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. 2018 Apr 6;2018(2):hoy004. doi: 10.1093/hropen/hoy004
Whether hysteroscopic septum resection has beneficial effects (improving live birth rates, and decreasing miscarriage rates, without doing harm), should be evaluated in the context of surgical trials in women with RPL and septate uterus (Rikken et al., 2017). Conditional ⊕○○○
Metroplasty is not recommended for bicorporeal uterus with normal cervix (former American Fertility Society classification (AFS) bicornuate uterus) and RPL (Bailey et al., 2015; Sugiura-Ogasawara et al., 2015). Strong ⊕○○○
Uterine reconstruction is not recommended for hemi-uterus (former American Fertility Society classification (AFS) unicornuate uterus) and RPL (Jaslow, 2014). Strong ⊕○○○
There is insufficient evidence in favour of metroplasty in women with bicorporeal uterus and double cervix (former American Fertility Society classification (AFS) didelphic uterus) and RPL (Bailey et al., 2015). Conditional ⊕○○○
There is insufficient evidence supporting hysteroscopic removal of submucosal fibroids or endometrial polyps in women with RPL (Pritts et al., 2009; Lieng et al., 2010; Salim et al., 2011; Jaslow, 2014). Conditional ⊕○○○
Surgical removal of intramural fibroids is not recommended in women with RPL. There is insufficient evidence to recommend removing fibroids that distort the uterine cavity (Pritts et al., 2009; Jaslow, 2014). Conditional ⊕○○○
There is insufficient evidence of benefit for surgical removal of intrauterine adhesions for pregnancy outcome. After hysteroscopic removal of intrauterine adhesions in women with RPL, precautions have to be taken to prevent recurrence of adhesions (Kodaman and Arici, 2007; Jaslow, 2014). Conditional ⊕○○○
Women with a history of second-trimester pregnancy losses and suspected cervical weakness should be offered serial cervical sonographic surveillance. Strong ⊕⊕○○
In women with a singleton pregnancy and a history of recurrent second-trimester pregnancy loss attributable to cervical weakness, a cerclage could be considered. There is no evidence that this treatment increases perinatal survival. Conditional ⊕⊕○○