Full and thick septum
The 2nd category septum occupies most of the cavity, is wide and contains muscle tissue and blood vessels; with a complete septum dividing the cervical canal, the cervical part is usually preserved, and the uterine part is dissected to the bottom. For safety, the depth of incision is controlled by transabdominal ultrasound or laparoscope (fundus transillumination), bleeding is stopped by coagulation, fluid balance is strictly taken into account; sometimes the operation is performed in two stages. Afterwards - estrogens, prevention of synechiae, control hysteroscopy after 1-2 months with dissection of the remainder if necessary. The pregnancy rate after surgery reaches 80–85%; childbirth is carried out taking into account the condition of the uterine fundus.
Indications
- intrauterine septum (complete or incomplete) with recurrent miscarriage, infertility, unsuccessful IVF;
- septum identified during pregnancy planning and examination (by doctor’s decision);
- bicornuate uterus, T-shaped uterus, complex anomalies with miscarriage (metroplasty);
- combination of septum with polyps, synechiae, fibroids.
Uterine abnormalities and pregnancy
The intrauterine septum is the most common anomaly of the uterus: it is poorly supplied with blood, and implantation on it leads to miscarriages in 60–80% of cases, premature birth and abnormal position of the fetus. Hysteroscopic incision of the septum eliminates the problem without incisions, and the miscarriage rate is reduced from 80 to 10-15%. A bicornuate uterus (two horns with a common or separate body) in case of repeated pregnancy losses is corrected by metroplasty - open union of the horns into a single cavity. The diagnosis is clarified by 3D ultrasound or MRI and hysteroscopy with laparoscopy to distinguish the septum from a bicornuate uterus.
