Complete Septate Uterus Research Articles

Ultrasound at the intersection of art, science and technology: complete septate uterus with longitudinal vaginal septum

Ultrasound at the intersection of art, science and technology: complete septate uterus with longitudinal vaginal septum

Clinical characteristics and management of patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis.

To analyze the clinical characteristics and management of patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis. This retrospective study reviewed the medical records of 17 patients with complete septate uterus, double cervix, obstructed hemivagina, and ipsilateral renal agenesis admitted to the Third Xiangya Hospital of Central South University between June 2007 and December 2019. The median age at surgery was 23 years. The most common presenting complaint was infertility. Seven (41.2%) patients were misdiagnosed previously. The obstruction was complete in five patients. All 17 patients underwent vaginoplasty, in which seven adolescent girls underwent vaginoscopic vaginal septum resections. Eight patients underwent hysteroscopic resections of the uterine septum for infertility or spontaneous miscarriage. Laparoscopy was performed in seven patients for specific indications, and only one patient was found to have pelvic endometriosis during the laparoscopy. During the follow-up, seven patients wished to conceive, and there were five living infants (four cesarean deliveries at term and one preterm vaginal delivery). Complete septate uterus with double cervix, obstructed hemivagina, and ipsilateral renal agenesis is an variant of obstructed hemivagina and ipsilateral renal agenesis syndrome. Consequently, healthcare providers should be aware of this potential variant.

Three Degrees of Separation: Complete Uterine Septums

Study Objective The goal of this video is to review how to diagnose and surgically manage three variations of incomplete Mullerian duct fusion and reabsorption. We focus on the differences between a complete septate uterus with a single septate cervix (unicollis), a septate uterus with duplicated cervix (bicollis), and a complete duplication of the uterus and cervix (uterine didelphis). Design N/A Setting All procedures were conducted at an academic medical center in the operating room setting. The patients were positioned in dorsal lithotomy with the legs supported using yellowfin stirrups. Patients or Participants Photos and video footage of three patients were collected during their respective surgeries in the operating room. Interventions We demonstrate the operative methods for safe vaginal, cervical and uterine septoplasty. In particular, we show different techniques that can be used for uterine/cervical septoplasty in the case of a complete septate uterus bicollis. We contrast this with the surgical management of a complete septate uterus unicollis. Measurements and Main Results N/A Conclusion This video explores the diagnosis and treatment of three Mullerian anomalies. Prior to surgical correction, it is essential to determine the specific type of anomaly. A complete septate uterus may be unicollis or bicollis; this is an important distinction due to their differing surgical management. In the case of a bicollis, we assert that it is best to avoid incision and repair of the two cervical canals due to the potential risk of cervical incompetence. A didelphys uterus does not require surgical intervention unless there is an accompanying symptomatic vaginal septum.

Longitudinal vaginal septum: a proposed classification and surgical management

To demonstrate various types of longitudinal vaginal septa (LVS), their classification, and the surgical management of typical and unique morphologic conditions of LVS. Video presentation of clinical appearance and surgical techniques for treatment of LVS. University hospital and two private. Representative cases from 121 consecutive women treated from 2013 to 2018 with LVS as a part of complex uterovaginal malformations or in isolated forms with [1] typical morphologic configuration of LVS, [2] rarer variants, or [3] specific anatomic restrictions. Resection of LVS performed as a main surgical procedure in cases with didelphys and bicornuate uterus in symptomatic women and as a part of corrective surgery of complete septate uterus. The three main nonsuturing techniques used were speculoscopy and septum excision using three different electrosurgical modalities; speculoscopy with laparoscopic devices; and vaginoscopy with hysteroscopic instruments. Clinical appearance and suggested classification, feasibility of surgery, and perioperative and anatomic results in a short follow-up period (3 months). We identified distinct types of longitudinal vaginal septa. Considering clinical appearance, we suggest classification of LVS based on four main features: [2] completeness of vaginal division: partial and complete type; [2] the symmetricity: symmetric and asymmetric position (with dominant left and right side); [3] association with the cervix: merged and isolated forms; and [4] concomitant vaginal openings: normal, and narrow openings: vaginal stenosis and hymen persistent (Fig.1). Vaginoscopic techniques by hysteroscope were successful in atraumatic treatment of women with substantial anatomic restrictions, and all of the presented techniques can be effectively used for typical LVS. However, vessel-sealing systems allow for bloodless surgery in contrast with other methods. This study was based on previously acquired data during large prospective study approved by the local ethics committee, and written informed consent to participate in the prospective study and permit publishing anonymous data regarding the medical images, videos of procedures, and results was obtained from all patients. A new classification of longitudinal vaginal septum allows better characterization compared with the currently available classification systems. Different surgical modalities are discussed with their respective advantages and disadvantages. Vaginoscopic incision using resectoscope is a reasonable alternative for women with an intact hymen and vaginal stenosis. The impact of vaginal septum resection on obstetric, reproductive, and sexual outcomes should be assessed in randomized controlled trials and large well-designed studies.

Analysis of postoperative pregnancy outcome in 180 women with congenital uterine malformation.

This study aims to explore the effects of combination of laparoscopy and hysteroscopy in pregnancy outcome in women diagnosed with congenital uterine malformation (CUM). The observation criteria include pregnancy rate, misdiagnosis rate, rate of spontaneous abortion and preterm birth rate. A total of 180 patients with congenital uterine malformation, who were treated in our hospital from January 2015 to June 2018, were enrolled in the study. Prior to hospitalization, all the patients had neither a history of genital tract surgery nor endocrine abnormalities, chromosomal abnormalities, immune abnormalities or other factors affecting pregnancy. Furthermore, the ovarian functions were normal, and there were no factors leading to infertility in the male partners. The diagnosis was mainly based on medical history, clinical manifestations, gynecological examinations, and ultrasonography including two-dimensional and three-dimensional ultrasonography, as well as hysterosalpingogram (HSG), magnetic resonance imaging (MRI), hysteroscopy, and/or laparoscopy or surgery. Patients were diagnosed and classified according to the Buttram classification. Among these 180 patients, 37 patients were diagnosed with complete septate uterus, 96 patients had sub-septate uterus, 25 patients had unicornuate uterus, 11 patients were diagnosed with bicornuate uterus, and 11 patients had didelphic uterus. The total number of preoperative pregnancies was 112, including 106 spontaneous abortions, with an abortion rate of 94.64%, and 86 total postoperative pregnancies, among which spontaneous abortions occurred 11 times, with an abortion rate of 12.79%. The difference was statistically significant (p < 0.05). Uterine malformation surgery can significantly improve the reproductive prognosis in patients with CUM.

Reproductive outcome of a complete septate uterus after hysteroscopic metroplasty.

ObjectiveThis study aimed to evaluate the reproductive outcomes of patients who underwent hysteroscopic metroplasty for correction of a complete septate uterus.MethodsThe study population comprised 92 women with complete septate uteri. Hysteroscopic metroplasty and laparoscopy were performed simultaneously in these patients. The postoperative reproductive outcome of each patient was evaluated.ResultsIn the primary infertility group, there were 32 (40%) pregnancies. In the abortion group, the number of miscarriages decreased from 68 (94.44%) to 5 (10.42%), while the number of live births increased from 1 (1.39%) to 42 (87.50%) after resection compared with before resection. The cumulative probability of pregnancy and that of live-birth pregnancy in the abortion group were significantly higher than those in the primary infertility group after surgery. Furthermore, resection of the cervical septum resulted in a significantly higher cumulative probability of live birth compared with preservation of the cervical septum.ConclusionHysteroscopic uterine metroplasty may improve the reproductive performance of a septate uterus. Resection of the cervical septum may increase the probability of a live-birth pregnancy for patients with a cervical septum, and this procedure could be recommended for cases of a complete uterine septum.

A Successful Pregnancy Outcome in a Complete Septate Uterus

A Successful Pregnancy Outcome in a Complete Septate Uterus

Hysteroscopic Resection of a Complete Uterine and Vaginal Septum Under Laparoscopic Ultrasound Guidance

Video Objective The aim of this video is to demonstrate the use of laparoscopic ultrasound guidance during hysteroscopic resection of a congenital uterine and vaginal septum. Setting Our patient is a 20 year old G0 female who presented for difficulty with tampon insertion and removal as well as painful intercourse. On physical exam, the patient was noted to have a complete, non-obstructing longitudinal vaginal septum with two separate normal cervices. MRI of the abdomen and pelvis showed a complete septate uterus, two cervices, and two normal kidneys. Interventions This video shows the simultaneous use of hysteroscopy and laparoscopic ultrasound to safely and successfully resect the uterine and vaginal septum. Conclusion The goal is to encourage use of this technique during similar procedures for patients with mullerian duct anomalies desiring surgical correction.

Double cervix, septate uterus, and longitudinal vaginal septu a rare Müllerian anomaly with leiomyoma of the uterus

Objective: To discuss a rare anomaly, double cervix, septate uterus, and longitudinal vaginal septum with a leiomyoma of the uterus. Case Report: A case of double cervix, septate uterus, and longitudinal vaginal septum that underwent surgery for incomplete uterine septoplasty and subserosal leiomyoma. Conclusion: Combination of leiomyoma with complete septate uterus, cervical duplication, and longitudinal vaginal septum is a rare entity. Treatment options should be individualized for patients’ expectations.

Hysteroscopic Corrections for Complete Septate and T-Shaped Uteri Have Similar Surgical and Reproductive Outcome.

To compare the surgical results and reproductive performances of patients with ESHRE/ESGE (European Society for Human Reproduction and Embryology/European Society for Gynaecologic Endoscopy) class U1a and U2b uterine anomalies after hysteroscopic correction. A retrospective cohort study was conducted at a university hospital infertility clinic. Ninety-six patients with class U2b (complete septate uterus) and 78 patients with class U1a (T-shaped uterus) uterine anomalies who underwent hysteroscopic correction between January 2009 and December 2015 were recruited. The operation time was significantly longer in class U2b anomalies (26.5 ± 5.3 minutes) than class U1a anomalies (22.8 ± 5.8 minutes; mean difference [95% confidence interval [CI]: 3.6 ± 0.9 [1.8-5.3]; P < .001). Six out of all complete septate patients and 3 of T-shaped patients were reoperated due to postoperative synechia or to further enlarge the cavity. There were no differences between the groups regarding intraoperative (blood loss and uterine rupture) and postoperative (bleeding and infection) complications. After surgical correction, the term delivery rates increased from 3% to 71% ( P < .001) in class U2b and from 4% to 62.1% ( P < .001) in class U1a. The chance of live birth significantly increased after hysteroscopic correction both in class U2b (odds ratio [OR] 106.1; 95% CI, 29.1-387.1; P < .001) and class U1a (OR 35.7; 95% CI, 11.6-109.9; P < .001). The postoperative reproductive performances of both anomalies were similar. Both types of anomalies seem to have similar severity and prognosis. Patients with both types of anomalies have excellent reproductive outcome after hysteroscopic correction.

Brachytherapy for cervical cancer in septate uterus: Dose-volume differences with tandem implant placement in right vs. left uterine canal: A case report.

Brachytherapy is a standard treatment modality for locally advanced cervical cancer. In patients with uterine anomalies, the radiation dose to the target volume and the organs at risk can vary depending on the positioning of the brachytherapy tandem implant. However, there have been few reports concerning the use of brachytherapy in patients with uterine anomalies. The present study reports the case of a 55-year-old woman with locally advanced squamous cell carcinoma of the cervix and complete septate uterus. The patient was treated with external-beam radiation therapy, cisplatin chemotherapy, and brachytherapy. Computed tomography-based planning was performed for image-guided brachytherapy with the tandem implant alternately in the right and left uterine canals and using the right and left point A. A comparison of the resulting dose-volume histograms revealed wide variations in the projected dose to the clinical target volume and organs at risk. Tandem implant positioning for brachytherapy was chosen to optimize the dose-volume distribution. At the point of writing, the patient has not experienced local recurrence.

New Ambulatory Hysteroscopic Septoplasty using Ballooning in a Woman with Complete Septate Uterus: A Case Report.

ABSTRACTA 40-year-old G1 P0 L0 A1 woman was referred to our clinic with 6-year history of infertility. Before visiting the clinic, she had 3 cycles of In-Vitro Fertilization (IVF) procedures (2 cycles of Controlled Ovarian Stimulation-IVF and 1 cycle of frozen-thawed Embryo Transfer (ET)) at other clinic. She had medical history of abortion at early gestation following FET (frozen-thawed-ET). The patient had complete type of septate uterus, double cervix and longitudinal vaginal septum. Vaginal septotomy was done first and 1 month later, hysteroscopic septoplasty was followed using ballooning filled with dye. After septoplasty, we inserted ballooning and left for several days to compress septal endometrium on the septectomy area. All procedures were done in the ambulatory operating room without laparoscopy or admission. 3 months later, she had in vitro fertilization-embryo transfer (IVF-ET) and FET procedures in our clinic. She had successful pregnancy and now is at 22 weeks of gestation. New ambulatory septoplasty using dye-filled ballooning is easy, safe and minimally invasive surgery for treatment of complete septate uterus.

Laparoscopic surgery for diagnosis and treatment of complete septate uterus with vaginal septum containing endometrial tumor

Laparoscopic surgery for diagnosis and treatment of complete septate uterus with vaginal septum containing endometrial tumor

Small-Diameter Hysteroscopic Metroplasty for a Septate Uterus after Open-Assisted Laparoscopic Radical Trachelectomy

Study ObjectiveTo describe a 2-step fertility preservation technique for early-stage cervical cancer of a patient with a complete septate uterus. DesignA step-by-step demonstration and explanation of the technique in a surgical video (Canadian Task Force classification III). SettingCenter for cancer, a tertiary referral center. Institutional Review Board approval was not required for this kind of procedure. PatientA 37-year-old woman. The patient provided informed consent to use images and videos of the procedure. InterventionsOpen-assisted laparoscopic radical trachelectomy (LRT) after metroplasty. Measurements and Main ResultsA 37-year-old woman presented with early-stage cervical cancer and a complete septate uterus. She desired fertility preservation. After careful counseling and in accordance with her wishes for fertility-sparing surgery, open-assisted LRT after metroplasty were scheduled. First, LRT was successfully completed, and a cervical cerclage using permanent Ethibond sutures (Ethicon, Inc, Somerville, NJ) was doubly inserted around the level of the internal os with a Hegar size 8 dilator to maintain patency. At 6 months after this procedure, magnetic resonance imaging (MRI) revealed no sign of recurrence. Then, metroplasty without dilatation of the cervical os was performed using a small-diameter (5.2-mm) resectoscope system (Karl Storz GmbH & Co. KG, Tuttlingen, Germany), scissor forceps, bipolar electrode, and normal saline. A hysteroscope was inserted without gripping the neocervix, and the septum was then resected with scissor forceps. The septum was cut from the cervical to the fundal side. Finally, an intrauterine device was placed in the uterine cavity to prevent adhesion in the uterine cavity. Three months later MRI confirmed normal development of the whole endometrium. No intraoperative or postoperative complications occurred. ConclusionsThis 2-step fertility preservation technique with a small-diameter hysteroscopy presents an effective alternative to the traditional resectoscope technique. Further analyses with long-term follow-up are warranted to evaluate this surgical method.

EP27.01: Complete septate uterus with double cervix and communication between both cavities: a case report of an uncommon anomaly

EP27.01: Complete septate uterus with double cervix and communication between both cavities: a case report of an uncommon anomaly

双頸を伴った完全中隔子宮に対し子宮鏡下子宮中隔切除を行ったのち妊娠成立し、生児を得た1例

双頸を伴った完全中隔子宮に対し子宮鏡下子宮中隔切除を行ったのち妊娠成立し、生児を得た1例

Long-Term Reproductive Outcomes After Hysteroscopic Metroplasty Technique Using Miniaturized Instruments in Partial and Complete Septate Uterus

Long-Term Reproductive Outcomes After Hysteroscopic Metroplasty Technique Using Miniaturized Instruments in Partial and Complete Septate Uterus

Suture Technique for Lysis of Lower Uterine Segment Synechiae After Complete Septoplasty

The complete septate uterus is a congenital malformation resulting from incomplete resorption of the paramesonephric ducts during embryogenesis. It is associated with infertility, recurrent pregnancy loss and obstetrical complications. Hysteroscopic resection of the septum results in improved fertility outcomes. The purpose of this video is to illustrate our surgical technique for advanced hysteroscopic resection of intrauterine septum using a continuous flow operative hysteroscope with a 5 French operating channel and to demonstrate a low cost, energy free, suture technique for lysis of lower uterine segment synechiae after complete septoplasty.

Hysteroscopy in Uterine Anomalies: A Boon!

ABSTRACT Introduction The incidence of congenital uterine malformations is as high as 3 to 4% with septate uterus being one of the most common forms of congenital malformation. Structurally anomalous uterus has been recognized as a cause of infertility, and obstetric complications. Of all known uterine anomalies, septate uterus is the most common and is associated with poorest reproductive outcome, with fetal survival rates between 6 to 28%. Also, it carries high rate of spontaneous miscarriage exceeding &gt; 60% but, on the bright side, it is one of the uterine anomaly that is most amenable via simple hysteroscopic management. Aims and objectives To describe a case series (comprising two cases) septate uterus managed successfully using hysteroscopy. Background Septate uterus results from incomplete resorption of paramesonephric mullerian ducts during the first trimester of pregnancy. Depending on the size of septum, it can be incomplete septum or complete septum dividing the uterine cavity into two separate components including two cervix and vaginal septum. Congenital malformations may be associated with recurrent pregnancy loss, preterm labor, abnormal fetal presentation, intrauterine growth restriction (IUGR) and infertility. Hysteroscopy is considered the gold standard for the assessment and treatment of intrauterine anomalies. Cases Authors report two cases of septate uterus managed hysteroscopically. • A case of complete septate uterus and another case of complete septate uterus with two cervices, managed hysteroscopically both subjects conceived successfully after treatment. Conclusion Operative hysteroscopy is an effective and safe minimally invasive technique to manage complete uterine septum, associated with quicker recovery. Additionally, there is no scar formation which promotes improved reproductive outcome. It has enabled more liberalized approach to treatment, i.e. now being extended to include patients with recurrent pregnancy loss and premature labor. Also, this intervention can be used successfully in patients diagnosed with infertility secondary to uterine septations, especially if in vitro fertilization (IVF) is being contemplated. How to cite this article Pathak C, Manchanda R, Yadav G. Hysteroscopy in Uterine Anomalies: A Boon! J South Asian Feder Obst Gynae 2016;8(1):74-76.

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.