Uterine Septum

Uterine septa are commonly found in reproductive-age women. Their impact on reproductive outcome is the subject of continuing debate. Congenital uterine anomalies can arise from essentially three general categories of developmental defects of the fetus (Müllerian defects) that can either be partial or complete. A septate uterus arises from the partial or complete failure of resorption of the midline septum between the two müllerian ducts.

Several classification systems have been reported for müllerian anomalies. The classification system proposed by the ASRM in 1988 is most used to describe or define müllerian defects.

The reported incidence of müllerian anomalies is between 0.5% and 6% of reproductive age women but is higher among women with poor reproductive outcome. Studies have reported and incidence of 5% to 10% among women with first trimester recurrent miscarriage and greater than 25% in women with late first-or early second-trimester loss or preterm delivery. In case series of women with unexplained infertility, the spontaneous abortion rate was 22% in women with septate uterus compared to 35% in women with bicornuate or unicornuate uterus.

A septate uterus is characterized by a smooth external uterine fundal contour with two uterine cavities. The extent of the septum or the degree of the septation can vary from a small midline septum to a complete septate uterus with a long midline septum dividing the uterine cavity in its whole length. Occasionally associated anomalies in the vagina and the cervix can exist.

Hysteroscopic resection is the surgical treatment of choice for the management of uterine septa. Normal saline solution and mechanical micro -scissors are most used with the bipolar diathermy systems reserved for broad-based septa. Review studies of the available medical literature report decrease of the miscarriage rates (pre- and post-hysteroscopic septum resection of 87.8% and 14.6% respectively), with term delivery rates increasing from 3,2% to 80,1%.

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Dr Eleftherios Meridis