Abstract
Objective: To address Septate Uterus causing Recurrent Pregnancy Loss (RPL) with Septoplasty by creating an adequate adhesion-free uterine cavity. Methods: A 44-year old G4P0(0040) with recurrent pregnancy losses with 2 previous curettages after an abortion consulted. 3D ultrasound showed a uterus with a symmetrical septum extending up to the level of the isthmus with internal indentation of 2.04 cm. Hysteroscopic Septoplasty was done using a Bipolar Colin’s Electrode, resecting the septum in anterograde movement in the median plane of the septum. High dose estrogen was given for 8 weeks for faster re-epithelization. Second look hysteroscopy and 3D ultrasound after two menstrual cycles. Results: Post-operatively, the procedure and hormonal regimen were well-tolerated. The second look hysteroscopy revealed a small remnant of the septum and no adhesions present while the repeat 3D scan showed a 45% reduction of the internal indentation at 1.12 cm. Conclusion: In cases of Recurrent Pregnancy loss due to a septate uterus, it is reasonable to perform a Septoplasty with post-operative hormonal therapy to ensure sufficient intrauterine space and faster endometrial recovery to facilitate implantation and delivery at a viable age of gestation. A Second look Hysteroscopy is recommended to evaluate the procedure.
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