KEEPING
FAITH

Hysteroscopic approach gives new hope
to women with Septate Uterus

The incidence of Mullerian Duct anomalies is 0.1 – 3.5% and septate uterus is the most common uterine anomaly encountered clinically. It is associated with infertility and adverse pregnancy outcomes including miscarriages and pre-term births. Over the past few decades, with the advent of Hysteroscopy, the diagnosis and surgical management of uterine septum have changed significantly. Compared with open surgery, treatment through hysteroscopic approaches is



associated with shorter operating times and good fertility outcomes.

A 28-year-old female came to the Gynae OPD with complaints of repeated miscarriages, dyspareunia and pain in the lower abdomen. She had irregular menstrual cycles associated with dysmenorrhoea.

On examination, it was diagnosed that she had a thick vaginal septum anterio-posteriorly, approximately 10cm in length and 4mm thick. It gave the appearance of two cervices.

3D ultrasound confirmed the findings of a septate uterus with complete septum extending from the uterine fundus till the vagina. A renal tract evaluation was done and was found to be normal.

Intraoperatively, the resection of the vaginal septum was done with scissors taking care of the bladder anteriorly and rectum posteriorly. Laparoscopy was done to confirm the diagnosis of septate uterus. Hysteroscopic transcervical resection of the cervical and uterine septum was done carefully using colin's knife. Laparoscopic dye test was also performed which showed patent tubes. An intrauterine contraceptive device was inserted after the procedure. The patient was feeling quite well and was discharged the following day of the surgery. She was given estradiol valerate 4mg daily for 4 weeks to encourage endometrial regeneration.

Thus, hysteroscopic resection of the septum has enabled the management of uterine septums to be safer and less morbid than the traditional transabdominal approach. With studies demonstrating good pregnancy outcomes and low morbidity after hysteroscopic resection, it has become the treatment of choice in patients with septate uterus seeking fertility.