A uterine septum is an abnormal structure that runs partially or completely through the middle of the uterus. A patient with this abnormality is said to have a septate uterus. Patients usually do not experience any problems as a result of having a uterine septum, unless they attempt to get pregnant, when the structure can increase the risk of pregnancy loss in some patients. It is possible to get pregnant with a septate uterus and carry the baby to term, and success of a pregnancy can vary depending on a number of factors, including the precise size and location of the septum.
In the process of embryonic development, the uterus forms from two structures known as mullerian ducts. During healthy embryonic development, the structures fuse together and the septum dissolves, starting at the base of the uterus and working its way up. In some people, for unknown reasons, the septum does not dissolve. It may partially disappear, causing the uterus to have a distinctive heart shape, or it may remain in place, leaving the woman with two uteri and a matching set of cervices.
Patients with a uterine septum have a small chance of also having kidney abnormalities. The patient may only have one kidney, which may not be a problem unless the patient's kidney function is strained. Other patients have skeletal problems in association with the uterine septum. In most cases, all of these issues go unnoticed until a patient is receiving ultrasound examinations during the course of a pregnancy or in a fertility evaluation to find out why she is not getting pregnant.
Medical imaging studies can reveal the uterine septum and provide information about its size. If the septum does not appear to interfere with pregnancy, a doctor will usually recommend leaving it in place. For patients who experience pregnancy loss recurrently because of the structure, the doctor may recommend surgery to remove the septum. In this surgery, the doctor will take care to excise the septum without compromising neighboring structures. The patient will need to heal completely before attempting pregnancy.
The chances of having a uterine septum are not known, because this structure is only identified and studied when it becomes a problem. It may be present in many members of the general population who are not aware of it. Patients diagnosed with a uterine septum may want to consider meeting with a gynecologist or obstetrician who has extensive experience with septate uteri in order to get advice on how to manage the issue.
