Skip to main content

Uterine Septum

  • Chapter
  • First Online:
Hysteroscopy

Abstract

Congenital uterine anomalies have long been heralded as the pinnacle of infertility surgery. The sheer magnitude of importance that the uterine cavity commands befits the status it holds as the temple of fertility. It is the only part of the female reproductive system which is absolutely crucial for conception and progressing to a favourable pregnancy outcome. To further the point, in cases of tubal factor, ovarian hypo function or male factor of infertility, IVF would still provide answers to all those desiring pregnancy and childbirth. However, there is no alternative for the womb which carries the embryo from implantation to delivery—the hospitable cavity which provides the environment for embryonic development and fatal maturation. In this chapter, the most common of all congenital uterine anomalies—the uterine septum—is discussed in full detail, outlining the incidence and histogenesis of the septum to fully understand the pathology, and in doing so the proper clinical workup and investigative techniques will aid in confirming the diagnosis. The main focus is the management of this anomaly and the techniques used to tackle various difficulties associated with intrauterine surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

References

  1. Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A. The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Hum Reprod Update. 2011;17(6):761–71.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  2. Pfeifer S, Butts S, Dumesic D, Gracia C, Vernon M, Fossum G, La Barbera A, Mersereau J, Odem R, Penzias A, Pisarska M, Rebar R, Reindollar R, Rosen M, Sandlow J, Widra E. Uterine septum: a guideline. Fertil Steril. 2016;106(3):530–40.

    Article  Google Scholar 

  3. Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P. Clinical implications of uterine malformations and hysteroscopic treatment results. Hum Reprod Update. 2001;7(2):161–74.

    Article  CAS  PubMed  Google Scholar 

  4. Ludwin A, Ludwin I. Comparison of the ESHRE–ESGE and ASRM classifications of Müllerian duct anomalies in everyday practice. Hum Reprod. 2015;30(3):569–80.

    Article  CAS  PubMed  Google Scholar 

  5. Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M, Li TC, Tanos V, Brölmann H, Gianaroli L, Campo R. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod. 2013;28(8):2032–44.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Dabirashrafi H, Bahadori M, Mohammad K, et al. Septate uterus: new idea on the histologic features of the septum in this abnormal uterus. Am J Obstet Gynecol. 1995;171:105–7.

    Article  Google Scholar 

  7. Abdel Moety GA, Gaafar HM, Shawki O, Faisal M. Histological structure and vascularity of hysteroscopically removed uterine septa in patients with primary infertility and patients with recurrent pregnancy loss. J Minim Invasive Gynecol. 2016;23(1):66–71.

    Article  PubMed  Google Scholar 

  8. LaMonica R, Pinto J, Luciano D, Lyapis A, Luciano A. Incidence of septate uterus in reproductive-aged women with and without endometriosis. J Minim Invasive Gynecol. 2016;23(4):610–3.

    Article  PubMed  Google Scholar 

  9. Moramezi F, Barati M, Shahbazian N, Golbabaei M, Hemadi M. Sonographic evaluation of mullerian anomalies in women with polycystic ovaries. Health. 2013;5:1313–7.

    Article  Google Scholar 

  10. Saleh HA, Shawky Moiety FM. Polycystic Ovarian Syndrome and congenital uterine anomalies : the hidden common player. Arch Gynecol Obstet. 2014;290(2):355–60.

    Article  PubMed  Google Scholar 

  11. Ugur M, Karakaya S, Zorlu G, Aslan S, Gulerman C, Kukner S, et al. Polycystic ovaries in association with mullerian anomalies. Eur J Obstet Gynecol Reprod Biol. 1995;62(1):57–9.

    Article  CAS  PubMed  Google Scholar 

  12. Heinonen PK. Complete septate uterus with longitudinal vaginal septum. Fertil Steril. 2006;85:700–5.

    Google Scholar 

  13. Zhuo Z, H Y, X J. A systematic review and meta-analysis of randomized controlled trials on the effectiveness of cervical ripening with misoprostol administration before hysteroscopy. Int J Gynaecol Obstet. 2016;132(3):272–7.

    Article  CAS  PubMed  Google Scholar 

  14. Parveen S, Khateeb ZA, Mufti SM, Shah MA, Tandon VR, Hakak S, Singh Z, Yasmeen S, Mir SA, Tabasum R, Jan N. Comparison of sublingual, vaginal, and oral misoprostol in cervical ripening for first trimester abortion. Indian J Pharm. 2011;43:172–5.

    Article  CAS  Google Scholar 

  15. Grow DR, Iromloo K. Oral contraceptives maintain a very thin endometrium before operative hysteroscopy. Fertil Steril. 2006;85(1):204–7.

    Article  CAS  PubMed  Google Scholar 

  16. Perino A, Chianchiano N, Petronio M, Cittadini E. Role of leuprolide acetate depot in hysteroscopic surgery: a controlled study. Fertil Steril. 1993;59:507–10.

    Article  CAS  PubMed  Google Scholar 

  17. Edstrom K. Intrauterine surgical procedures during hysteroscopy. Endoscopy. 1974;6:175–81.

    Article  Google Scholar 

  18. Bettocchi S, Ceci O, Nappi L, Di Venere R, Masciopinto V, Pansini V, Pinto L, Santoro A, Cormio G. Operative office hysteroscopy without anesthesia: analysis of 4863 cases performed with mechanical instruments. J Am Assoc Gynecol Laparosc. 2004;11(1):59–61.

    Article  CAS  PubMed  Google Scholar 

  19. Lin K, Zhu X, Xu H, Liang Z, Zhang X. Reproductive outcome following resectoscope metroplasty in women having a complete uterine septum with double cervix and vagina. Int J Gynaecol Obstet. 2009;105(1):25–8.

    Article  PubMed  Google Scholar 

  20. Choe JK, Baggish MS. Hysteroscopic treatment of septate uterus with Neodymium-YAG laser. Fertil Steril. 1992;57(1):81–4.

    Article  CAS  PubMed  Google Scholar 

  21. Simons M, Hamerlynck TW, Abdulkadir L, Schoot BC. Hysteroscopic morcellator system can be used for removal of a uterine septum. Fertil Steril. 2011;96(2):e118–21.

    Article  PubMed  Google Scholar 

  22. Valle RF, Baggish MS. Hysteroscopy for infertility. In: Baggish MS, Valle RF, Guedj H, editors. Hysteroscopy visual perspectives of uterine anatomy, physiology and pathology diagnostic and operative hysteroscopy. 3rd ed. Philadelphia: Lippincott Williams & Wilkins; 2007. p. 434–8.

    Google Scholar 

  23. Dabirashrafi H, Mohammad K, Moghadami-Tabrizi N, Zandinejad K, Moghadami-Tabrizi M. Is estrogen necessary after hysteroscopic incision of the uterine septum? J Am Assoc Gynecol Laparosc. 1996;3(4):623–5.

    Article  CAS  PubMed  Google Scholar 

  24. Nawroth F, Schmidt T, Freise C, Foth D, Römer T. Is it possible to recommend an “optimal” postoperative management after hysteroscopic metroplasty? A retrospective study with 52 infertile patients showing a septate uterus. Acta Obstet Gynecol Scand. 2002;81(1):55–7.

    Article  PubMed  Google Scholar 

  25. Bosteels J, Weyers S, Mol BWJ, D’Hooghe T. Anti-adhesion barrier gels following operative hysteroscopy for treating female infertility: a systematic review and meta-analysis. Gynecol Surg. 2014;11:113–27.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Fedele L, Bianchi S, Marchini M, Mezzopane R, Di Nola G, Tozzi L. Residual uterine septum of less than 1 cm after hysteroscopic metroplasty does not impair reproductive outcome. Hum Reprod. 1996;11(4):727–9.

    Google Scholar 

  27. Parsanezhad ME, Alborzi S, Zarei A, et al. Hysteroscopic metroplastyof the complete uterine septum, duplicate cervix, and vaginal septum. Fertil Steril. 2006;85:1473–7.

    Article  PubMed  Google Scholar 

  28. Rock JA, Jones HW Jr. The double uterus associated with an obstructed hemivagina and ipsilateral renal agenesis. Am J Obstet Gynecol. 1980;138(3):339–42.

    Article  CAS  PubMed  Google Scholar 

  29. Propst AM, Liberman RF, Harlow BL, Ginsburg ES. Complications of hysteroscopic surgery: predicting patients at risk. Obstet Gynecol. 2000;96:517–20.

    CAS  PubMed  Google Scholar 

  30. Agostini A, Cravello L, Bretelle F, Shojai R, Roger V, Blanc B. Risk of uterine perforation during hysteroscopic surgery. J Am Assoc Gynecol Laparosc. 2002;9:264.

    Article  PubMed  Google Scholar 

  31. Ergenoglu M, Yeniel AO, Yildrim N, Akdemir A, Yucebilgin S. Recurrent uterine rupture after hysterescopic resection of the uterine septum. Int J Surg Case Rep. 2013;4(2):182–4.

    Article  PubMed  Google Scholar 

  32. Kenda Šuster N, Gergolet M. Does hysteroscopic metroplasty for septate uterus represent a risk factor for adverse outcome during pregnancy and labor? Gynecol Surg. 2016;13(1):37–41.

    Article  PubMed  Google Scholar 

  33. Valle RF, Ekpo GE. Hysteroscopy metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol. 2013;20(1):22–42.

    Article  PubMed  Google Scholar 

  34. Sentilhes L, Sergent F, Roman H, Verspyck E, Marpeau L. Late complications of operative hysteroscopy: predicting patients at risk of uterine rupture during subsequent pregnancy. Eur J Obstet Gynecol Reprod Biol. 2005;120(2):134–8.

    Article  PubMed  Google Scholar 

  35. Kerimis P, Zolti M, Sinwany G, Mashiach S, Carp H. Uterine rupture after hysteroscopic resection of uterine septum. Fertil Steril. 2002;77(3):618–20.

    Article  PubMed  Google Scholar 

  36. Mollo A, De Franciscis P, Colacurci N, Cobellis L, Perino A, Venezia R, Alviggi C, De Placido G. Hysteroscopic resection of the septum improves the pregnancy rate of women with unexplained infertility: a prospective controlled trial. Fertil Steril. 2009;91(6):2628–31.

    Article  PubMed  Google Scholar 

  37. Pang LH, Li MJ, Li M, Xu H, Wei ZL. Not every subseptate uterus requires surgical correction to reduce poor reproductive outcome. Int J Gynaecol Obstet. 2011;115(3):260–3.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Osama Shawki .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG

About this chapter

Cite this chapter

Shawki, O., Shawki, Y. (2018). Uterine Septum. In: Tinelli, A., Alonso Pacheco, L., Haimovich, S. (eds) Hysteroscopy. Springer, Cham. https://doi.org/10.1007/978-3-319-57559-9_10

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-57559-9_10

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-57558-2

  • Online ISBN: 978-3-319-57559-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics