Uterine septum

Abstract

Septate uterus is a common benign uterine congenital anomaly with an estimated prevalence of ˜2 % in the general population, ˜3 % in infertile women and >5 % in patients with recurrent pregnancy losses. It is an absorption defect and according to the ESHRE/ESGE classification system, it is classified into two sub-classes, the partial (Class U2a) and the complete (Class U2b) one. An interesting clinically sub-category is the co-called bicorporeal septate uterus (Class U3c) as a result of a combined fusion and absorption defect. The anatomical statuses of the cervix and of the vagina further subdivide the main classes to various anatomical variants. Septate uterus is associated with poor pregnancy outcome in terms of increased first and second trimester abortions, higher preterm delivery rates, impaired fetal growth and perinatal mortality. It seems that it is also associated with lower conception rates, a topic that still needs further investigation. Surgical correction of septate uterus is, nowadays, easy and simple with the use of operative hysteroscope and/or resectoscope and it is aiming in the unification of the uterine cavity by cutting or resecting the septum. It seems that septum incision is associated with an improvement in the evolution of pregnancy by decreasing the probability of first and second trimester pregnancy losses as well as of preterm delivery rates. Although there is some indirect evidence that it is also associated with higher conception rates in infertile patients, the issue is still open for further investigation. Thus, based on the current best available evidence, it seems that septum incision is indicated in patients with a history of infertility and poor pregnancy outcome. It is still not yet elucidated if it could be also applied as a prophylactic procedure in asymptomatic women.