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Paper 2
Published in Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw, The Final FRCR, 2020
Amanda Rabone, Benedict Thomson, Nicky Dineen, Vincent Helyar, Aidan Shaw
A septate uterus is caused by the incomplete resorption of the uterovaginal septum and the septum can be ‘partial’ or ‘complete’, extending to either the internal or external os. The external fundal contour of the uterus helps to differentiate a bicornuate from a septate uterus. A bicornuate uterus has a septum too; however, in contrast to a septate uterus it cannot be resected due to the risk of uterine perforation.
Implantation and In Utero Growth
Published in Arianna D'Angelo, Nazar N. Amso, Ultrasound in Assisted Reproduction and Early Pregnancy, 2020
Kugajeevan Vigneswaran, Ippokratis Sarris
The septate uterus is the most frequent uterine abnormality found in the population suffering from both infertility and recurrent pregnancy loss (3%–15.4% in a recent meta-analysis). It is thought that a septate uterus consists of a hypovascular region of muscle that may also affect the overlying endometrium, thus resulting in a possible impairment in both implantation as well as early in utero development. When examining the studies showing the reproductive outcomes of women with untreated septate uteri, there appears to be an increased miscarriage rate (41.1% versus 12.1%) [22]. However, there is a large degree of heterogeneity within the studies conducted and a tendency to put forth the worst-case scenarios. That being said, a septate uterus can be corrected relatively easily via the hysteroscopic route (Figure 13.3) and may improve reproductive outcomes in some women.
Uterine Anomalies and Recurrent Pregnancy Loss
Published in Howard J.A. Carp, Recurrent Pregnancy Loss, 2020
Daniel S. Seidman, Mordechai Goldenberg
Septate uterus is more prevalent in women with repeated pregnancy loss [44]. However, it may be difficult to differentiate between a “normal” arcuate uterus and a septate uterus (Figures 12.6 and 12.7). In order to justify metroplasty, reliable diagnosis is required.
Management of recurrent implantation failure: British Fertility Society policy and practice guideline
Published in Human Fertility, 2022
Mariano Mascarenhas, Yadava Jeve, Lukasz Polanski, Abigail Sharpe, Ephia Yasmin, Harish M. Bhandari
Congenital and acquired uterine anomalies may affect endometrial receptivity and therefore be associated with RIF (Chan et al., 2011). The septate uterus is the most common congenital uterine anomaly associated with RIF (Ban-Frangez et al., 2009). However, a recent observational study found no difference in clinical pregnancy and live birth rates following IVF in women with a congenital uterine anomaly, but did note an increase in preterm birth rates (Prior et al., 2018). A number of acquired uterine pathologies, including submucous fibroids, adenomyosis, endometrial polyps and intrauterine adhesions, may contribute to implantation failure (Maheshwari et al., 2012; Stanekova et al., 2018; Taylor & Gomel, 2008). The reported frequency of unrecognised intrauterine pathologies in patients with RIF varies between 25 and 50% (Makrakis & Pantos, 2010). Adnexal pathologies such as hydrosalpinx which are detectable by transvaginal ultrasound can also negatively impact embryo implantation following IVF (Strandell, 2000).
Second look hysteroscopy following hysteroscopic septum resection improves reproductive outcomes in patients undergoing ICSI
Published in Journal of Obstetrics and Gynaecology, 2022
Bulat Aytek Sık, Ozkan Ozdamar, Ozan Ozolcay, Alper Sismanoglu, Yilda Arzu Aba, Serkan Oral, Mehmet Koc
Septate uterus is a congenital anatomic defect arising from a resorption failure of the tissue connection between bilateral Mullerian ducts during embryogenesis. Septum represents the most common anomaly of uterus, accounting for 35% of all identified uterine anomalies (Hassan et al. 2010). According to the new classification system, proposed in 2013 by European Society of Human Reproduction and Embryology (ESHRE) and European Society for Gynaecological Endoscopy (ESGE), septate uterus is defined as an internal indentation extending >50% of myometrial wall thickness that divides uterine cavity without any restrictions to the length of the septum (Grimbizis et al. 2013). On the other hand, American Society for Reproductive Medicine (ASRM), in 2016, recommended considering a uterus as septate when there is both an indentation depth >15 mm and an indentation angle <90° (ASRM 2016).
“One-stop shop” for the evaluation of the infertile patient: hystero-salpingo foam sonography combined with two and three dimensional ultrasound and sonohysterography
Published in Journal of Obstetrics and Gynaecology, 2022
Michal Zajicek, Eran Kassif, Boaz Weisz, Raz Berkovitz Shperling, Shlomo Lipitz, Tal Weissbach, Eran Barzilay, Raoul Orvieto, Jigal Haas
There is no universally accepted definition of septate uterus. Septate uterus was classified as class V in the ASRM classification and was further divided into partial or complete. In 2016 the definition of septate uterus was updated by the ASRM. A complete septate uterus was defined as a uterus with a single fundus and a septum extending from the top of the endometrial cavity and continuing through the cervix, and partial septum was defined as an indentation from the fundus into uterine cavity measured from the interstitial line to the apex of the indentation >1.5 cm and angle of the indentation <90 degrees (Practice Committee of the American Society for Reproductive Medicine. Electronic address and Practice Committee of the American Society for Reproductive 2016). The ESHRE/ESGE consensus defined septate uterus (class U2) as a uterus with normal outline and an internal indentation at the fundal midline exceeding 50% of the uterine wall thickness. Class U2 is divided to partial septate uterus (U2a) and complete septate uterus (U2b). Recently, the Congenital Uterine Malformation by Experts (CUME) defined septate uterus as a uterus with external fundal indentation depth less than 1 cm, while internal fundal indentation depth is ≥1 cm (Ludwin et al. 2019). Differences among the available classifications may lead to significant differences in the frequency of diagnosis of septate uterus. Septate uterus is associate with miscarriages and the association with infertility is not clear (Chan et al. 2011).