation en Santé

Contact Address: 2 avenue du Stade de France, 93218 Saint-Denis La Plaine Cedex, France. Tel: +33 01 55 93 71 88; Fax: +33 01 55 93 74 35;

Contact Name: sh.leerobin@has-sante.fr

Contact Email: sh.leerobin@has-sante.fr

Copyright: L'Agence Nationale d'Accreditation d'Evaluation en Sante (ANAES)