Complete Septate Uterus Research Articles

An Exceptional Case of Complete Septate Uterus With Unilateral Cervical Aplasia (Class U2bC3V0/ESHRE/ESGE Classification) and Isolated Mullerian Remnants: Combined Hysteroscopic and Laparoscopic Treatment

Study ObjectiveTo report the combined hysteroscopic and laparoscopic treatment of a complete septate uterus with unilateral cervical aplasia (class U2bC3V0/ESHRE/ESGE classification) and isolated mullerian remnants. DesignStep-by-step presentation of the surgical treatment (Canadian Task Force classification 4). SettingComplete septate uterus with unilateral cervical aplasia (formally Robert's uterus) is characterized by the presence of a uterine septum completely dividing the endometrial cavity into an obstructed hemicavity and a contralateral nonobstructing hemicavity connected normally to the existing cervix. It has always been described as isolated without any associated anomaly. PatientA 30-year-old woman was referred to our department for dysmenorrhea and primary infertility. Hysterosalpingography showed the presence of a right (RT) hemiuterus with a patent fallopian tube; further evaluation with 2- and 3-dimensional ultrasound and magnetic resonance imaging showed an externally normal-appearing uterus, a right normal hemicavity connected normally with the existed cervix and, a left hemicavity fully divided from the right one by a complete septum and not connected with the cervix. Interestingly, a peculiar complex mass with cystic areas, attached posterolaterally from the left side to the uterine wall at the level of the isthmus and the upper cervix, was also diagnosed. InterventionsThe study protocol was approved by our local institutional review board. During outpatient hysteroscopy, a right uterine hemicavity with a single ostium was identified without any communication with the left hemicavity. The patient was then scheduled for combined laparoscopic and hysteroscopic treatment. During laparoscopy, a normal uterine body with multiple myomas and a pseudocystic lesion attached posteriorly and left laterally to the uterus at the level of the isthmus and the upper cervix were shown; no communication between the cystic part of that lesion and the isthmus or the cervicovaginal canal was observed. During hysteroscopy, a longitudinal incision of the septum with a 5F bipolar electrode was performed; the left hemicavity was opened, and the corresponding tubal ostium was identified. The pseudocystic lesion was then excised after opening and sent for pathological analysis; the defect was closed with interrupted intracorporeal knots. Measurements and Main ResultsA single normal endometrial cavity with both tubal ostia was obtained, thus restoring obstruction by unification of the uterine cavity. A histologic report of the removed pseudocystic lesion was compatible with the diagnosis of mullerian remnants. A follow-up hysteroscopy 3 months after showed a normal uterine cavity without postsurgical adhesions. ConclusionThe use of 3-dimensional ultrasound and magnetic resonance imaging in combination with the new ESHRE/ESGE classification system gives the opportunity to obtain a precise representation of the female genital anatomy even in the presence of complex anomalies. Although a septate uterus with unilateral cervical aplasia has been already described, the presence of mullerian remnants is a rare entity associated with cyclic pelvic pain, thus needing adequate recognition and treatment. The combined hysteroscopic and laparoscopic approach offers a unique opportunity for the treatment of complex anomalies.

Septo uterino completo acompañado de doble cérvix y tabique vaginal

Complete septate uterus with double cervix and septate vagina Abstract The aim of this study was to present two patients with the same alterations in their genital system. These alterations are not included in the classical classification of Mullerian malformations because of their co-occurrence. An accurate diagnosis is essential for correct management, because the identification of septate uterus with double cervix and septate vagina in these two patients will allow us to resect the two septa, leaving the cervix intact, thus improving gynecological and obstetric symptoms.

A classification of congenital uterine anomalies predicting pregnancy outcomes.

To evaluate pregnancy outcomes in women with uterine anomalies by applying a method for diagnosing and classifying congenital uterine malformations. Retrospective study. Tertiary care center. Ninety-four women with uterine anomalies who delivered after 22 gestational weeks. Excluding the 14 women with a history of surgery and seven with one endometrial cavity, 73 women with two endometrial cavities were subdivided into those with two external uterine orifices (2-OS subgroup) and those with one external uterine orifice (1-OS subgroup). Pregnancy outcomes, such as preterm birth, abnormal fetal presentation, cesarean delivery and placental abruption. The 2-OS subgroup comprised women with a didelphic or complete septate uterus who had a significantly higher rate of cesarean delivery (91% vs. 18%, p<0.001) than the control group (normal uterine morphology; n=5763). The 1-OS subgroup comprised women with a bicornuate or incomplete septate uterus who had significantly higher rates of preterm birth (27% vs. 5%, p<0.001) and placental abruption (14% vs. 0.7%, p<0.001) than the control group. Classification of uterine anomalies by the number of uterine endometrial cavities and external uterine orifices is an easy and reliable means of predicting pregnancy outcomes.

Light-Guided Hysteroscopic Resection of Complete Septate Uterus With Preservation of Duplicated Cervix

The objective of the present study, performed at a tertiary university hospital, was to propose a novel method of hysteroscopic resection of complete septate uterus with preservation of duplicated cervix. The retrospective study included 5 women with complete septate uterus and cervical duplication and who also experienced infertility with or without pregnancy loss. All patients underwent bougie-guided or light-guided hysteroscopic perforation of the uterine septum above the endocervix, followed by septum resection. The success rate of complete uterine septum perforation under bougie guidance was 60% (3 of 5 procedures), and of light guidance was 100% (2 procedures). After hysteroscopic septum resection, 2 of 5 women achieved pregnancy within 3 months and delivered uneventfully at term. It is concluded that light guidance is superior to bougie guidance for hysteroscopic perforation of complete septate uterus with preservation of the duplicated cervix.

Vaginal septoplasty in septate uterus with double cervix.

Fusion defects of the Müllerian ducts occur frequently and they have been described by the American Fertility Society. However, septate uterus with cervical duplication and longitudinal vaginal septum is not described by this classification and has suggested a change in the classical theory of fusion of the Müllerian ducts. This paper describes a rare case report of a patient with complete septate uterus with double cervix and longitudinal vaginal septum, submitted to the vaginal septoplasty for dyspareunia, progressing to clinical improvement. The description of this case is to contribute with all uncommon cases of Müllerian anomalies reports and clinical treatment protocols, which is not yet established.

Management and reproductive outcome of complete septate uterus with duplicated cervix and vaginal septum: review of 21 cases

To evaluate the reproductive outcomes of complete septate uterus with duplicated cervix and vaginal septum. Twenty-one patients who have complete septate uterus with duplicated cervix and vaginal septum were retrospectively reviewed in this study. In Group I, 11 patients with a poor reproductive outcome (spontaneous miscarriage or infertility) or dyspareunia underwent hysteroscopic metroplasty and removal of vaginal septum with the preservation of cervical septum. In Group II, 10 patients without a history of spontaneous miscarriage did not undergo hysteroscopic transection of the uterine septum. Of 10, four underwent vaginal septum incision due to dyspareunia, two underwent mere laparoscopic pelvic adhesiolysis because of infertility, and four without symptoms had no intervention. The primary endpoints included the pregnancy rate and outcomes of pregnancies. In Group I, the pregnancy rate after surgery is 81.8 % (9/11). Of nine women who conceived, six had term delivery, one encountered induced abortion due to the malformation of the fetal heart, and two had ongoing pregnancy. In Group II, among six patients accepting surgery, three had term delivery. The pregnancy rate after operation is 50 % (3/6). The uterine septum may not necessarily be transected for patients who have complete septate uterus with duplicated cervix and vaginal septum, and meanwhile have no a history of poor reproductive outcome.

MRI characters of 52 cases of septate uterus

Magnetic resonance imaging (MRI) findings of 52 patients with septate uterus were retrospectively analyzed.There were 19 cases of complete septate uterus and 32 cases of partial septate uterus confirmed by hysteroscopy or hysteroscopy combined with laparoscopy,and 1 case without surgery.According to MRI findings,19 cases were diagnosed as complete septate uterus,32 cases as partial septate uterus and 1 case as intrauterine adhesion.The results indicated that MRIcan be used in diagnosis of septate uterus. Key words: Uterus diseases; Magnetic resonance imaging

Complete Septate Uterus with an Obstructed Left Hemivagina and Ipsilateral Renal Agenesis

Complete Septate Uterus with an Obstructed Left Hemivagina and Ipsilateral Renal Agenesis

Expression of vascular endothelial growth factor receptors in the endometrium of septate uterus

To compare the messenger RNA (mRNA) expression of vascular endothelial growth factor (VEGF) receptors (KDR, Flt-1, and sflt) in the different endometrial locations of septate uterus and normal uterus. Prospective, observational study. University teaching hospital. Twelve women with complete septate uterus undergoing hysteroscopic metroplasty and 12 women with normal uterus. Endometrial tissue samples were obtained from the endometrium covering the septum and the endometrium lining the lateral wall of the uterus. Moreover, endometrial samples were obtained from patients with normal uterus. Differences in the mRNA expression of VEGF receptors between the endometrial samples of septate and normal uterus. The mRNA expression of VEGF receptors, both KDR and Flt-1, was significantly lower in the endometrium lining the septum as compared with the endometrium covering the lateral wall of septate and normal uterus. Conversely, no differences were observed in mRNA expression in the soluble receptor sflt between the different endometrial samples studied. The results suggest that a local defect of both VEGF transmembranous receptors (KDR and Flt-1) in the endometrium covering the septal area may be responsible for the clinical comportment of this müllerian anomaly.

Complete septate uterus, obstructed hemivagina, and ipsilateral renal anomaly: pregnancy course complicated by a rare urogenital anomaly

Abnormalities of the female reproductive tract are associated with a multitude of intrapartum complications. In the case that follows, we report the complicated pregnancy course of a woman diagnosed postpartum with the uncommon syndrome of obstructed hemivagina and ipsilateral renal anomaly (OHVIRA) associated with a complete septate uterus. A 19-year-old nulliparous woman with a history of a right nephrectomy secondary to multicystic dysplastic kidney disease presented with premature rupture of membranes at 30 weeks' gestation. After failed induction of labor at 34 weeks' gestation, a uterine anomaly was discovered at the time of cesarean section. Magnetic resonance imaging performed postpartum revealed a complete septate uterus, longitudinal vaginal septum, and obstructed right hemivagina. The OHVIRA syndrome is classically associated with uterus didelphys, not complete septate uterus as in this woman. This case illustrates the potential for intrapartum complications in women with abnormalities of the urogenital tract.

Hysteroscopic septum resection of complete septate uterus with cervical duplication, sparing the double cervix in patients with recurrent spontaneous abortions or infertility

To evaluate the safety and efficacy of hysteroscopic septum resection of the complete septate uterus with cervical duplication in patients with recurrent spontaneous abortions or infertility. Prospective consecutive clinical study. University hospital for obstetrics, gynecology, and reproductive medicine. Twenty-five patients with a complete septate uterus, cervical duplication, and history of recurrent spontaneous abortions (13 cases) or infertility (12 cases) were included. Hysteroscopic septum resection and sparing the double cervix using a bougie served as a means of orientation and blockage of internal cervical os. Intraoperative and postoperative complications, and postoperative anatomic identification of the uterus. No intraoperative and postoperative complications were encountered. Postoperatively, ultrasound revealed minor fundal septal remnants in 7 (31.8%) of 22 patients receiving the ultrasound detection, and no residual septum in the other 15 cases (68.2%). By using a bougie technique, hysteroscopic correction of complete septate uterus with cervical duplication and sparing the double cervix can be performed successfully.

Intrauterine fallopian tube incarceration: an uncommon complication of termination of pregnancy by vacuum aspiration

A 34-year-old woman presented with an intermittent abdominal pain 5 years after voluntary vacuum aspiration for interruption of a first-trimester pregnancy. Magnetic resonance imaging demonstrated complete septate uterus and a cystic mass that infiltrated the posterior myometrial wall of the right side of the uterus. Laparoscopy and hysteroscopy revealed an intra uterine fallopian tube incarceration.

Reproductive Outcome of Septate Uterus after Hysteroscopic Treatment with Neodymium:YAG Laser

The aim of this study was to assess fertility outcome and obstetrical prognosis of 46 patients after hysteroscopic section of uterine septa with neodysmium:yttrium-aluminum-garnet (Nd:YAG) laser. Approximately 15-25% of spontaneous miscarriages are related to Müllerian fusion defects, most of which are associated with uterine septa. Operative hysteroscopy is a safe and effective treatment for uterine septa. Forty-six sterile patients with septate uterus received hysteroscopic metroplasty with Nd:YAG laser. Forty-one patients with incomplete septate uterus were under the guidance of B-ultrasonography, while the other 5 patients with complete septate uterus were treated by laparoscopy. The metroplasty was successfully conducted in 45 patients, with a success rate of 98% (45 /46). Postoperative follow-up examinations of 28 patients revealed pregnancy within 12 months in 20 patients, 16 of whom acquired term delivery. The pregnancy rate within 1 year was 71%. Hysteroscopic treatment of septate uterus with Nd:YAG laser is effective. The cervix may not be excessively dilated, the intraoperative bleeding can be thoroughly controlled, and the procedure under local anesthesia is relatively safe.

3259: Transvaginal 3D sonohysterographic diagnosis of congenital uterine malformation

To evaluate the diagnostic value of transvaginal three-dimensional ultrasonic hysterography on congenital uterine malformation. We examined 35 women with suspected uterine malformation after intrauterine injection via transvaginal ultrasound. Then we compared the ultrasonic results with hysterography and laparoscopy. Six cases were diagnosed as complete septateuterus, 19 cases as subseptate uterus and 10 cases as bicornuate. Accuracy of three-dimensional ultrasonic hysterography was 100%. Transvaginal three-dimensional ultrasonic hysterography is a simple and convenient method with high accuracy, and can be regarded as a feasible way to diagnose congenital uterine malformation.

Complete septate uterus with longitudinal vaginal septum

To review clinical implications, reproductive outcome, and long-term consequences in women with complete septate uterus and longitudinal vaginal septum. A retrospective study. A university hospital. Sixty-seven patients who had a complete septate uterus including the cervix and a longitudinal vaginal septum. The longitudinal vaginal septum was incised in 36 cases and metroplasty for uterine septum was undertaken in 4 patients. Fertility, outcome of pregnancies, possible late consequences, and presence of other anomalies. Eight (15.7%) of 51 women attempting pregnancy had primary infertility of nonuterine causes. Forty-nine women not undergoing metroplasty produced 115 pregnancies, abortion rate 27%, preterm delivery 12%, and live birth rate 72%. Only five women with no metroplasty had only miscarriages and 44 women at least one delivery. One of four women undergoing metroplasty delivered preoperatively and three after metroplasty. During the follow-up period endometriosis was observed in two (3%) of 61 cases and two patients had borderline ovarian tumors. Kidney abnormalities were found in 11 (20%) of 55 patients studied, double ureter being the most common. Complete septate uterus with longitudinal vaginal septum is not associated with primary infertility, and pregnancy may progress successfully without surgical treatment. The results do not support elective hysteroscopic incision of the septum in asymptomatic patients or before first pregnancy.

Imaging of Complete Septate Uterus With Intercornual Cysts

Imaging of Complete Septate Uterus With Intercornual Cysts

The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum

Objective This study was undertaken to evaluate the diagnostic management and the reproductive outcome after surgical repair of a rare reproductive malformation. Study design Sixteen women with a complete septate uterus, double cervix, and a longitudinal vaginal septum were referred for evaluation. Presenting complaints were chiefly pregnancy loss in parous women (n = 9) and dyspareunia in nulligravid women (n = 7). The combination of hysterosalpingography, ultrasonography, and/or magnetic resonance imaging was used to correctly identify the anomaly in 15 of the 16 cases. Both hysteroscopic (n = 11) and transabdominal (n = 5) surgical techniques were used to repair the uterine septum. Results In no case was the correct diagnosis made before referral; the uterus didelphys was the most common misdiagnosis. The preoperative pregnancy loss was 81%. Postoperatively, 12 women conceived for a total of 17 pregnancies; there were 14 term live births or ongoing pregnancies in the third trimester (82%), with a first trimester spontaneous abortion rate of 18%. In 9 women who conceived after hysteroscopic surgery, term live births occurred in 9 of 12 (75%) conceptions. A modified Tompkins metroplasty was performed in 5 women with subsequent term live births or ongoing third trimester pregnancies in 5 of 5 (100%) patients. Conclusion The identification of a duplicated cervix and a vaginal septum is consistent with several uterine malformations, which leads to frequent misdiagnosis and errors in management. Significant pregnancy wastage, obstetric complications, and dyspareunia are common, and surgical treatment is therefore advisable. Making the best choice between hysteroscopic or transabdominal metroplasty depends on the anatomic features of the cervix and the uterine cavity, but optimal patient management requires familiarity with both techniques.

Magnetic resonance imaging in the evaluating of double uterus and associated urinary tract anomalies: a report of five cases

Uterine anomalies are associated with unilateral renal aplasia. We present the MR features of five cases with 'double' uteri. The anomalies consisted of four cases of uterus didelphys and one of a complete septate uterus. All the cases with uterus didelphys also had a longitudinal vaginal septum. The MR diagnoses were confirmed with hysterosalpingography and with laparoscopy. In one case of didelphic uterus, MR images predicted the (three-dimensional helical) computer tomography (CT)-pyelographic diagnosis of renal aplasia in which the single kidney was normal. The study shows that MR is a valuable tool for the diagnosis of not only uterine anomalies but also associated anomalies in other systems.

Pregnancy in asymmetric blind hemicavity of Robert’s uterus—a previously unreported phenomenon

An 18-year-old primigravida presented following recurrent failed attempts at pregnancy termination for intra-uterine fetal death. Clinical examination aroused suspicion of non-communicating uterine horn with bicornuate uterus. Examination under anaesthesia and laparotomy revealed a partial vaginal septum, complete septate uterus with septum deviated to one side and fetus lying in the non-communicating right blind hemicavity (Robert’s uterus). Hysterotomy and ipsilateral tubal ligation were performed.

Blind hemivagina: long-term follow-up and reproductive performance in 42 cases.

Our purpose was to analyse the reproductive performance of women with obstructed hemivagina after surgical treatment. After laparoscopic exploration of 42 cases (mean age: 18 years), didelphic and complete septate uterus were found in 78 and 22% of cases respectively. Resection of vaginal septum and hemihysterectomy with ipsilateral hemicolpectomy were performed in 88% and 12% of the cases, respectively, between 1970 and 1997. Long-term results were assessed by a questionnaire and obtained for 38 patients (mean years after treatment and range: 6.5; 1-23). Dysmenorrhoea and abdominal pain were resolved in 87% and 100% of the cases, respectively. Nine patients experienced 20 pregnancies (13 living children, four early spontaneous abortions, two early terminations and one ectopic pregnancy). Nine offspring (69% of live births) were delivered after 37 weeks. Four patients had four pregnancies ipsilateral to blind hemivagina after vaginal septum resection (two living children, one early spontaneous abortion and one ectopic pregnancy). These results suggest that laparoscopic exploration and resection of vaginal septum are the appropriate treatments for obstructed hemivagina. Subsequent reproductive performance was comparable to that reported following treatment of the associated uterine malformation.