About 7% of women have a
malformation to the genital apparatus known as a Mullerian anomaly
which occurs during the fetal stage and is therefore already present
at birth. The most common anomaly is the septate uterus which occurs
when the median septum has failed to dissolve and the uterus retains
a double cavity. It can appear to be a single uterus (septate uterus)
or even more commonly it is a partial, sub-septate uterus. How this
affects conception rates is controversial, however what is certain is
how it causes repeated miscarriages and preterm births.
Although
new ultrasound technologies exist, the recommended method of
diagnosis is by hysteroscopy. An ultrasound in any case can be useful
pre-operatively to see the external profile of the uterine wall.
Hysteroscopic metroplasty (metro=uterus; plasty=reshape) is a surgical procedure (opertive hysteroscopy) performed in a day hospital that removes the fibrous tissue from the uterine wall, known as the septum, and through to the edge of the myometrium (muscular tissue of the uterus). Depending on the length of the septum local anesthesia or sedation can be used. About 40 days after the procedure, or at least after the first menstrual cycle, a diagnostic hysteroscopy is necessary to see if the scar is forming properly on the uterine wall where the metroplasty was performed and that there are no adhesions.
© Massimo Zuanetti