A uterine septum is one of the abnormalities that occur in the uterus. The uterus is the female reproductive organ that extends from both sides towards the fallopian tubes. The uterine septum is the condition of this organ being divided or narrowed in the middle by a curtain or membrane that descends from top to bottom. These developmental defects of unknown cause are called fusion errors. It is a condition that should be given importance because it can cause miscarriage and premature birth in pregnant women. The uterine septum, which many women know little about, is often discovered incidentally during a pelvic exam. Let’s examine in detail the uterine septum, which is important because it narrows the inner volume of the uterus.
Uterine Septum
A uterine septum is a problem that occurs as a result of uterine deformation that occurs in the embryological period. In the formation of a healthy uterus, the cervix and the uterus begin to form two separate canals, known as Müller’s canal, and then these two canals merge in the middle. In a healthy development, the cervix and uterus should thin and disappear over time, resulting in a single cervix and uterus. However, in the formation of curtains in the uterus, this union and fusion do not occur completely.
The septum, a fibrous, muscular structure that can be thin or thick, divides the uterus in half. It significantly increases the risk of septal miscarriage in the uterus, which has no proven effect on pregnancy formation and may even cause recurrent miscarriages. Compared to normal pregnancies, the probability of miscarriage increases almost twice in pregnant women who have a problem in the uterus.
Uterine Septum Symptoms
The uterine septum alone does not cause any complaints. It does not prevent menstruation when entering the adolescence period. Girls with a septum in the womb enter puberty at the expected time and begin to menstruate. The uterine septum does not cause problems such as menstrual irregularity, painful menstruation, or unusual bleeding. For this reason, it is possible to detect the presence of a uterine septum that does not show any symptoms only by ultrasonography during the doctor’s examination. The reason for applying to the doctor may be painful menstruation, routine check-ups, or recurrent miscarriages. Detection of the uterine septum is important in order to prevent loss in pregnancy, and for the health of both mother and baby, expectant mothers who have a septum in the uterus should become pregnant under the supervision of a specialist doctor.
Uterine Septum and Pregnancy
The uterine septum alone does not prevent pregnancy. The fact that this anomaly is detected for the first time in many women during post-pregnancy examinations can be considered proof of this. There is no obstacle for a woman who has previously had uterine septum treatment to becoming pregnant. It would be appropriate for people who are planning a pregnancy to be sure that there is no such situation as an examination in order not to encounter undesirable results during pregnancy.
How the Uterine Septum Affects Pregnancy
- The uterine septum does not prevent pregnancy in women, but it raises the risk of miscarriage from 10–20% to 20–25% in normal pregnancies. The septum may make it difficult for the embryo to attach and cause miscarriage. In addition, recurrent miscarriages are encountered in the presence of an intrauterine septum.
- The uterus, which is divided into two due to the uterine septum, may not be able to meet the needs of the baby and may cause premature birth with the increase in the baby’s weight.
- In some cases, the uterine septum may prevent vaginal delivery in pregnant women and necessitate a cesarean section.
- Due to the different structure of the uterus, the baby may be in different positions, which increases the risk of lateral or breech presentation.
- Other risks associated with the uterine septum condition include postpartum hemorrhage and the loss of a baby in the womb.
Uterine Septum Treatment
Since the uterine septum is a structural disorder, it cannot be treated with medication or medical methods. With the procedure called hysteroscopy, the purpose of which is to cut the membranous wall that divides the uterus, the treatment of the uterine septum is very easy and gives fast results. After this surgery, in which the septum is located and cut from the camera extending into the uterus, the possibility of miscarriage due to the septum is eliminated and vaginal delivery becomes possible. Although uterine septum surgery can be performed by laparotomy and cutting the lower part of the uterus, hysteroscopy is the most preferred and most comfortable method due to the the necessity of cesarean delivery in pregnancy after these surgeries.
Uterine Septum Surgery
Metroplasty is the name given to the treatment of the uterine septum. The uterine cavity is entered through the cervix with an illuminated camera called a hysteroscope, and the curtain that divides the uterine cavity is cut with the cutting devices at the end. Although the cutting process can be done using scissors, electrical energy, or a laser, the most accepted method is cutting the septum with electrical energy. Uterine septum surgery performed with the hysteroscopic method takes an average of 20 minutes. The patient is discharged on the same day, and complications are extremely rare. Perforation of the uterus during cervical dilation or cutting is almost uncommon in experienced surgeons. For hysteroscopy, which can be performed under examination conditions by applying general or local anesthesia, operating room conditions may be needed in the case of large polyps or fibroids in the uterus.
Uterine Septum Surgery Prices
Hysteroscopy, i.e., uterine septum surgery, is performed in the uterine region in accordance with the size and nature of the condition diagnosed. Although basically the same techniques are used, the price determined for this surgery, where the conditions provided are important, may vary depending on the hospital where the procedure will be performed, the physician who will perform the procedure, or the size of the septum. The patient who wants to get price information for uterine septum surgery should contact his doctor for his own situation.
Things to Consider After Uterine Septum Surgery
One week after the end of menstruation, hysteroscopy should be performed within one week after the end of the last menstruation since the image of the uterus is in the most suitable state for hysteroscopy. Things to consider after uterine septum surgery can be listed as follows:
- Considering that the uterus has undergone a process and needs recovery, it is necessary to wait for the period to be determined by the doctor for pregnancy after the surgery.
- Vaginal spotting is normal for a few days after uterine septum surgery, but if there is heavy vaginal bleeding, a doctor should be consulted.
- Patients who have undergone this surgery can take a bath after the operation, return to their normal diet, and return to work the next day.
- Pain similar to menstrual pain may be felt for 1-2 days. In this case, there is no harm in taking painkillers.
- The hormonal treatment process can begin if the surgeon performing the surgery is required.
- Sexual intercourse is prohibited for a period of time following uterine septum surgery, but patients can resume their normal lives after the recovery period.
Adhesion After Uterine Septum Surgery
All surgical operations cause tissue trauma, and the healing process of the trauma begins. The healing process, which starts 3-5 days after the operation, is completed in 3-4 weeks. Adhesion, on the other hand, is the disruption of the normal physiological healing process. Adhesion may occur as a result of infection, cutting, mechanical or thermal damage, radiation, desiccation, abrasion, or foreign body reaction. In the event of adhesion development in the patient, a clot-dissolving treatment is applied.
A probe is applied to the uterine canal in order to avoid adhesion problems after uterine septum surgery. The catheter, which is inflated with 10-15 cc of serum, is left in the uterine canal for 10-14 days. Antibiotics are given to the patient to prevent infection, and when the time is up, the probe is removed under ultrasound guidance.
Adhesions in the uterus, the frequency of which is not known exactly, may lead to decreased menstruation, missed menstruation, infertility, miscarriage, and chemical pregnancies in some patients.
Menstrual Cycle After Uterine Septum Surgery
Since uterine septum surgery (hysteroscopy) usually does not cause any complications, patients continue their normal monthly period after menstruation. However, some patients menstruate 10-15 days after the expected period after hysteroscopy. This delay usually resolves after the first menstruation. Menstrual irregularities such as delayed menstruation or early menstruation may be seen for 6 months after hysteroscopy. However, if the problems experienced do not improve, if menstruation lasts longer than normal and excessive bleeding is observed, or if the menstrual delay still continues, a doctor should be consulted and the necessary treatment should be applied if the doctor deems it appropriate.
Pregnancy After Uterine Septum Surgery
In the uterine septum (hysteroscopy), anomalies that prevent the attachment of the embryo or cause miscarriage are eliminated, and situations that prevent pregnancy are also. Physicians usually recommend abstinence for one week after hysteroscopy. During this time, the traumatized tissues heal. Patients can become pregnant within 30 days following hysteroscopy.
In some patients, thanks to the uterine septum surgery, the factors that prevent pregnancy and the attachment of the embryo have disappeared, so pregnancy occurs after the operation and continues in its normal course. In vitro fertilization treatment can be applied to patients who have a different condition that prevents the formation of a pregnancy naturally.
Sexual Intercourse After Uterine Septum Surgery
After uterine septum surgery (hysteroscopy), it is necessary to wait a while before having sexual intercourse. While it is sufficient to wait 1-2 days for diagnostic hysteroscopy, it is useful to wait for 7-10 days for operative hysteroscopy as the risk of bleeding and infection is higher. Considering the patient’s condition, the physician may sometimes extend this waiting period until the next menstrual period. Immediately after the recovery period, patients can resume their active sexual lives.
Frequently Asked Questions
You can find answers to many questions, such as whether the uterine septum is visible on ultrasound, whether it causes miscarriage, whether it is congenital, whether it causes menstrual irregularity, and whether it causes painful intercourse.
Is the uterine septum visible on ultrasound?
The septum and even its severity can be clearly understood during ultrasonography. The diagnosis can be made with a careful vaginal ultrasound and no uterine tube film or MRI is required to confirm the diagnosis. While ultrasound can be used to detect the septum, hysterosalpingography, which is a technique for imaging the uterus and canals with X-rays, can also be used.
Does the uterine septum cause miscarriage?
Pregnancy results in miscarriage because the uterine septum prevents the baby from getting enough nutrition. Due to the septum, the intrauterine cavity, which is necessary for the development of the baby, is narrowed in the uterus. This causes early and late miscarriages. Untreated uterine septum causes the patient to experience recurrent miscarriages. Since many patients do not show any other symptoms that they have a uterine septum, it is detected by ultrasonography when they apply to the doctor after abortion.
Is the uterine septum congenital?
Although deformities may occur later, deformities are usually congenital. Like many other deformities, the uterine septum is a congenital genetic abnormality. It is not known what causes the anomaly that occurs in the womb during embryo development. The uterus, which starts to develop as a double horn in the mother’s womb, does not fully dissolve during the fusion of the two uterine horns, so a partial residual tissue remains and a septum is formed.
Does the uterine septum cause menstrual irregularity?
The uterine septum does not cause menstrual irregularity. It is possible to say that the intrauterine veil does not show any symptoms, as it does not cause other gynecological complaints such as menstrual irregularity, abortion, heavy menstruation, and painful menstruation. Therefore, patients do not realize that they have a uterine septum unless they consult a doctor due to another accompanying problem. Detection of the uterine septum usually happens after an abortion due to the septum.
Does the uterine septum cause pain during intercourse?
The uterine septum does not cause pain during intercourse. The uterine septum, which does not cause problems such as post-coital bleeding and painful sexual intercourse, can only be detected by ultrasonography since it does not show any symptoms. After uterine septum surgery, after abstaining from sexual intercourse for the period recommended by the doctor, and returning to an active sexual life, no pain is felt during intercourse.
Reference and citation:
- UNDERSTANDING UTERINE ANOMALIES
https://healthcare.utah.edu/the-scope/shows.php - Resection of uterine septum using gynaecoradiological
http://citeseerx.ist.psu.edu/viewdoc/download?doi=10.1.1.546.6905&rep=rep1&type=pdf - Septate Uterus
https://www.webmd.com/baby/septate-uterus