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
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
was done carefully
using colin's knife.
dye test was also
showed patent tubes.
was inserted after the
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
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.