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A septate uterus is a structurally malformed uterus, where a thick or thin tissue membrane called the septum separates the uterine cavity into two compartments. This malformation happens in babies during the development stage inside the uterus. A normal uterus is a single compartment bag with a small extended neck-like opening that resembles an inverted potli pouch. Unfortunately, on rare occasions, two separate reproductive organs and a separate cervix known as the bicornuate uterus are formed.
Septate resection is a procedure performed to correct the malformed interior walls of the uterus by cutting the extra septum away. Hysteroscopes are instruments with a camera and light that help during the procedure. The doctor will insert the tube into the vagina through the cervix and into the uterus. And with one more probe, he will cut and remove the septum. This procedure is known as hysteroscopic-septal resection. It is a simple outpatient operation and does not need an abdominal incision and stitching. Surgery significantly increases the chances of getting pregnant. Almost 70-80 percent of septate women proceed to normal and healthy pregnancies after the procedure. If you do not want a child, there is no need to undergo this surgery. It is not mandatory to remove the septum on diagnosis, and there is no such prophylactic need. The decision to remove it depends on the need for obstetrical performance of the uterus.
A septate uterus is a genetic and congenital anomaly in the development of a fetus. You may note that the septate uterus is not inherited from parents or ancestors. The process of embryogenesis is the fusion of two tube-like structures called Mullerian ducts. They fuse and form a uterus. After fusion of the tubes, the partition present in between is reabsorbed and then disappears. This reabsorption starts from the cervix and extends to the head of the uterus. A disturbance in this reabsorption procedure leaves a thick or thin band of tissue intact, either to the complete length of the uterus or partial length. Open surgery or laparoscopic procedure can correct this anatomical malformation.
Most women will not have any signs or symptoms until puberty. And only very few have heavy bleeding during menstruation. Other than that, a woman will be completely normal. Most of the time, the septal uterus remains undiagnosed until the woman experiences miscarriages. The miscarriage usually happens in the first trimester of pregnancy. It can also happen in the second trimester. Women with septate uterus suffer abortions, and some also have recurrent miscarriages. The likelihood of these problems or complications in a woman with a septate uterus ranges from 20 to 25 percent. Some women with a septate uterus do not have a miscarriage, but they are at risk for the following:
A septate uterus does not necessarily determine a woman’s ability to carry a child. With proper procedures and corrections, a woman can still choose to have babies after the diagnosis.
A septate uterus does not show any external features other than visible miscarriages. It is usually diagnosed during the examinations conducted for miscarriages. Sometimes, a normal routine pelvic exam or ultrasound imaging performed to investigate another disease reveals a septate uterus. An early diagnosis can help you understand the structure of your uterus better. Your doctor performs procedures such as a hysterosalpingogram or hysteroscopy to confirm the diagnosis. It also helps evaluate the extent of malformation.
Hysteroscopy is nothing but an endoscopy with light and a camera at one end of the tube that evaluates the internal environment of the uterus and the fallopian tubes. It also has another tube that helps inflate the uterus for better imaging and visualization. Other imaging methods used for diagnosis are MRI, a 2D or 3D transvaginal ultrasound, and hysterosalpingography.
Hysteroscopic septal resection is a minimally invasive procedure usually performed in 30 minutes to one hour, and the total duration of hospitalization will be one day. This procedure begins with mild general anesthesia. A hysteroscope is then inserted into the uterus through the cervix via the vagina. Hysteroscope is a telescopic-like instrument with a light and camera on one end.
The doctor performing the procedure uses a screen to see the internal environment. It has another tube to connect an external syringe and fill a fluid or gas such as carbon dioxide to expand the uterus cavity. Then the doctor inserts an instrument called LEEP (Loop Electrical Excision Procedure) and cuts off the extra septum. The procedure corrects the malformation and builds a normal inner wall of the uterus. After this procedure, doctors recommend a few hours of observation, medication, and care for a quick recovery. The hysteroscopic procedure is the best method for preserving the structure of the hymen. Also, procedure-related blood loss is completely negligible.
The outcome of surgery is usually good. You may have vaginal blood flow and period-like pain for one or two days. Your doctor will prescribe a few follow-ups and some personal care advice. The doctor will advise follow-up imaging to ensure the complete removal of the septum, check the patency of the fallopian tube, and evaluate postoperative healing.
Hysteroscopic septal resection is a simple outpatient procedure that removes the abnormal septum. It is the best method to increase obstetric outcomes and help women conceive. Almost 70-80% of women proceed to normal pregnancy and childbirth after this surgery. The septate uterus is not an indicator of a woman’s ability to conceive. The surgical procedure improves the reproductive outcome greatly. An untreated septum itself is not a threat to a woman’s wellbeing, and it does not cause any ailments. The decision to undergo surgery depends on a woman’s wish to get pregnant.
The procedure is usually performed on an empty stomach. Hence, you are not allowed to eat or drink anything before the procedure. However, you can take some easily digestible foods and drinks once the septal resection procedure is complete. Also, you can return to consuming your normal diet in a day or two.
Septum in a uterus does not affect a woman’s ability to conceive. She can still conceive a baby, and the baby will start growing in the uterus. Later due to a lack of space, abortion may be inevitable. The septal resection procedure removes the septum and makes the uterus a single big pouch, favorable for the baby to grow. Studies have shown that 70-80% of women proceed to normal pregnancy and childbirth after the procedure.
Komala’s Women Clinic is a multidisciplinary organization dedicated to the advancement of the art, science and practice of reproductive medicine.
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