Complete septate uterus

Complete septate uterus is a congenital uterine anomaly in which a fibrous or muscular septum (wall of tissue) extends from the top (fundus) of the uterus all the way down to the cervix, dividing the uterine cavity into two separate compartments. Unlike a bicornuate uterus, the external contour of the uterus appears normal or near-normal, but the internal cavity is fully divided. This condition falls under the broader category of Müllerian duct anomalies, which arise during embryonic development when the paired Müllerian ducts fail to properly fuse or when the midline septum fails to resorb. It is classified as a Class V uterine anomaly under the American Fertility Society system. The septum may also extend through the cervix (complete septate uterus with cervical septum) and occasionally into the vagina. Many individuals with a complete septate uterus are asymptomatic and may not be diagnosed until they experience reproductive difficulties. The condition is strongly associated with adverse pregnancy outcomes, including recurrent miscarriage (particularly second-trimester losses), preterm labor, malpresentation of the fetus (such as breech presentation), and intrauterine growth restriction. Some patients may also experience dysmenorrhea (painful periods) or abnormal uterine bleeding. The septum has relatively poor blood supply compared to normal uterine tissue, which is thought to contribute to implantation failure and pregnancy loss when an embryo implants on the septum. Diagnosis is typically made through imaging studies such as three-dimensional transvaginal ultrasound, magnetic resonance imaging (MRI), or hysteroscopy combined with laparoscopy. The primary treatment is hysteroscopic metroplasty (surgical resection of the septum), which is a minimally invasive procedure performed through the cervix. This surgery has been shown to significantly improve reproductive outcomes in women with a history of pregnancy loss or infertility. The procedure is generally considered safe, with low complication rates. Management decisions are individualized based on the patient's symptoms and reproductive history, as some asymptomatic individuals may not require intervention.

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