- Abstract Objective: To determine the reproductive outcome following hysteroscopic septum resection in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries. Study Design: A retrospective, cohort study investigating reproductive outcomes following septum resection was conducted. Patients who had no other apparent cause for spontaneous miscarriage or preterm delivery were included in the study. Reproductive outcomes were compared between pregnancies prior to and after the septum resection. Multiple pregnancies were excluded. Results: Twenty-eight patients met the inclusion criteria with a total of 85 pregnancies, 45 prior and 40 after septectomy. The mean gestational age increased from 33.73±6.27 (weeks) prior to the resection to 38.47±1.71 (weeks) after it (p<0.05). The mean birth-weight increased from 2520±764.4 (grams) to 3202.6±630.2 (grams) after the resection. Spontaneous miscarriage rate dropped from 63.6% to 12.5%. Multivariate analysis models showed uterine septectomy to be independently associated with increased gestational age at delivery (Beta=0.606, Adjusted R(2)=0.328, CI 10.647-20.612, P<0.01), increased birth weight (Beta=0.424, Adjusted R(2)= 0.129, CI 202.097-1210.287, P<0.01) and with lower risk for preterm delivery (OR=0.073, CI 0.16-0.327, P<0.01). Conclusion: Hysetroscopic resection of a uterine septum improves reproductive outcomes in women with a septated uterus and a history of spontaneous miscarriages or premature deliveries.