Uterus septate

Two uterine cavities with normal zonal anatomy can be depicted. The leading imaging feature is a fundal cleft greater than 1 cm of the external uterine contour that helps to distinguish bicornuate uterus from septate uterus. 

Definition Septate uterus is a result of partial or complete non-regression of the midline uterovaginal... 

Septate uterus is the most common Mullerian duct anomaly and is unfortunately associated with the poorest reproductive outcome. Because of different treatment options, septate uterus must be differenti-... 

Differentiation from bicornuate uterus is based on the complete fundal unification however, a broad-based septate uterus is difficult to distinguish from an arcuate uterus. There is much controversy as to whether an arcuate uterus should be considered a real anomaly or an anatomic variant. Fact is that MRI may detect this abnormality but, typically, it is not clinically significant because arcuate uterus has no significant negative effects on pregnancy outcome. 

Homer HA, Li TC, Cooke ID (2000) The septate uterus a review of management and reproductive outcome. Fertil Steril 73 1-14... 

Fedele L, Bianchi S (1995) Hysteroscopic metroplasty for septate uterus. Obstet Gynecol Clin North Am 22 473-489... 

Fedele L Bianchi S,Marchini M, Franchi D,Tozzi L, Dorta M (1996) Ultrastructural aspects of endometrium in infertile women with septate uterus. Fertil Steril 65 750-752... 

A longitudinal vaginal septum (Fig. 12.9) occurs as a consequence of incomplete fusion of the miille-rian ducts or resorption failure of the vaginal septum. This anomaly is also typically associated with other malformations of the mullerian ducts [septate uterus, bicornuate uterus, uterus didelphys (Fig. 12.9), cervical duplication] [2j. 

HSG of a bicornuate uterus will demonstrate separate uterine cavities with an intercornual angle that usually exceeds 105X With this imaging modality, however, the outer uterine contour cannot be evaluated, and overlap with the appearance of a septate uterus can occur. 

Sonographic diagnosis of a bicornuate uterus is made by analysis of both the outer fundal contour as well as visualization of a separate endometrial stripe in each horn. However, sonographic differentiation of a bicornuate uterus from a septate uterus may be difficult. 

Septate uterus results from failure of resorption of a septum after complete fusion of the mtillerian ducts. In the majority of cases the midline, septum is partial... 

Most patients evaluated for repeated abortions and found to have a uterine anomaly will have a septate uterus [27]. Avascular fibrous septa can be safely resected hysteroscopically, whereas vascularized myometrial tissue within the septum requires metroplasty as a surgical procedure for treatment of this anomaly and may enhance fetal survival, with one report indicating that 95% of patients became pregnant, 73% carried to term, and 77% delivered a liveborn baby [36]. 

HSG of a septate uterus demonstrates two narrowly diverging cavities, yielding a V-shape configuration with relatively straight medial borders. The angle formed by the medial borders of the two uterine hemi-cavities is usually greater than 75X Diagno-... 

Fig. 16.20a-c. Class V. Complete septate uterus. On HSG one cervical opening was missed only one uterine cavity was spilled with contrast media a unicornuate uterus was assumed (a). Sonography (b) and coronal T2 w MRI (c) clearly demonstrate the uterine cavity divided by a thick septmn extending to the level of the cervix. The angle formed by the medial borders of the two uterine hemi-cavities is greater than 75T... 

Sonography and MRI are each superior to HSG. The external uterine contour is normally convex, flat, or minimally indented by less than 1 cm [14], in contrast to that of a bicornuate uterus. Coronal MRI allows the characteristic fundal changes of a septate uterus to be identified. 

In addition to fundal contour, a second sonographic feature of a septate uterus is splitting of the endometrial echo by a hypoechoic band, most easily seen in the fundus. 

Formerly this MDA was classified as the mildest form of either a bicornuate or septate uterus. In 1988, the American Fertility Society issued a separate classification of arcuate uterus. Arcuate uterus should be considered a normal variant and it has no effect on fertility. 

Fig. 7.4a-f. Schematic presentation of classes 111, IV, and V. a Uterus didelphys (class 111) b-d bicornuate uterus (class IV) b complete, c partial, d arcuate e,f septate uterus (class V) e complete, f partial... 

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