Uterine septum (separated uterus) and its effect on pregnancy
The uterine septum, or what is known as the separate uterus or the reserved uterus, is a congenital malformation in the uterus in which a woman is born, represented by the presence of a wall of fibrous tissue in the middle of the uterus, extending vertically from the top to the bottom of the uterus, and separating the uterus into two cavities.
Many women do not realize that they suffer from this condition even during pregnancy and childbirth, and it may pass normally unless it has an effect on the pregnancy .
A woman with a separated uterus has a normal-shaped uterus with a wall of tissue separating the uterus into two cavities.
A separated uterus does not need to be treated unless there is frequent pregnancy loss. In other cases, surgical removal of the septum is the most appropriate option to improve the chances of pregnancy and its continuation.
Does uterine septum prevent pregnancy or cause miscarriage ?
In general, the presence of a septum or a separated uterus does not reduce a woman's ability to conceive. The possibility of pregnancy is possible, but it greatly increases the chances of miscarriage and repeated miscarriage .
The incidence of miscarriage among pregnant women is generally estimated between 10-25%, while the rate rises to 25% and may reach 40%, as indicated by some studies among women who suffer from a separated uterus.
The reason for this is due to the nature of the uterine septum; It is a wall made of fibrous tissue that is not provided with blood vessels, so the process of implantation of the fertilized egg in the wall loses its opportunity to grow due to the lack of blood supplies necessary for the nutrition and growth of the fetus.
Mostly a miscarriage occurs in the second trimester of pregnancy, and this is a sign associated with the presence of the uterine septum in most of the times, as the vast majority of miscarriages occur in the first trimester, that is, during the first trimester of pregnancy.
Also, pregnant women who suffer from uterine septum in the event that they continue to have a pregnancy and do not abort, face many risks:
Premature birth.
The need for a cesarean delivery
The position of the breech fetus, with the fetus’s head up and its backside down
Does the presence of the uterine septum affect sexual intercourse ?
No. The uterine septum does not affect in any way the process of sexual intercourse or sexual pleasure.
Is the separated uterus different from the two-horned uterus?
Yeah. The bicornuate uterus is a form of deformation of the uterus, in this case the uterus takes the shape of a heart, while this deformity is not considered in any way normal, but it does not usually increase the risk of miscarriage except in rare cases.
On the other hand, the separated uterus contains a separating wall in the uterine cavity, but the outward appearance of the uterus is normal, while the bicornuate uterus appears in the shape of a heart and has an upper end that is completely separate internally and externally.
Does the uterine septum appear in the ultrasound?
A separate uterus is often discovered after the woman has had repeated miscarriages, and then we do some examinations and images, including ultrasound (ultrasound) or magnetic resonance imaging (MRI), and the final diagnosis may require x-rays of the uterus and fallopian tubes or a hysteroscopy. With the aim of the correct diagnosis of the condition and the ability to distinguish it from a two-horned uterus
How can the uterine septum be treated? Does the uterine septum return after it is removed?
Surgery is the only way to treat a separated uterus and remove the uterine septum. This is done through a minimally invasive procedure known as laparoscopic metroplasty, as the hysteroscopy allows access to the inside of the uterus and the removal of the fibrous wall without the need to make an external incision in the abdomen.
During a laparoscopic hysterectomy, the doctor passes other instruments with the scope through the cervix to cut and remove the uterine septum.
Laparoscopic hysteroplasty is one of the minimally invasive surgical procedures that takes place in the outpatient clinic. It usually takes about an hour, and the woman is then able to return home on the day of the procedure.
After septal removal surgery:
Removing the uterine septum helps improve the chances of a successful pregnancy for women who suffer from recurrent miscarriage, as studies indicate that between 50-80% of women who have suffered repeated pregnancy loss are able to continue a healthy pregnancy in the future after this procedure.
What we should say is that this surgery remains an option that has tangible results in improving the chances of a healthy pregnancy and its continuation, but if you suffer from a separate uterus and do not wish or think about a future pregnancy, then the separated uterus does not constitute or increase your risk of cancer on its own.
Dr. Qassem Shehab , consultant of advanced laparoscopic surgery, gynecology and obstetrics. Subspecialty specialization in the treatment of urinary incontinence and gynecological edema
Abdali Hospital , Boulevard, 24th floor
Oman Jourdan
For reservations and inquiries
References:
How a Septate Uterus Increases Miscarriage Risk, Retrieved on: 7/11/2020, from: https://www.verywellfamily.com/how-septate-uterus-affects-miscarriage-pregnancy-loss-risk-2371692
Septate Uterus, Retrieved on: 7/11/2020, from: https://www.healthline.com/health/septate-uterus
Septate Uterus, Retrieved on: 7/11/2020, from: https://www.childrenshospital.org/conditions-and-treatments/conditions/s/septate-uterus
UTERINE SEPTUM, Retrieved on: 7/11/2020, from: https://www.tlcfertility.com/uterineseptum