Uterine Septum
Publication Date: September 1, 2016
Last Updated: March 14, 2022
Summary
Septate uterus configurations include partial septum, and complete septum in association with cervical septum or duplicated cervix. (, )
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There is no uniform definition of septate configurations. (, )
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Most women with a septate uterus have efficient reproductive function. (, )
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Arcuate uterus, although developmentally considered part of the spectrum of resorption failure, is considered a normal variant and should be differentiated from septate uterus for purposes of prognosis and surgical management. (, )
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There is fair evidence that 3-D ultrasound, sonohysterography, and MRI are good diagnostic tests for distinguishing a septate and bicornuate uterus when compared with laparoscopy/hysteroscopy. (, B)
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The data regarding reproductive implications of septate uteri and treatment effects are limited and comprised primarily of observational, principally descriptive studies without untreated control groups. (, )
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There is insufficient evidence to conclude that a uterine septum is associated with infertility. (, C)
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Several observational studies indicate that hysteroscopic septum incision is associated with improved clinical pregnancy rates in women with infertility. (, C)
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There is fair evidence that a uterine septum contributes to miscarriage and preterm birth. (, B)
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Some evidence suggests that a uterine septum may increase the risk of other adverse pregnancy outcomes such as malpresentation, intrauterine growth restriction, placental abruption, and perinatal mortality. (, B)
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Some limited studies indicate that hysteroscopic septum incision is associated with a reduction in subsequent miscarriage rates and improvement in live-birth rates in patients with a history of recurrent pregnancy loss. (, C)
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Some limited studies indicate that hysteroscopic septum incision is associated with an improvement in live-birth rate in women with infertility or prior pregnancy loss. (, C)
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There is insufficient evidence to conclude that obstetric outcomes are different when comparing the size as defined by length or width of uterine septa. (, C)
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Commonly used techniques to resect uterine septum include incision or removal of the septum utilizing cold scissors, unipolar or bipolar cautery, or laser. (, )
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Use of distending media for the uterus is dependent on the incision technique or energy source and includes CO2, saline, glycine, sorbitol, or mannitol. (, )
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There is insufficient evidence to recommend a specific method for hysteroscopic septum incision. (, C)
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Although the available evidence suggests that the uterine cavity is healed by 2 months postoperatively, there is insufficient evidence to advocate a specific length. (, )
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There is insufficient evidence for or against recommending danazol or GnRH agonists to thin the endometrium prior to hysteroscopic septum incision. (, C)
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There is insufficient evidence to recommend for or against adhesion prevention treatment, or any specific method following hysteroscopic septum incision. (, C)
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Recommendations
It is recommended that imaging or imaging with hysteroscopy should be used to diagnose uterine septa rather than laparoscopy with hysteroscopy because this approach is less invasive. (, B)
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In a patient with infertility, prior pregnancy loss, or poor obstetrical outcome it is reasonable to consider septum incision. (, C)
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In a patient without infertility or prior pregnancy loss, it may be reasonable to consider septum incision following counseling regarding potential risks and benefits of the procedure. (, C)
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Recommendation Grading
Overview
Title
Uterine Septum
Authoring Organization
American Society for Reproductive Medicine
Publication Month/Year
September 1, 2016
Last Updated Month/Year
July 22, 2022
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Document Objectives
The purpose of this guideline is to review the literature regarding septate uterus and determine optimal indications and methods of treatment for it. Septate uterus has been associated with an increase in the risk of miscarriage, premature delivery, and malpresentation; however, there is insufficient evidence that a uterine septum is associated with infertility.
Target Patient Population
Patient with uterine septum
Inclusion Criteria
Female, Adolescent, Adult
Health Care Settings
Ambulatory, Hospital, Operating and recovery room, Outpatient
Intended Users
Nurse, nurse practitioner, physician, physician assistant
Scope
Counseling, Assessment and screening, Management, Treatment
Diseases/Conditions (MeSH)
D007246 - Infertility, D007247 - Infertility, Female, D014599 - Uterus, D014591 - Uterine Diseases
Keywords
infertility, uterine septum