Uterine septum or uterine septum is the condition in which the middle wall of the developing uterus does not disappear and remains as a curtain while it is formed as a result of the mullerian canals merging in fetal life. A membranous structure divides the inner cavity of the uterus into 2. This event can lead to recurrent miscarriages.
A curtain in the uterus is the condition in which the middle wall formed after the mullerian canals that form the uterus in the embryological period do not disappear. Depending on when the wall disappears in the embryological period, it can be a complete curtain and is called a complete septum or a partial septum as a half curtain. No abnormality is observed in the outer borders of the uterus. The structure of the curtain can be fibrotic or originating from the muscle layer.
Septum or uterine septum is defined as Class 5 in the American Society of Reproductive Medicine (ASRM) classification or U2 in the European Society of Reproductive Medicine and Gynecological Endoscopy classification.
The reason for the formation of a uterine septum is the failure of the middle wall to disappear during the union of the muller ducts in the embryological period of the uterus.
It is the most common muller duct anomaly. 55% of muller duct anomalies are caused by a uterine septum. It is the muller anomaly that most negatively affects reproductive health.
Imaging methods of the uterine cavity are used to diagnose a uterine septum or uterine septum. The most commonly used methods in diagnosis;
2D ultrasound is the most practical method in clinical use. The visibility of the septum in ultrasound depends on the user's experience.
3D ultrasound requires more training. The cervix and vagina are better evaluated.
MRI is considered the gold standard in evaluating the uterine septum. It is more expensive and more difficult to access than ultrasound.
Use of medicated ultrasound is low-cost and provides sufficient information about the cervix and uterine cavity. It depends on the user's experience and shows the inner wall borders of the uterus.
HSG or hysterosalpingography provides sufficient information about the uterine cavity and tubes. It is mostly used for infertility treatment. HSG is a painful procedure and does not distinguish the uterine septum from the bicornuate uterus. It does not show the outer borders of the uterus. HSG is not used in vaginal and cervical obstructions.
Hysteroscopy is a non-invasive procedure performed with a camera placed inside the uterus. It provides information about the vagina, cervical canal and uterine cavity. It does not provide information about the uterine wall thickness and the outer borders of the uterus. It does not distinguish the uterine septum from the bicornuate uterine structure.
Laparoscopy can distinguish the outer wall borders of the uterus and peritoneal formations. It is an interventional method. It does not evaluate the uterine wall thickness.
Treatment of the septum in the uterus is not done with medication or medical methods. The only treatment for uterine septum is uterine septum surgery, or metroplasty. Metroplasty is the term used for all corrections made hysteroscopically on the inner wall of the uterus. It is the most frequently performed uterine septum surgery among these types of correction surgeries.
Uterine septum is a Mullerian duct anomaly that creates the worst results in terms of reproductive health. It causes miscarriages in the first and second trimesters of pregnancy. Hysteroscopic correction creates positive results in terms of reproductive health.
The treatment of uterine septum or septum is called Metroplasty. It is the process of cutting the septum that divides the uterine cavity with a cutting device at the end of a lighted camera called a hysteroscope that enters the uterine cavity through the cervix.
Metroplasty surgery performed hysteroscopically is a day procedure. The patient can be discharged on the day of the procedure.
The risk of uterine perforation or perforation is low in uterine septum surgery. In such a case, repair can be done laparoscopically or the patient can be followed up.
Gynecological endoscopy or camera surgeries are divided into 2 as laparoscopy and hysteroscopy. While laparoscopy is performed with a camera entering the abdomen through the navel, the hysteroscopy camera allows surgery by entering the uterine cavity through the cervix. Since the uterine septum is located in the uterine cavity, a hysteroscopy device is used.
Hysteroscopic septum surgery is performed under sedation and anesthesia in operating room conditions and allows patients to be discharged on the same day.
Uterine septum surgery is in the group of day surgeries performed hysteroscopically. The patient who undergoes the procedure under anesthesia is discharged after a short follow-up period.The patient can return to their normal diet and take a bath after the surgery. They can return to work the next day. It is normal to have vaginal spotting for a few days after the surgery. In case of heavy vaginal bleeding, a doctor should be consulted.
Pregnancy can be allowed at the earliest 3 months after hysteroscopy surgery.
A uterine septum will not cause bleeding and does not cause any gynecological complaints.
A uterine septum can be seen on ultrasound. However, the user's practice is important. The gold standard for diagnosis is MRI.
Recent studies have shown that some patients can get pregnant despite the presence of a uterine septum, and the necessity of the procedure has begun to be questioned. However, there are many studies showing that the risk of miscarriage increases in the first or second trimester.
Uterine septum or uterine septum does not show any clinical symptoms.
It is thought that uterine septum increases the miscarriage rates in the first and second trimesters.
