Natasha CiteroniFormerly, GKT School of Medical Education, King’s College London, United Kingdom
Title: Luteal phase pregnancy after Mirena Coil insertion for intrauterine septum resection
Hysteroscopic resection is a recognised management option for an anomalous uterine septum in cases of recurrent miscarriage. This involves metroplasty of the septum to aid the likelihood of successful implantation; via the reformation of an anatomically normal uterine cavity. Although less established, uterine septum resection is also commonly performed where a septum is present in instances of primary subfertility, where no other cause can be identified. We report an unusual case of an intrauterine singleton pregnancy with a Mirena Coil (IUS) in situ. This occurred following elective hysteroscopic intrauterine septum resection for primary subfertility treatment in a 27-year-old female patient. The patient decided to continue with the pregnancy and underwent additional monitoring via ultrasonography. Planned delivery occurred through caesarean section (c-section) at 39-weeks gestation and a healthy male infant was born. Intraoperative recovery of the Mirena coil occurred after visualisation in the placental membranes.
Due to the rarity of pregnancy occurring with Mirena coil insertion as an adjunct to hysteroscopic septum resection, this case presented a novel clinical scenario. Following a review of the literature, no clear management guidelines were found to be advised and previous recorded foetal outcomes in such cases were limited. Furthermore, we discuss adjunctive treatments available for Congenital Uterine Abnormalities (CUAs) and the current evidence base for intrauterine septum excision. This case thus demonstrates a lack of high-quality large scale evidence in the field whilst also proposing potential management options and learning points for intrauterine septum excision in the context of primary subfertility.
Natasha Citeroni is a current Academic Foundation Doctor at University Hospital Southampton in the faculty of Human Development. She graduated with distinction from GKT School of Medical Education, King’s College London (KCL), England and has a particularly interest in the field of women’s health. Previously, she was the Secretary for KCL’s OBG Society and the KCL Ambassador for the British Undergraduate Society of Obstetrics and Gynaecology (BUSOG).