Partial Septate Uterus Research Articles

Twin pregnancy in a partial septate uterus and the contribution of Magnetic Resonance Imaging (MRI). A case report

Introduction: Septate uterus is the most common (34%-48%) structural abnormality of all Müllerian duct defects. It results from incomplete resorption of the medial septum after the complete fusion of the müllerian ducts has occurred and is associated with infertility and obstetrical complications. Magnetic Resonance Imaging (MRI) is used for diagnosing müllerian malformations with a specificity of 96 to 100%.

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

No clinical relevance of the height of fundal indentation in subseptate or arcuate uterus: a prospective study

The American Fertility Society has classified the arcuate uterus as a minor malformation with a benign clinical behaviour. The aim of this prospective study was to verify whether there is any scientific basis for this differentiation. Patients with at least one early miscarriage and a subseptate or arcuate uterus were admitted for hysteroscopic metroplasty. Patients were allocated to a subseptate uterus group, with an indentation of 1.5cm or more, or an arcuate uterus group, with a smaller indentation. The miscarriage rates after metroplasty were similar between the two groups (14.0% in the subseptate uterus group versus 11.1% in the arcuate uterus group). Before metroplasty, the miscarriage rates were significantly higher in subseptate uterus group, as well as in the arcuate uterus group (both P<0.001). According to these results, there is no evidence to support that the arcuate uterus has a different effect on the reproductive outcome in comparison to the subseptate uterus, neither before nor after surgical correction of the anomaly. Since there is no scientific basis for a separate classification of the arcuate uterus, a review of the classifications of uterine congenital anomalies should be considered as necessary.Congenital uterine malformations have been classified by the American Fertility Society (AFS) since 1988. Although the AFS classification received wide acceptance and is still the most broadly used system, it is associated with various limitations in effective categorization of the anomalies. It is interesting that, until now, none of the other available options have been able to effectively replace the AFS system. Numerous papers indicate septate or subseptate (partial septate) uterus (AFS class V) is a possible cause of an unfavourable pregnancy outcome. Arcuate uterus (AFS class VI), a slight malformation similar to septate uterus, should differ from septate or subseptate uterus, because this ‘minor’ malformation should behave benignly with respect to the septate uterus. The aim of this study was to scientifically validate the difference between the arcuate and subseptate uterus in their effect on reproductive outcome through the results of a metroplasty in both groups of patients. A group of 96 patients, who underwent metroplasty after at least one early miscarriage, was divided into two groups according to the severity of the congenital uterine malformation. Our results indicate that there are no differences in pregnancy outcome after metroplasty either in patients with septate or arcuate utera. The poor pregnancy outcome in women with septate uterus seems not to be correlated to the dimension of the septum itself. There are no scientific bases for a separate classification of the arcuate uterus and it is proposed that a review of the classification of uterine congenital anomalies is necessary.

Effective Treatment for Recurrent Pregnancy Loss

Understanding the etiology of recurrent pregnancy loss (RPL) has been increasing in importance in reproductive medicine, especially in societies with low birth rates. Since the cause of human miscarriage is often complicated and multifactorial, effective treatment for the successful maintenance of pregnancy requires the comprehensive clinical management of recurrent wastages. Immunology for the maintenance of pregnancy is a very attractive field; however, the role of immunology during human gestation cannot be confirmed in couples with a history of recurrent pregnancy loss unless other clinical causes of miscarriage are especially ruled out.Balanced chromosomal rearrangements have been found at an increased frequency in couples with recurrent pregnancy loss compared with the general population. The major anomalies are Robertosonian or reciprocal translocations, while most minor variants include pericentric inversion of chromosome 9. Both major and minor anomalies result in a spontaneous abortion rate of approximately 80-90%. Though the incidences of these chromosomal abnormalities vary in reported studies, a survey indicated an incidence of 9.8% (3.9% in male partners and 5.9% in female partners) among 1,639 couples with a history of recurrent pregnancy loss.Congenital uterine anomaly resulting in a suboptimal uterine environment may influence ovum implantation and early fetal development and may be a candidate in the etiology of reproductive wastage.A review on the relation between congenital uterine anomalies and the spontaneous abortion rate concluded that a precise diagnosis of uterine cavity deformity, especially arcuate uterus, is a key issue for determining the clinical prognosis during human gestation. After establishing diagnostic criteria for uterine cavity anomaly, 278 congenital uterine anomalies were detected in a series of 2,061 hysterosalpingographies (13.5%) performed in women with a history of recurrent pregnancy loss. Among these abnormalities, the incidences of spontaneous abortion were equally high among patients with arcuate uterus and those with partial septate uterus. A few studies on abortion mechanism in patients with congenital uterine anomalies have been reported. Histological findings using CD34- positive staining indicate the lack of a blood capillary system in both the uterine septum and the fundus muscle layer. The results of metroplastic surgery on congenital uterine anomaly are also controversial. Based on our fundamental findings of the maldistribution of uterine capillaries, we performed ideal metroplastic surgery in 173 women and significantly reduced the spontaneous abortion rate from a pre-operative values of 93.2% to a post-operative value of 12.5%.Anti-cardiolipin antibody was first described by Huge et al. as a pathogenic auto-antibody capable of causing recurrent pregnancy loss. Since then several other candidates for zwitterionic antiphospholipid antibodies to anionic phospholipids that are capable of inducing miscarriage such as phosphatidylethanolamine (aPE) and phosphatidylserine (aPS). In a multicenter study on antiphospholipid antibodies conducted at 15 insitutes and hospitals between 2000 and 2002, significant levels of IgG and IgM for aPE were detected among women with a history of recurrent pregnancy loss. By establishing an enzyme-linked immunosorbent assay system, we determined that the IgG and IgM levels for aPE were significantly higher than those for other phospholipids antibodies during the first trimester recurrent spontaneous abortions. Coagulation factor XII, prekallikrein and the high molecular weight molecule kininogen have been reported as plasma contact proteins in the intrinsic pathway of the blood coagulation system. Deficiencies of these proteins are not associated with clinical obstetrical intrauterine bleeding, suggesting that these proteins possess anticoagulant and profibrinolytic activities.(View PDF for the rest of the abstract.)

Partial septate uterus and tubal implantation: a normal phenomenon in the Eidolon helvum

The aim of the study was to investigate the macro and micro-anatomical adaptations in the uterus and the type and nature of implantation found in Eidolon helvum. A total of thirty pregnant bats sampled from Obafemi Awolowo University Campus were used in this study. They were harvested and sacrificed by cervical dislocation after being carefully assessed and confirmed to be presumably healthy. Abdominopelvic incisions were made on the bats to expose and excise their uteri. The uteri were observed macroscopically while some were fixed in 10% formol saline and processed for routine Heamatoxylin and eosine (HE the lateral end of either of the uterine limbs was always enlarged or distended more than the other. As the dormant zygote began to develop in either of the uterine limbs, it grew lateromedially causing the particular limb to distend gradually towards the midline of the body. The uterine body did not participate in any way in carrying the developing fetus till term. Tubal implantationa pathologic condition in some mammals was also observed to be natural in E. helvum. Thus, the presence of partial septate uterus and tubal implantation being a normal phenomenon in the E. helvum shows its primitiveness as a mammal.

Resectoscope or Versapoint for hysteroscopic metroplasty

ObjectiveTo assess the feasibility, safety, and reproductive outcome of hysteroscopic metroplasty using the Versapoint device compared with the resectoscope using the Collins loop. MethodsSixty-three women diagnosed with partial septate uterus were included in the study. Forty-two women underwent hysteroscopic metroplasty using Versapoint and 21 women had the procedure using the resectoscope. Operating time, complications, pregnancy rate, and mode of delivery were recorded. Data were analyzed with the Mann–Whitney test. ResultsOperating time was 20.5 min for the resectoscope group and 15.4 min for the Versapoint group (P<0.05). Pregnancy rate, delivery rate, and spontaneous abortions were similar in both groups. ConclusionOperative hysteroscopy with Versapoint does not require cervical dilation, thus avoiding cervical incompetence, cervical lacerations, and uterine perforation. The Versapoint technique is a safe and effective alternative to the resectoscope. It could be used predominantly in nulligravida women, especially in those with cervical canal stenosis.

Pregnancy outcome after hysteroscopic treatment of partial septate uterus in 141 WOMEN suffering from infertility or recurrent abortion

International Journal of Gynecology & ObstetricsVolume 70, Issue S1 p. A116-A116 Medical and surgical complications 1 Pregnancy outcome after hysteroscopic treatment of partial septate uterus in 141 WOMEN suffering from infertility or recurrent abortion S. Venturoli, S. VenturoliSearch for more papers by this authorF.M. Colombo, F.M. ColomboSearch for more papers by this authorF. Vianello, F. VianelloSearch for more papers by this authorF. Govoni, F. GovoniSearch for more papers by this authorS. Rossi, S. RossiSearch for more papers by this authorG. Possati, G. PossatiSearch for more papers by this author S. Venturoli, S. VenturoliSearch for more papers by this authorF.M. Colombo, F.M. ColomboSearch for more papers by this authorF. Vianello, F. VianelloSearch for more papers by this authorF. Govoni, F. GovoniSearch for more papers by this authorS. Rossi, S. RossiSearch for more papers by this authorG. Possati, G. PossatiSearch for more papers by this author First published: 09 December 2003 https://doi.org/10.1016/S0020-7292(00)83374-3AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS12000Pages A116-A116 RelatedInformation

Detection of congenital müllerian duct anomalies using three-dimensional ultrasound.

The purpose of this study was to assess the value of 3-dimensional sonography in the diagnosis of congenital müllerian duct anomalies, which cause infertility, preterm labor, and first trimester abortion. A prospective study was undertaken in which 40 patients with histories of repeated spontaneous abortions or infertility were first examined using conventional 2-dimensional sonography or hysterosalpingography. Three-dimensional transvaginal sonography was then performed. Twenty-eight women had müllerian duct abnormalities, and 12 women had normal uterine anatomy. Müllerian duct defects detected in this study were unicornuate uterus (3), bicornuate uterus (3), complete or partial septate uterus (12), arcuate uterus (9), and didelphic uterus (1). The diagnosis of müllerian duct anomalies in these patients was confirmed by laparoscopic and/or hysteroscopic examinations. Three-dimensional sonography demonstrated all congenital uterine abnormalities with a sensitivity and specificity of 100%. Separate uterus and bicornuate uterus could be correctly diagnosed using 3-dimensional sonography in 11 (92%) of 12 cases and 3 (100%) of 3 cases, respectively. These 2 abnormalities were commonly confused with each other using hysterosalpingography and conventional sonography. Three-dimensional sonography with image reconstruction is less expensive and less invasive than hysterosalpingography for the assessment of uterine anatomy and diagnosis of müllerian duct abnormalities. The ability to visualize both the uterine cavity and the myometrium on a 3-dimensional scan facilitates the diagnosis of uterine anomalies and enables the differentiation of septate from bicornuate uteri for preoperative surgical planning.

Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment

To evaluate reproductive performance in women with a confirmed uterine anomaly treated by abdominal or hysteroscopic metroplasty, or by no surgical procedure. Retrospective study. A university hospital. Four hundred four women with uterine anomaly, of whom 247 had complete or partial septate uterus or partial bicornuate uterus. Hysteroscopic metroplasty was performed in 32 patients with septate or subseptate uterus. Twenty women underwent abdominal metroplasty (Jones or Tompkins procedure) and 140 had no operative treatment. Fetal survival improved from 13% to 91% after hysteroscopic metroplasty and from 3% to 86% after the abdominal procedure. A living child was born in 67% of 264 pregnancies in 116 women with septate uterus with no surgical treatment. When 19 patients with hysteroscopic metroplasty were matched by age, gravidity, and type of uterine anomaly with 19 women not subjected to metroplasty, the rates were 86% and 68%, respectively (p = 0.089). Hysteroscopic metroplasty has replaced abdominal metroplasty in the treatment of septate uterus. It improves the fetal survival rate in women with repeated miscarriage. It does not enhance pregnancy rates in infertile women with septate uterus, but as a minimally invasive uterine repair, it may be carried out before assisted reproduction. Pregnancy in the septate uterus can also progress without any surgical treatment. Metroplasty seems to prevent breech delivery and to decrease the cesarean section rate, which are potential benefits.

Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis

To evaluate reproductive prognosis after hysteroscopic metroplasty. The cumulative proportions of women who became pregnant and gave birth, subdivided according to previous obstetric history, were calculated by the product limit method and compared using the log rank test. Outpatient infertility clinic of Milan University. One hundred two consecutive patients with complete (n = 23) or partial septate uterus (n = 79) referred because of infertility or repeated abortion. Hysteroscopic metroplasty performed by microscissors (n = 80), argon laser (n = 10), or electroresectoscope (n = 12). Postoperative cumulative pregnancy and birth rates. At 36 months the cumulative pregnancy and birth rates were 89% and 75%, respectively, in the septate uterus group and 80% and 67% in the subseptate uterus group. Reproductive prognosis after hysteroscopic metroplasty was favorable and not influenced by the malformation subclass.

Can ultrasound be used to screen uterine malformations?

Eighty-nine patients were examined by ultrasound during the second phase of the menstrual cycle. The operators were not aware of the patients' history or results of previous ultrasonographic or radiologic investigations. The operators' aim was to diagnose uterine malformations graded as normal, suspected, or abnormal. Ultrasound identified 7 of 9 patients with a didelphic or complete septate uterus and 2 out of 3 with a bicornuate or partial septate uterus. Two other cases were suspected (one with a unicornuate, the other with a didelphic uterus). One false-positive case occurred, and 10 patients were not identified as having a malformed uterus (sensitivity, 42.9%; specificity, 97.8%). False-negatives involved mainly minor malformations.

Infertility and metroplasty.

Various techniques of metroplasty were performed in 32 cases of double uterus. In these patients the fetal survival rate before the operation was nil, whereas post-operatively it reached as high as 92.6%. Strassmann's operation was carried out in 16 cases, Jones & Jones's modified method in 12 cases and Tompkins's operation in 4 cases. The merits and demerits and the applicability of each technique and the various types of uterine malformation are discussed. It is concluded that a correct diagnosis of uterine malformation can only be established by a combination of precise HSG with direct macroscopical observation of uterine body. The Strassmann transverse incision is well suited for a bicornuate uterus, and Jones & Jones's wedge-shaped fundal resection for a partial septate uterus. The postoperative deformation in the fundus uteri is most frequently seen after the application of Strassmann's method, and is much less common with the modified method of Jones & Jones. Metroplasty can be applied in such cases of uterine malformation as when primary sterility is complained of but where any other cause for sterility is ruled out or is deemed to be corrected. Maximum care should be taken to prevent postoperative adhesion. Three months is considered to be a sufficient period for postoperative contraception. The mode of delivery depends on the individual case, though cesarean section is recommended.