Dr. Pulcinella Ruggero

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Operative hysteroscopy

Utero-septum Hysteroscopic Metroplasty

Uterine septum is the most common uterine malformation and consists of the presence of a fibrous septum, most often with a mixed muscle-fibrous structure, that partially or completely divides the uterine cavity into two parts. May be associated with other malformations of the female genital apparatus (vaginal septum, double cervix, cervical septum) or other systems (urinary malformations, skeletal malformations endometriosis )

The septum is formed during the development of the embryo and is therefore a congenital malformation:

  • the septum uterus is present in 13% of miscarriages
  • has a 46 % risk of causing miscarriages up to the 5th month, preterm deliveries and placental abruption due to reduced gestational capacity

It is associated with dysmenorrhoea, dyspareunia, pelvic pain, infertility. Untreated it can lead to:

  • miscarriage
  • g.e.u. (extrauterine pregnancy)
  • placental abruption
  • breech or transverse presentation
  • p.r.o.m. (premature rupture of membranes) 
  • i.u.g.r. (fetal growth retardation)
  • premature and/or dystocic birth
  • caesarean section
  • post-partum haemorrhage and placental retention
  • m.e.f. (endouterine fetal death)

Mechanism of Action

  • fibrous or mixed septum structure
  • impaired development of the endometrium lining it
  • abnormal vascularisation

Diagnosis

  1. hysteroscopy: only shows the 2 uterine haemicavae, the thickness and length of the septum, if any, but does not say whether it is a septum or a bicornuate uterus and does not display the fundus
  2. eco3d: high diagnostic capacity. It allows the morphological study of the uterine fundus
  3. diagnostic laparoscopy + hysteroscopic metroplastywould allow a definite differential diagnosis between septum and bicornuate uterus and direct visualisation of the uterine fundus. Laparoscopy can be avoided if the 3D ultrasound is performed by highly experienced sonographers

Operational Technique:

  • It is performed strictly during the first 10 days of the menstrual cycle
  • In partial septa, micro-perforates can be used and in some cases it can be performed on an outpatient basis
  • In other cases, general anaesthesia and the use of miniresectors, which are easier to work with in confined spaces such as a septum, are indispensable.
  • The percentage of live and full-term births increases from 30% to over 80%
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