SEPTATE UTERUS (Part 2)

Last week, we started a discussion on Septate Uterus. We defined septate uterus and explained the types, causes, symptoms and septate uterus with its correlation with fertility. This week we will continue with septate uterus and fertility, diagnosis and treatment.

SEPTATE UTERUS AND FERTILITY

• Reduced space for the fetus – A septate uterus can reduce the space available for the fetus to grow, leading to a higher risk of miscarriage or the fetus being in a breech position.
• Preterm delivery – There is a high probability of the baby being born prematurely (before 37 weeks gestation) if the uterus is septate. Some of the baby’s organs and systems might not fully develop but being preterm or having a septate uterus does not mean that the child will be born disabled. Numerous women who have a septate uterus go on to have healthy pregnancies and deliver at term.

It is crucial to remember that not all septate uteri will impair fertility or result in miscarriage, and the chance of miscarriage can change based on how severe the condition.

DIAGNOSIS OF SEPTATE UTERUS

This will usually start with a pelvic exam. However, unless the septum extends into the vagina, a pelvic exam will not show the depth or position of the septum. Instead, the healthcare provider will use imaging tools to get the best picture of the septum, its thickness and its exact position in the uterus. To diagnose a septate uterus, one or more of the following methods may be used –

• Ultrasound – This is an imaging test that uses high-frequency sound waves to create pictures of the uterus and cervix. An ultrasound can help identify any abnormalities in the shape or size of the uterus, including a septum.
• Hysterosalpingography (HSG) – This is a special type of X-ray that uses dye to highlight the inside of the uterus and fallopian tubes. An HSG can help identify any blockages or abnormalities in the uterus, including a septum.
• Magnetic Resonance Imaging (MRI) – This is a non-invasive diagnostic tool that provides detailed images of the uterus. This imaging test can help determine the extent of the septum and whether it is complete or incomplete. It is a safe diagnostic test that does not use ionizing radiation or contrast dyes. It is also relatively quick, taking about 30-60 minutes to complete.
• Endometrial sampling – This involves removing a small sample of tissue from the lining of the uterus (the endometrium) to check for any abnormal cells or growths. The sample can be collected during a hysteroscopy procedure, which uses a thin, lighted tube with a camera on the end to visualize the inside of the uterus.

If any of these tests indicate the presence of a septate uterus, further testing may be recommended or treatment to address any related issues, such as infertility or recurrent miscarriage.

TREATMENT OF SEPTATE UTERUS

The treatment of a septate uterus depends on various factors such as the severity of the septum, symptoms experienced by the patient, and the desire for fertility.

• Observation – In some cases, if the septum is small and does not cause any symptoms or complications, observation may be recommended. This approach is often chosen when the patient does not have any fertility issues or recurrent pregnancy loss. Regular monitoring through ultrasound examinations may be performed to ensure there are no changes or complications.

• Surgical Intervention – Surgical intervention is often recommended for patients with a septate uterus who experience infertility or recurrent pregnancy loss. The main goal of surgery is to remove or reduce the septum to improve fertility outcomes and reduce the risk of miscarriage.

There are two main surgical approaches for treating a septate uterus:

• Hysteroscopic Metroplasty

Hysteroscopic metroplasty is a minimally invasive procedure performed using a hysteroscope, which is a thin tube with a camera attached to it. During this procedure, the surgeon inserts the hysteroscope through the vagina and cervix into the uterus to visualize the septum. Surgical instruments are then used to remove or resect the septum, creating a normal uterine cavity.

• Open Surgery (Metroplasty)

Open surgery, also known as metroplasty, is another surgical option for treating a septate uterus. This procedure is performed through an abdominal incision, typically a low transverse or vertical incision. The surgeon accesses the uterus and removes or resects the septum to create a normal uterine cavity. Open surgery may be recommended for patients with a large or complex septum that cannot be adequately treated hysteroscopically.

• Postoperative Care

After surgical intervention for a septate uterus, postoperative care is essential to ensure proper healing and reduce the risk of complications. This may include pain management, antibiotics to prevent infection, and follow-up appointments to monitor progress.

CONCLUSION

Women who are having trouble getting pregnant or who are experiencing repeated miscarriages may face difficulties due to a septate uterus. A  Gynaecologist /Fertility Specialist’s advice and recommendation is essential for  precise diagnosis and individualized treatment plan. Patients can make informed   decisions regarding their reproductive health if they are aware of the causes, symptoms, diagnosis, and available treatment options.