The cause of miscarriage turned out to be this

This is the 4841th article of Da Yi Xiao Hu

Xiao Wang is 30 years old and has never had a gynecological examination. She prepared for pregnancy for two years after getting married. She finally got pregnant, but she had a miscarriage for unknown reasons. It turned out that Xiao Wang's uterus was different from that of other women. There was an extra partition in her uterus, which is medically called a septate uterus.

1. What is a septate uterus?

Septate uterus is the most common type of uterine developmental malformation, accounting for 80% to 90% of uterine malformations. It is mainly caused by the obstruction of mediastinal absorption after the fusion of the bilateral paramesonephric ducts. According to the degree of absorption of the mediastinum, it is divided into: complete septate uterus and incomplete septate uterus. In the former, the terminal end of the septum reaches or even exceeds the internal os of the cervix, while in the latter, the terminal end of the septum is above the level of the internal os of the cervix. In clinical practice, we often see incomplete septate uterus.

2. What effects does a septate uterus have on women?

A septate uterus is generally asymptomatic and will menstruate like a normal uterus. Therefore, women generally do not discover it very early. Most of the time, it is discovered through ultrasound examination. Some women will find it when they do an ultrasound examination of the uterus and ovaries before preparing for pregnancy, while some women will not do an ultrasound examination to discover a septate uterus until they have a miscarriage or long-term infertility. In our clinical practice, a septate uterus mainly causes some adverse pregnancy outcomes, such as: recurrent miscarriage, premature birth, premature rupture of membranes, etc., and can also cause female infertility. From Figure 1, it is not difficult to find that the appearance of the septum affects the entire spatial layout of the uterine cavity. The growth and development of the fetus in such a space will inevitably be restricted, thus affecting the outcome of the pregnancy.

3. How to detect uterine septate early?

In addition to ultrasound examination, which can diagnose uterine septate at an early stage, hysterosalpingography and hysteroscopy are also commonly used clinical methods. The former can understand the morphology of the uterine cavity and evaluate the patency of the fallopian tubes, and is often used in the initial examination of infertile patients. In addition to understanding the morphology of the uterine cavity, the latter can also evaluate the endometrium and diagnose other uterine cavity lesions. At the same time, the uterine septum can be further surgically removed under hysteroscopy. However, the common disadvantage of both is that the outer contour of the uterus cannot be understood, and it is difficult to distinguish it from a bicornuate uterus and a saddle uterus. Hysteroscopy combined with laparoscopy can make up for the above shortcomings, conduct a comprehensive assessment of the interior and exterior of the uterus, and also assess the pelvic cavity and fallopian tube and ovarian conditions.

4. How to deal with uterine septate?

The presence of uterine septum mainly affects fertility and pregnancy outcomes. The most commonly used method is surgical resection, including laparotomy and hysteroscopic combined resection. The former is a traditional surgical method with relatively large trauma, while the latter is performed by hysteroscopic resection under laparoscopic monitoring, which is not only less invasive, but also safe and has a quick recovery. For women with uterine septum who are unmarried or have no fertility requirements, no intervention is required.

5. How long does it take to get pregnant after hysterectomy?

After the removal of the uterine septum, the wound and the endometrium need a certain amount of time to repair before preparing for pregnancy. Generally, preparing for pregnancy can be considered at least 3 months after the operation.

Author: East China Hospital Affiliated to Fudan University

Gynecology Zhu Lihong Deputy Chief Physician