Surgical Correction of the Septate Uterus

Abstract

Metroplasty for septate uterus performed in 28 patients at Methodist Hospital in Houston is discussed. The preoperative fetal survival rate was 19.5%. Prior to laparotomy, D and C was performed in all patients. During the operation a lower abdominal transverse incision was used for abdominal exploration. The uterus was first divided from above downward in an anteroposterior direction until the endometrial cavity was entered. The incision was kept in the midline to minimize blood loss. Once the endometrial cavity was exposed, scissors were used to cut the septum bilaterally without excising it. Care was taken not to cut into the myometrium superiorly. The uterine walls were then reapproximated by simple interrupted no. 1 chromic catgut sutures that transversed serosa, myometrium, and endometrium. The first sutures were placed on the anterior and posterior aspects of the uterus just below the incision in the uterine wall. The remaining sutures were placed about .5 to 1 cm apart; none were tied until all sutures were in place. Closure was in a longitudinal anteroposterior direction along the same line as the incision. Approximation of the serosal surface was further enhanced by a running inverting 3-0 chromic catgut suture. In 16 patients, an IUD was placed in the uterine cavity before closure and left in place for 1 to 3 months. The frequency of associated endometriosis was 32.1%. Of the patients wishing to conceive, 73% became pregnant. The postoperative fetal survival rate was 87.5%. Delivery was by cesarean section.