Septate or partitioned uterus: complications in pregnancy

The septate or septate uterus is a genetic anomaly that in some cases can cause problems to carry a pregnancy to term or to have a natural birth.

Last update: 07 October, 2022

We speak of a septate or septate uterus when this organ is divided into two parts by a membrane that is given the name “septum”. This condition is present at birth and can only be corrected through surgery.

Congenital uterine anomalies are present in around 4% of women. This in particular represents between 30% and 90% of said irregularities. In this context, it can be said that it is a very common problem.

However, it is possible that its presence causes complications during pregnancy. Specific, there is a risk of miscarriage ranging from 25% to 47%. Of course, it also brings other complications. In the following space we detail them.

What is the septate or partitioned uterus?

The septate or septate uterus is a congenital malformation in which there is a membrane that runs through the entire organ, dividing it into two parts. That membrane—called the septum—runs from the top of the uterus and can reach as far as the cervix or even the vagina.

Under normal conditions, the uterus is a hollow organ in the shape of an inverted pear. If it is partitioned, it has not one, but two cavities. Many women may have this anomaly without knowing it.even after pregnancy and childbirth. It is usually only found when it causes problems, especially recurrent miscarriages.

The septate or partitioned uterus can be of three types:

  • partially septate. It occurs when the septum does not reach the cervix.
  • Complete septate uterus. If the septum reaches the cervix.
  • Septate uterus and vagina. Corresponds to cases in which the septum extends to the vagina.
The septate uterus is a congenital malformation that can lead to complications during pregnancy.

Symptoms

Most women with a septate or septate uterus have no symptoms. As noted above, most often this abnormality is only detected when a study is done to identify the cause of recurrent miscarriages.

It is very rare that it is diagnosed before puberty. In any case, it is possible that after this more painful menstruation than usual. However, it is very common to normalize said pain or attribute it to other causes.

It is also possible to experience pelvic pain, before or after menstruation. Also, using a tampon may not be enough to prevent menstrual blood from escaping.

These symptoms are usually mild and therefore often go unnoticed.

Causes

The septate or septate uterus is a genetic anomaly and science does not know the cause that produces it. Hypotheses suggest that it takes place during embryonic development. There are two ducts, called the Mullerian ducts, which normally unite to form the uterus.

Typically, the fallopian tubes form first, along with the uterus. After this process, a membrane, or septum, remains, which is reabsorbed by the body. If this does not happen, the tissue remains in the uterus and the two cavities form.



Effects of septate or septate uterus in pregnancy

The septate or septate uterus is not necessarily a problem. It does not always cause health complications and it does not always prevent pregnancy or childbirth under normal conditions. Even so, it constitutes a risk factor in some cases.

Although it does not affect sexual life or fertility, it is a fact that this type of uterus increases the risk of miscarriage, especially during the second trimester of pregnancy. It is also possible that it generates difficulties such as the following:

  • position of the fetus. When there is a septate uterus, the baby is more likely to be in a “breech” position at birth. It’s because you have less room to rotate with your head down.
  • Caesarean section. Due to improper positions of the fetus, there is an increased chance of having a cesarean delivery.
  • premature birth. There is a greater risk that delivery occurs before 37 weeks of gestation, with what this implies.
  • Low birth weight.
  • It has been found that women with a septate uterus are more likely to develop endometriosis.

Diagnosis

Because a septate uterus does not usually cause symptoms, it is very common for it to go undiagnosed. It is sometimes found on a routine exam, but in most cases it is only identified after several miscarriages.

Typically, the doctor will first do a pelvic exam. But unless it is a case of a septate uterus and vagina, that clinical examination does not allow to make a diagnosis. The best way to identify it is with imaging testslike the following:

  • Ultrasound.
  • Magnetic resonance imaging.
  • Hysteroscopy.

These tests allow the length and thickness of the septum to be determined. Other similar conditions should be ruled out during diagnosislike the bicornuate uterus, in which this organ does not have the traditional shape of an inverted pear, but rather a heart, but without any septum.

Treatment

This condition only requires treatment if it causes problems such as recurrent miscarriages or excessive pain. Many women with this anomaly have normal pregnancies and deliveries, either naturally or following a doctor’s orders.

The treatment for this malformation is surgery.. This is not recommended for adolescents, asymptomatic women, or for those women who do not want to have children. The usual procedure is called “hysteroscopic metroplasty” and involves removing the septum.

It is an outpatient surgery in which a device is inserted into the uterus—through the cervix—and the tissue is cut. It takes between 30 and 60 minutes. It is usually a safe procedure. However, it rarely generates risks such as the following:

  • Reaction to anesthesia.
  • Infection.
  • abnormal bleeding
  • Damage to the cervix.
  • Damage to the uterus.
Once the diagnosis of septate uterus is established, the doctor may suggest surgery to correct it.


Final recommendations

Most women who have surgery to correct a septate uterus go on to have a normal pregnancy. The success rate is estimated to be 53.5%. Postoperative complications are very rare.

If a pregnant woman has this condition, she must attend to all the professional recommendations of the case. It is necessary for her to contact the doctor if she experiences vaginal bleeding, pelvic cramps, contractions or rupture of the membranes.

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