The uterus plays an important role in a woman’s life, without which life may feel incomplete. This is because the uterus is responsible for female fertility. Furthermore, when a woman is without her uterus, there are some changes that can influence her life, physical and emotional health, ranging from changes in libido to drastic shifts in the menstrual cycle.

The uterus can experience some anomalies, whether genetic or acquired over time. Today, we will talk about the septate uterus.

What is a Septate Uterus?

A septate uterus is the result of a congenital anomaly, a malformation of the uterine cavity. This starts while a woman is being formed in her mother’s uterus.

Normally, at about 9 weeks of gestation, the girl’s uterus is formed. This process occurs through the fusion of the Müllerian ducts (channels that develop into the fallopian tubes, uterus, and the upper two-thirds of the vagina).

During this fusion, a process of reabsorption eliminates the separation between the two ducts to create a single cavity. The cause is unknown, but in some girls, this absorption is incomplete, which results in a thin membrane called a septum.

This membrane divides the uterus, partially or completely, into two separate cavities. Septate uterus is the most common type of Müllerian anomaly, estimated to be present in 3% to 7% of the general population.

Can Women with a Septate Uterus Get Pregnant?

There is no way to answer this question positively or negatively without first understanding what happens in a septate uterus. In general, the septum has some blood vessels, but not enough for a fetus to implant. A baby implanted on the septum will not receive enough nutrients and oxygen, and at a certain point, this will affect its development.

A septate uterus significantly increases the risk of miscarriage and can be a key factor in recurrent miscarriages. Although statistics vary, it is believed that the miscarriage rate in women with a septate uterus is between 25 and 47 percent. In contrast, the miscarriage rate in the general population is only between 10 and 25 percent.

Risks

If the fetus is implanting on the normal wall of the uterus, it will receive all the nutrients and oxygen from the placenta. This constitutes a “normal” pregnancy, however, the space inside the uterus will be smaller and the baby may not be able to move easily.

Along with the lack of space, the pressure exerted on the uterine walls will be greater and the excess pressure can stimulate the uterus to contract and expel the baby. These conditions may lead to an early birth, resulting in a premature baby.

Another condition for pregnancy in a septate uterus is the baby’s position, which may not be correct, requiring a cesarean section.

Symptoms of a Septate Uterus

In the great majority of women, a septate uterus can be asymptomatic. They may even have a history of normal pregnancies (which is why some women do not realize they have a uterine anomaly).

In others, pelvic pain may occur, heavy bleeding during menstruation, but this fact is sometimes not connected to the septate uterus condition, as it can be caused by other diseases.

How is it Diagnosed?

A septate uterus often remains undiagnosed until a woman experiences repeated miscarriages. Or, when a doctor comes across an unusual situation during a routine physical exam.

This is because a septate uterus is often accompanied by similar malformations of the cervix and vagina. Typically referred to as “double cervix” and “double vagina,” these are often the first clues to a similar abnormality in the uterus.

Even with these exams, a septate uterus can sometimes be misdiagnosed as a bicornuate uterus, also known as a “heart-shaped uterus.” Although the malformation is not considered normal, in general it does not increase the risk of miscarriage.

Diagnostic Procedures

If a woman experiences repeated miscarriage in the first trimester, the doctor may use the following techniques to identify a septate uterus:
Pelvic exam (almost always done during a pelvic examination)

  • Hysterosalpingogram (an X-ray procedure that highlights the uterus)
  • Diagnostic hysteroscopy (a visual exam carried out with fiber optics)
  • Magnetic Resonance Imaging
  • Ultrasound

How is a Septate Uterus Treated?

As such, if the woman has no symptoms and no intention to become pregnant, there is no need to treat the septate uterus. Infertility and recurrent pregnancy loss are indications for treatment. Surgery is the only method for treating a septate uterus as medications cannot correct it.

Indications for Surgery

Currently, the indications for surgical correction of a uterine septum include pelvic pain, endometriosis, obstructive phenomena, recurrent miscarriage, and a history of premature birth. Infertility is a controversial indication for surgery, since its association with septate uterus has not been clearly established by randomized studies.

However, several of these studies have shown promising results with postoperative pregnancy rates of 25% to 70% in patients with fertility problems, and consequently, there has been a movement to expand the use of hysteroscopic septoplasty for this subset of patients.

How is the Procedure Done?

A septate uterus is treated by removing the septum during a surgical hysteroscopy or through an abdominal incision (laparotomy). Surgical hysteroscopy is associated with shorter recovery time and a lower incidence of adhesion formation. This is a relatively minor procedure and is generally performed on an outpatient basis.

The technique is considered methodical, minimally invasive and involves inserting a medical device through the cervix and into the uterus to cut the excess tissue. This can generally be performed in 30 to 60 minutes.

The procedure has proven to be safe and effective for women with a history of recurrent miscarriage and other poor reproductive outcomes. Although a causal relationship between septate uterus and infertility remains unproven, the encouraging findings from numerous retrospective and observational studies are supporting the use of the procedure in patients with primary infertility.

Postoperative Care and Follow-up

Postoperative care and follow-up should include strategies to prevent intrauterine adhesion formation and to confirm the success of the procedure.

Some methods are prescribed, ranging from placement of a device or intrauterine catheter to estrogen supplementation, which have been proposed to minimize or prevent intrauterine adhesion formation after hysteroscopic septoplasty.

Supplemental estrogen can be used to stimulate endometrial proliferation and thus promote healing over the operative site.

There are multiple procedures and sometimes they are combined with progestins (a natural or synthetic hormone with effects similar to progesterone). No standard regimen is reported in the medical literature and, therefore, this choice depends on familiarity and comfort.

Special obstetric measures that were previously indicated for septate uterus, such as cesarean section, are generally no longer necessary after a hysteroscopic uterine septoplasty.

See Also: Can Uterus Size Indicate Pregnancy?
Photos: therapractice