Uterine septum

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Uterine septum
SpecialtyGynaecology Edit this on Wikidata

A uterine septum is a congenital

caudally into the vagina resulting in a "double vagina".[1]

Signs and symptoms

Four types of uterine malformations

The condition may not be known to the affected individual and not result in any reproductive problems; thus normal pregnancies may occur. In more serious cases have reported high infertility rates.

malpresentation. According to the classical study by Buttram there is a 60% risk of a spontaneous abortion, this being more common in the second than in the first trimester.[3] However, there is no agreement on this number and other studies show a lower risk. Woelfer found that the miscarriage risk is more pronounced in the first trimester.[4]

The condition is also associated with abnormalities of the renal system. Further, skeletal abnormalities have been linked to the condition.[5]

Cause

The uterus is formed during

cranially, thus a complete septum formation represents an earlier disturbance of this absorption than the incomplete form. Causes for incomplete absorption are not known.[citation needed
]

Diagnosis

A pelvic examination may reveal a double vagina or double cervix that should be further investigated and may lead to the discovery of a uterine septum. In most patients, however, the pelvic examination is normal. Investigations are usually prompted on the basis of reproductive problems.[citation needed]

Helpful techniques to investigate a septum are

MRI, and hysteroscopy. More recently 3-D ultrasonography has been advocated as an excellent non-invasive method to delineate the condition.[4] Prior to modern imaging hysterosalpingography
was used to help diagnose the uterine septum, however, a bicornuate uterus may deliver a similar image. An important category of septate uterus is the hybrid type a variant that may be misdiagnosed as bicornuate uterus when seen by laparoscopy[6] Professor El Saman From Egypt was the first to describe this anomaly and warned gynecologist about this common misdiagnosis, whenever there is a uterine fundus depression on laparoscopy gynecologists should compare the depth of this depression with the depth of the dividing internal interface. Hybrid septate uterus benefit from hysteroscopic metroplasty under laparoscopic control.[7]

Differential diagnosis

Other forms of uterine malformation need to be considered in the work-up for uterine septum. An arcuate uterus contains a residual cranial septum that is smaller than an incomplete septum but definitions between the two conditions are not standardized, - a cause for discrepancies in the literature. A bicornuate uterus is sometimes confused with a septate uterus as in each situation the cavity is partitioned, however, in the former case the uterine body is cranially doubled (two uterine horns) while in the latter a single uterine body is present. The former represents a malformation of incomplete fusion of the Müllerian systems, and the latter of incomplete absorption. A hysterosalpingogram may not be able to distinguish between the two conditions. The differentiation, however, is important as a septum can be corrected by hysteroscopy, while a bicornuate uterus would be corrected by a metroplasty via laparotomy if necessary.[citation needed]

Management

A septum can be resected with surgery. Hysteroscopic removal of a uterine septum is generally the preferred method, as the intervention is relatively minor and safe in experienced hands. A follow-up imaging study should demonstrate the removal of the septum. Tactile cold scissor metroplasty was described as a back technique for hysteroscopic challenges that interfere with proper visualization[8] or uterine distention.

It is not considered necessary to remove a septum that has not caused problems, especially in women who are not considering pregnancy. There is controversy over whether a septum should be removed prophylactically to reduce the risk of pregnancy loss prior to a pregnancy or infertility treatment.[9]

Epidemiology

Most studies are based on populations of women who have experienced a

recurrent pregnancy loss anatomical problems are thought to be causative with the septate uterus as the most common finding.[10]

References

  1. PMID 16500341
    .
  2. ISBN 0-7216-6590-X
    .
  3. PMID 456629
    .
  4. ^
    S2CID 37650526
    .
  5. S2CID 26387695
    .
  6. PMID 21514191
    .
  7. S2CID 6177612
    .
  8. PMID 19591982
    .
  9. PMID 17359587
    .
  10. PMID 11355792
    .

External links

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