How a Septate Uterus Affects Miscarriage Risk

This Malformation Can Cause Miscarriage, But it Can Be Treated

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What a Septate Uterus is:

A woman who has what's called a septate uterus has a band of tissue called a septum running down the middle of her uterus that either partially or completely separates the uterus. Septate uterus is a type of congenital uterine malformation that results from a problem in the formation of the woman's uterus during her own prenatal development. 

Septate Uterus and Miscarriages:

A uterine septum increases the risk of miscarriage and can be a factor in recurrent miscarriages.

 Different studies have found different figures, possibly due to the sensitivity of the technique used for diagnosis, but miscarriage rates in women with septate uteri tend to be between 25% and 47%. For comparison, most healthy women who don't have septate uteri have a roughly 15% to 20% chance of miscarrying, according to the American Pregnancy Association.

What causes the increased risk of miscarriage? Typically, the septum is fibrous tissue that doesn't have much of a blood supply. So fertilized eggs that implant on the septum are thought to be at higher risk for miscarriage because the placenta cannot develop properly and access nutrients. Women with septate uteri who do not miscarry may be at increased risk for preterm labor and having a premature baby.

Number of Women With Septate Uteri:

Findings vary heavily (again, possibly due to diagnosis technique), but anywhere from 8% to 23% of women who experience recurrent miscarriages may have some type of uterine malformation.

About 33% of women with congenital uterine malformations have septate uteri.

Septate Uterus Diagnosis:

Doctors can sometimes detect that a woman has a uterine septum by indicators on an ultrasound exam (also known as a sonogram) or through an MRI, but usually the means of diagnosis is by a hysterosalpingogram (HSG) or a hysteroscopy.

On an HSG, septate uterus can sometimes be misdiagnosed as a bicornuate uterus, another type of congenital uterine malformation. Sometimes a woman doesn't know that she has a septate uterus until she begins experiencing recurrent miscarriages and testing reveals it. 

Septate Uterus Treatment:

Treatment is surgery—most commonly resection during a hysteroscopy. This is a fairly minor procedure that's usually done as an outpatient treatment (in other words, it's done in a clinic, as opposed to in a hospital). During the surgery, a doctor puts a medical tool up the vagina and through the cervix and takes out the septum, so he or she doesn't actually have to cut open your pelvis. This is what's called a minimally invasive type of surgery. A woman may be prescribed estrogen after the procedure. 

Getting surgery to correct a septate uterus is likely to improve chances of a successful pregnancy. Figures vary, but the most drastic was a study that found that treatment improved positive outcomes (giving birth and infant survival) from 4.4% to 87.5%.

Deciding Whether to Seek Treatment When You Have a Septate Uteri:

The decision to seek treatment is obviously a personal one, and having any type of surgery can be scary. Merely having a uterine septum does not impact a woman’s health most of the time, except for increasing the risk of miscarriage.

Sources:

Acien, Pedro. "Reproductive performance of women with uterine malformations." Human Reproduction 1993. 122-126. Accessed 4 Dec 2007.

Gaucherand, P., A. Awada, R.C. Rudigoz, and D. Dargent, "Obstetrical prognosis of the septate uterus: a plea for treatment of the septum." European Journal of Obstetrics, Gynecology, and Reproductive Biology. 1994. 109-12. Accessed 4 Dec 2007.

Lin, Paul C. "Reproductive Outcomes in Women With Uterine Anomalies." Journal of Women's Health 2004. 33-39. Accessed 4 Dec 2007.

Raga, Francisco, Celia Bauset, Jose Remohi, Fernando Bonilla-Musoles, Carlos Simon and Antonio Pellicer. "Reproductive impact of congenital Mullerian anomalies." Human Reproduction 1997. 2277-2281. Accessed 4 Dec 2007.

Reuter, K.L., D.C. Daly and S.M. Cohen, "Septate versus bicornuate uteri: errors in imaging diagnosis." Radiology. 1989. 749-752. Accessed 4 Dec. 2007.

Salim, R., L. Regan, B. Woelfer, M. Backos, and D. Jurkovic. "A comparative study of the morphology of congenital uterine anomalies in women with and without a history of recurrent first trimester miscarriage." Human Reproduction 2003. 162-166. Accessed 4 Dec 2007.

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