Septal Resection
Uterine septum is said if there is a division in the cavity of the uterus.
It is the most common type of Mullerian anomaly, and occurs in 3%-7% of the general population.Septum can be complete or incomplete.
Septum is associated with the poor reproductive outcomes and is associated with recurrent pregnancy loss, preterm labor, malpresentation and intra uterine growth restriction. It is also seen in patients with unexplained infertility.
The endometrium on the septum is thought to be different from the surrounding endometrium in the uterine cavity and is believed to be the cause for failed implantation. But presence of septum does not mean that there will be always be a problem. But women with recurrent pregnancy losses do benefit with septal resection.
Diagnosis
Uterine septum is suspected in women with recurrent pregnancy loss or in women who fail to conceive. Imaging modalities that are used in the diagnosis of a uterine septum are hystero-salpingogram (HSG), ultrasound (2D and 3D), and MRI. However direct confirmation at hysteroscopy remains gold standard.
Treatment
Septal resection improves reproductive and obstetric outcomes in women with earlier pregnancy failures. With advancement in hysteroscopy technology, septoplasty is a simple day care procedure today with minimal morbidity. The procedure has proven to be safe and effective for women with a history of recurrent miscarriage and other poor reproductive outcomes. In the hands of experienced gynaecologic surgeons, this procedure has low rates of intra-operative complications and postoperative sequelae. Some of the potential intra-operative complications can be bleeding, distention media overload, and perforation. Intra uterine adhesions can be delayed complications of hysteroscopic septoplasty. However these complications are less than 1%.
Hysteroscopy surgery involves incising the uterine septum and this is done with either microscissors or electrosurgery. The use of microscissors, an energy-free technique, is more beneficial as it prevents intrauterine adhesions due to less thermal damage to the surrounding endometrium.Concomitant laparoscopy can be done to help differentiate septate uterus from bicornuate uterus. Laparoscopy can provide a guide to the extent of septal resection and can diagnose perforation of the uterus. Coexisting pelvic pathology like endometriosis, adhesion or altered tubo-ovarian anatomy also can be diagnosed and treated by laparoscopy.