Journal of Reproductive Medicine Gynaecology & Obstetrics Category: Medical Type: Case Report
A Successful Pregnancy Outcome in a Complete Septate Uterus
- Catalina Renata Elizalde Martinez-Peñuela1*, Jesus Zabaleta2, Gema Campo2, Francisco Javier Elizalde 2, Beatriz Pérez2
- 1 Department Of Gynecology, Hospital Virgen Del Camino, Irunlarrea St 31008. Pamplona, Spain
- 2 Department Of Gynecology, Hospital Virgen Del Camino, Pamplona, Spain
*Corresponding Author:Catalina Renata Elizalde Martinez-Peñuela
Department Of Gynecology, Hospital Virgen Del Camino, Irunlarrea St 31008. Pamplona, Spain
Received Date: Jul 15, 2017 Accepted Date: Aug 01, 2019 Published Date: Aug 08, 2019
At 34 wks of gestation the patient presented with prelabour premature rupture of membranes. In view of non-reassuring foetal heart rate, an emergency lower segment caesarean section was done with the following intra operative findings: A complete uterine septus with pregnancy in the right horn seen. A live male child in right occipito posterior position weighing 1.7 kg was delivered. Placenta is located anteriorly in the upper segment. By exteriorizing the uterus, findings are confirmed. She had uneventful post operative period and was discharged on 8th post operative day.
One year later, she cames to the hospital for gestational desire and after the hysterosalpingography (Figure 3) we recommend the possibility of performing a septoplasty prior to a new gestation (Figure 4). 6 months later she got pregnant and had a eutocic deivery without any problem during pregnancy.
Figure 3: Hysterosalpingography.
Figure 4: Histeroscopy after septoplasty.
Most of the uterine septi are diagnosed by fertility subspecialists, after the patient presents with recurrent pregnancy loss. It is important that fertility specialists make the correct diagnosis of the uterine septum versus a bicornuate uterus. The uterine septum contains a separation in the uterine cavity, however the outer appearance of the uterus is normal. A bicornuate uterus at the other hand has a completely separated upper end both internally and externally. Diagnosing this properly is very important since an attempted resection of the bicornuate uterus, that is improperly diagnosed as a uterine septum might create a uterine perforation.
Ultrasonography is a simple, quick, and non invasive technique for detecting and diagnosing uterine anomalies. Despite the notable advantages of this technique, unfortunately the obstetric ultrasound scan done on our patient in her first pregnancy could not detect the septate uterus as anomalies accordance with uterus exactly and it could be probably as a result of lack of experience and poor ultrasound quality. However, our MRI images diagnosed this problem accuracy. Grimbizis et al., reported that 12 (26.1%) out of their 46 infertile patients with septate uterus had laparascopic finding of endometriosis . Fayez also found endometriosis in three (43%) out of seven similar patients . It seems possible that septate uterus may be involved in the pathogenesis of endometriosis and thereby plays an important role in indirect relationship within fertility. Therefore, it seems that any finding about endometriosis should be followed by careful investigation for uterine malformation especially in women affected by septate uterus.
Hysteroscopy remains the standard for evaluation of intracavitary abnormalities. Its use is especially practical, as it offers the opportunity for treatment at the time of diagnosis. The septum incision is performed with a hysteroscopic resectoscope and it may be controlled under laparoscopic supervisión.
Hysteroscopy without damaging the intact hymen is feasible and helpful for the diagnosis in the treatment of pathologic endometrial changes in women [8,9]. Although hysteroscopy is now the preferred method for treatment of the septate uterus, a report of two cases described successful removal of the septum at the time of cesarean section. The difficulty in achieving complete uterine septum caesarean has been reported [10,11], however in the in present case we didn’t found any trouble.
Early diagnosis and proper antenatal care is required to successfully manage a pregnancy with bicornuate uterus. Patient with mullerian duct anamolies are known to have a higher incidence of infertility, repeated first, second trimester spontaneous abortions intrauterine growth retardation, fetal malpositions, preterm labor, prelabour preterm rupture of membranes & retained placenta. Anticipation and preparedness to deal with these known complications will ensure positive outcome for the mother and baby.
The finding of a septate uterus perse is not an indication for surgical intervention because it is not always associated with poor obstetric performance. However, when a septate uterus is found in association with adverse reproductive outcome, surgical intervention ought to be considered . Hysteroscopic septal incision is the best method for the preservation of the hymen and it can be performed using the microscissors, electrosurgery, or fiber optic light laser energy.
In conclusion, the diagnosis of septate uterus as a congenital anomaly can be achieved easily with MRI. It can be corrected by hysteroscopic surgery and thereby decreases the rate of abortion for women greatly.
- Nahum GG (1998) Uterine anomalies. How common are they, and what is their distribution among subtypes? J Reprod Med 43: 877-887.
- Acién P (1997) Incidence of Müllerian defects in fertile and infertile women. Hum Reprod 12: 1372-1376.
- Fayez JA (1986) Comparison between abdominal and hysteroscopic metroplasty. Obstet Gynecol 68: 399-403.
- Raga F, Bauset C, Remohi J, Bonilla-Musoles F, Simón C, et al. (1997) Reproductive impact of congenital Müllerian anomalies. Hum Reprod 12: 2277-2281.
- Rock JA, Schlaff WD (1985) The obstetric consequences of uterovaginal anomalies. Fertil Steril 43: 681-692.
- Ludmir J, Samuels P, Brooks S, Mennuti MT (1990) Pregnancy outcome of patients with uncorrected uterine anomalies managed in a high-risk obstetric setting. Obstet Gynecol 75: 906-910.
- Grimbizis G, Camus M, Clasen K, Tournaye H, De Munck L, et al. (1998) Hysteroscopic septum resection in patients with recurrent abortions or infertility. Hum Reprod 13: 1188-1193.
- Xu D, Xue M, Cheng C, Wan Y (2006) Hysteroscopy for the diagnosis and treatment of pathologic changes in the uterine cavity in women with an intact hymen. J Minim Invasive Gynecol 13: 222-224.
- Cheong ML (2010) Minihysteroscopy for examination and management of pathologic lesions of virginal reproductive tracts: Can we preserve the hymen intact? Arch Gynecol Obstet 281: 375-376.
- Lipitz S, Shalev J, Kokia E, Kushnir O, Serr DM, et al. (1990) Successful outcome of pregnancy following complete removal of uterine septum during cesarean section. Gynecol Obstet Invest 29: 78-80.
- Green LK, Harris RE (1976) Uterine anomalies. Frequency of diagnosis and associated obstetric complications. Obstet Gynecol 47: 427-429.
Citation: Martinez-Peñuela CRE, Zabaleta J, Campo G, Elizalde FJ, Pérez B (2019) A Successful Pregnancy Outcome in a Complete Septate Uterus. J Reprod Med Gynecol Obstet 4: 025.
Copyright: © 2019 Catalina Renata Elizalde Martinez-Peñuela, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.