18 November 2019

A septate uterus: what is it, how is it detected and how does it affect pregnancy?

A septate uterus: what is it, how is it detected and how does it affect pregnancy?

What is a septate uterus?

Unless you have a medical background, you may struggle for a definition. You may assume that it has something to do with infection because the word is similar to sepsis or septic, but this is not the case. The word comes from septum, which is simply a tissue dividing two chambers, such as those found in the heart or the middle of the nose. A septate uterus is therefore a uterus which is divided into two by a septum.

This is a congenital malformation of the uterus which is believed to be the most common of uterine abnormalities, and one which affects one in a hundred women. Indeed, it is so frequent that some authorities consider it a variant of normality. Although the condition is not in itself damaging or dangerous, it can have an impact on pregnancy and is known to increase the risk of miscarriage. Diagnosis often does not take place until after a miscarriage, but once detected, treatment is relatively straightforward.

What causes a septate uterus?

A septate uterus is a congenital condition. This means that it occurred during the development of the female foetus in the womb before birth, although it is not clearly understood why it happens. In the female foetus, the uterus starts out as two tubes that eventually fuse together to form one chamber in the body’s mid-line. The extent of the septum varies between individuals in a wide range from a minimum to practically complete, creating a complete separation between the two cavities. This is known as a double uterus.

There is some comfort in the fact that a congenital condition is only rarely due to genetic factors. In most cases, if you did find that you had a septate uterus, you would only have your own condition to deal with and would not have the additional worry of passing it on to future generations of daughters. You would also have no need to be concerned about the condition at all if you did not want to have children since in itself it poses no health threat or increased risk of cancer or any other disease. It is only a problem for women who do wish to have children.

How does a septate uterus affect pregnancy?

A septate uterus has no effect on a woman’s ability to conceive, but it does increase the likelihood of a miscarriage and could well be a factor in cases of recurrent miscarriage. This is frequently due to the fact that the septum itself has a poor blood supply. So, if an embryo were to implant on the septum, it would be unable to develop in the normal way since the source of sustenance is cut off.

There are no hard and fast statistics on the extent of the risk because it is not always possible to pinpoint the cause of a miscarriage and having a septate uterus does not always, or inevitably, lead to miscarriage. However, it is estimated that the likelihood of miscarriage with this condition is between 25% and 47%, compared with an overall miscarriage rate of 10% to 25% in the general population. A miscarriage caused by this condition usually occurs during the first trimester because of problems resulting from the embryo implanting on the septum. Miscarriage can also occur during the second trimester when the problem is lack of space for foetal development due to the reduced capacity of the uterine cavity. Further risks are that even for women who do not miscarry, this condition makes a premature or pre-term birth more likely. In addition, there is frequently a need for delivery by caesarean section because the lack of space caused by the septum means that the baby is unable to get into the correct position for birth.

How is a septate uterus detected and treated?

A septate uterus could be detected as a result of a routine ultrasound or MRI scan but this is not always the case. A more reliable test is a hysteroscopy in which the interior of the uterus is visually examined with the help of an illuminated medical instrument. Alternatively, a hysterosalpingogram, in which liquid is inserted through the cervix into the uterus and fallopian tubes, is the most reliable diagnostic method. The liquid contains a dye which shows up on an x-ray, allowing the examiner to see the shape of the organs on a screen.

Removal of the septum can be achieved with a relatively straightforward surgical process, depending on the size of the septum. The uterus is enlarged with a fluid and then a small surgical instrument is inserted through the vagina in order to trim away the septum. After removal, when the uterus has healed, it provides the normal environment in which a foetus can implant and develop. In order for the healing to take place before pregnancy, doctors usually advise a period of two or three menstrual cycles before trying to get pregnant.

How can a fertility clinic consultation help?

Anyone who has experienced the shock and grief of a miscarriage is bound to want to know why, and whether a future occurrence could be prevented. When you make an appointment for an initial consultation at one of our IVI clinics, the consultant will of course ask about your medical history. They will also run a number of diagnostic tests, which for a woman would include a hysterosalpingogram. This would show whether or not there is any uterine abnormality.

You can find out more about what to expect from your first visit to IVI, and gen up on the whole range of tests and treatments available. Or just go ahead and contact us at IVI and we will get right back to you.

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