44 women with congenital uterine malformations, aged 22-39, underwent metroplasty during a 19-year period. They constituted 7.3% of all patients with such malformations diagnosed during that period. Indications were a high rate of spontaneous abortions (78.3%), and low rates for term deliveries (9.3%) and live children (11.8%) among 163 pregnancies. The operations were tailored to the uterine malformations; some were by the abdominal route and others involved hysteroscopic resection of a uterine septum (13 cases). After metroplasty, in 52 pregnancies the abortion rate was reduced to 26.9%, and term deliveries increased to 59.6% and neonatal survival to 69.2% (for all 3, p less than 10(-8)). It is concluded that a poor obstetric history is an indication to search for uterine malformations, and that if found, there is a clear indication for metroplasty. The surgeon must know the types of malformations and should be well acquainted with the different operative techniques.
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