What Is A Uterine Septum?

Uterine septum is a disorder in the process of uterine formation that occurs during the development of the fetus before birth. In this complication, a membrane called the septum forms the inner part of the uterus, in the middle of it, and divides the uterine cavity into two parts. This dividing septum is a fibrous and muscular tissue that can be thick or thin.

Women with uterine septa are at risk for miscarriage. It is not entirely clear why this is happening. The septum cannot provide the proper support needed for a healthy pregnancy. The septum may also interfere with pregnancy in a variety of ways. The condition can be treated with surgery, which has significantly improved outcomes.

The types

Septate uterus is divided into three types:

• Partial septate uterus: When the septal tissue does not include the cervix.
• Complete septate uterus: When the septum also includes the cervix, which is the womb’s opening.
• Septate uterus and vagina: When the septum extends into the vagina.

Symptoms

Women with a septum uterus often have regular periods and no symptoms, and they are usually diagnosed randomly or during infertility tests. The septum is asymptomatic until the girl reaches puberty and is undetectable for a long time. It can make menstruation more painful.

Women with septum are at risk for miscarriage. A common theory is that the uterine septum cannot provide adequate support for a healthy pregnancy; it may also interfere with pregnancy in various ways, severely limiting enough space for the fetus and placenta to settle and grow.

The rate of miscarriage in the general population is about 10 to 20 percent in pregnant women; this rate in women with septum is between 20 to 25 percent and may reach forty percent.

Is a septate uterus the same as a bicornuate uterus?

An angle of less than 75 degrees between the branches of the uterus indicates the presence of a separate uterus, and an angle of more than 105 degrees is more compatible with a two-horned uterus. Unfortunately, most of the divergence angles between the horns lie between these ranges, and there is considerable overlap between the two anomalies.

The uterus is two-pronged with a heart or two separate horns at the top. In this condition, the upper part of the uterus or fundus sinks into the midline of the uterus. In a septal uterus, whether or not the upper part is sunken, the uterine cavity membrane splits in two, which can be thick or thin.

Very light bifurcations do not normally affect a woman’s chances of a successful pregnancy, but if the severity of the bifurcation completely halves the upper part of the uterine cavity, a chance of miscarriage is more likely.

Diagnosis

The septum is usually a very thin tissue line and is difficult to see. Therefore, doctors prefer to use a variety of imaging techniques for diagnosis, including:

• MRI
• ‌2D or 3D ultrasound
• Hysteroscopy

Ultrasound can be done using an ultrasound probe on the outside of the abdomen or by inserting an ultrasound probe into the vagina. To diagnose the uterine septum, three-dimensional ultrasound is better than two-dimensional ultrasound because it provides an accurate picture of the uterus.

MRI, or magnetic resonance imaging, is often used to determine if the disease is a single uterus or two horns. A two-horned uterus is when the uterus splits into two horns and may or may not have a septum.

Treatment

Hysteroscopic surgery can be used to cut or shave the nasal septum. The uterus is no longer divided into two parts by cutting the septum. This procedure is considered as a minor outpatient surgery. That is, the doctor allows the patient to go home on the same day of surgery. If the case is more complicated, the doctor may advise the patient to stay overnight in the hospital to be monitored.

During surgery, the surgeon uses a small scope placed on a tube to go from the vagina to the uterus and then cut the septum. The surgeon also uses ultrasound during surgery to make sure the septum is completely removed. Hysteroscopic surgery rarely involves major risks, but it can include the following:

• Infection
• Reaction to the anesthesia
• Damage to the cervix
• Damage to the uterus‌

This surgery’s most common side effects are pain such as period pain and some bleeding for one to two days. Using a tampon after surgery can increase infection risk, so the doctor may recommend using a sanitary pad instead.

Depending on the type of surgery, it should be possible to return to work within a day or two after surgery, and complete recovery can be expected in about 2 to 4 weeks. There may be some abdominal pain after uterine surgery and vaginal pain after vaginal surgery. Some women find it difficult to sit comfortably for several days after surgery. This is normal, but call a doctor if the pain gets worse.

If there are signs of infection such as nausea, chills, fever, or vomiting, should contact the doctor immediately.

What is the purpose of corrective surgery of vaginal and uterine septum?

The vaginal septum can cause menstrual problems or pain during sex or the use of tampons. Most doctors recommend surgery to correct this abnormality. Septum removal surgery can allow a girl to menstruate and use tampons regularly, relieve associated menstrual pain, and lead a normal, healthy sex life.

The uterine septum is not usually a health problem in women and may not need treatment at all, but it can cause fertility problems in some patients. Women with a uterine septum are more likely to have infertility, preterm birth, miscarriage, and recurrent miscarriages. The septum may prevent sperm from reaching one of the ovaries or significantly reduce the fetus’s space to grow inside the uterus. Surgery to remove the septum can sometimes improve the condition of the uterus and increase the chance of pregnancy.

The bottom line

Uterine abnormalities can be caused by infertility, miscarriage, or premature birth. Causes of uterine abnormalities can be congenital or acquired. In this way, the uterus may not grow normally from birth and during the fetal period or deformed due to disease or other factors. Uterine abnormalities can be diagnosed and treated if needed.

A uterine septum is a uterine abnormality that occurs as the fetus grows before birth. A membrane called the uterine septum divides the inside of the uterus in half. If this disorder causes problems, it can be treated with surgery.

Dr. Arjang Naim, MD, will remove the uterine septum with surgery if it causes problems for fertility or menstruation.

Additional questions