The uterus plays an important role in a woman’s life, with which without it, her life can become incomplete. This is because the uterus is responsible for female fertility. Furthermore, when a woman is without a uterus, there are some changes that can influence her life, physical and emotional health, from changes in libido to sudden changes in the menstrual cycle.
The uterus may suffer from some abnormalities, whether genetic or acquired over the course of life. Today we will talk about the septate uterus.
What is a Septate Uterus?
The septate uterus is the result of a congenital anomaly , a malformation of the uterine cavity. This starts when the woman is being formed in the mother’s womb.
Normally, at approximately 9 weeks of gestation , the girl’s uterus is formed. This process is done by fusing the Muller ducts (channels that originate the uterine tubes, uterus and the upper two thirds of the vagina).
During this fusion, a resorption process eliminates the separation between the two ducts to create a single cavity. The cause is not known, but in some girls this absorption is incomplete , which generates a thin membrane called the septum.
This membrane divides the uterus, partially or completely, into two separate cavities. The septate uterus is the most common type of Müller anomaly, estimated in 3% to 7% of the general population.
Can Women with Septum Uterus Get Pregnant?
There is no way to answer this question in the affirmative or in the negative, 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 in the septum will not receive enough nutrients and oxygen, and at some point it 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, the rate of abortion in women with septum uterus is believed to be 25 to 47 percent. In contrast, the abortion rate in the general population is only between 10 and 25 percent.
If the fetus is implanted in the normal wall of the uterus , it will get all the nutrients and oxygen from the placenta. Characterizing a “normal” pregnancy, however, the space inside the uterus will be smaller and the baby will not be able to move easily.
Along with the lack of space, the pressure exerted on the walls of the uterus will be greater and the excess pressure can stimulate the uterus to contract and expel the baby. These conditions can lead to premature delivery, 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 caesarean section.
Symptoms of a Septate Uterus
In the vast majority of women, a septate uterus can be asymptomatic . They may even have a history of normal pregnancy (which makes some women unaware that they have a uterine abnormality).
In others, pelvic pain, excessive bleeding during menstruation may occur, but this fact is sometimes unrelated to the condition of the septate uterus, and is caused by other diseases.
How is the diagnosis?
A septate uterus often remains undiagnosed until a woman experiences repeated miscarriage. Or, when the doctor is faced with a different situation during a routine physical examination.
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 signs of a similar abnormality in the uterus.
Even with these tests, 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, it generally does not increase the risk of miscarriage.
If a woman experiences a repeated abortion in the first semester, the doctor may use the following techniques to identify a septate uterus:
Touch examination (often performed during a pelvic examination)
- Hysterosalpingogram (an X-ray procedure that highlights the uterus)
- Diagnostic hysteroscopy (a visual examination performed with optical wires)
How is a Septum Uterus Treated?
As such, if the woman has no symptoms and does not intend 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 the treatment of the septate uterus as the drugs cannot correct it.
Indications for Surgery
Currently, indications for surgical correction of a uterine septum include pelvic pain, endometriosis, obstructive phenomenon , recurrent abortion and a history of premature birth. Infertility is a controversial indication for surgery, as its association with the septate uterus has not been demonstrated by random studies.
However, several of these studies have shown promising results with postoperative pregnancy rates of 25% to 70% in patients with infertility problems, and consequently a move 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 a shorter recovery time and a lower incidence of adhesion formation. This is a very small procedure and is usually performed on an outpatient basis.
The technique is considered methodical, minimally invasive and involves the insertion of a medical device through the cervix and into the uterus to cut off excess tissue. This can usually be done between 30 and 60 minutes .
The procedure proved to be safe and effective for women with a history of recurrent abortion and other defective reproductive outcomes. Although a causal relationship between the 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 the formation of intrauterine adhesion and to confirm the success of the procedure.
Some methods are prescribed, from the placement of an intrauterine device or catheter to estrogen supplementation , have been proposed to minimize or prevent the formation of intrauterine adhesion after hysteroscopic septoplasty.
Supplemental estrogen can be used to stimulate endometrial proliferation and, therefore, promote healing over the operating site.
There are multiple procedures and sometimes they are combined with progestins (natural or synthetic hormone that has effects similar to those of 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 delivery through a cesarean section, are generally not necessary after a hysteroscopic uterine septoplasty.
See Also: Can Uterus Size Mean Pregnancy?
My name is Dr. Alexis Hart I am 38 years old, I am the mother of 3 beautiful children! Different ages, different phases 16 years, 12 years and 7 years. In love with motherhood since always, I found it difficult to make my dreams come true, and also some more after I was already a mother.
Since I imagined myself as a mother, in my thoughts everything seemed to be much easier and simpler than it really was, I expected to get pregnant as soon as I wished, but it wasn’t that simple. The first pregnancy was smooth, but my daughter’s birth was very troubled. Joana was born in 2002 with a weight of 2930kg and 45cm, from a very peaceful cesarean delivery but she had already been born with congenital pneumonia due to a broken bag not treated with antibiotics even before delivery.