With this anomaly, a resorption defect leads to a persistent complete or partial longitudinal uterine septum (see Fig. 3-5). Less often, a complete vaginocervicouterine septum is found (Ludwin, 2013). Many septate uteri are identiied during evaluation of infertility or recurrent pregnancy loss. Although an abnormality may be identiied with HSG or 2-D TVS, typically 3-D TVS or MR imaging is required to diferentiate this from a bicornuate uterus (see Fig. 3-6).
Septate anomalies are associated with diminished fertility and increased risks for adverse pregnancy outcomes that include miscarriage, preterm delivery, and malpresentation (Chan, 201i1a; Ghi, 2012). Hysteroscopic septal resection has been shown to improve pregnancy rates and outcomes (Mollo, 2009; Pabu:cu, 2004). From their metaanalysis, Valle and colleagues (20l3) reported a 63-percent pregnancy rate and 50-percent live birth rate following resection.
his malformation is a mild deviation from the normally developed uterus. Although some studies report no increased adverse associated outcomes, others have found excessive secondtrimester losses, preterm labor, and malpresentation (Chan, 2011a; Mucowski, 2010; Woelfer, 2001).
Treatment with Cerclage
Some women with uterine anomalies and repetitive pregnancy losses may beneit from transvaginal or transabdominal cervical cerclage (Golan, 1992; Groom, 2004). Others with partial cervical atresia or hypoplasia may also benefit (Hampton, 1990; Ludmir, 1991). Candidacy for cerclage is determined by the same criteria used for women without such defects, which is discussed in Chapter 18 (p. 354).
During the 1960s, a synthetic nonsteroidal estrogen-diethylstilbestrol (DES)-was used to treat pregnant women for threatened abortion, preterm labor, preeclampsia, and diabetes. he treatment was remarkably inefective. Later, it was also discovered that women exposed as fetuses had increased risks of developing several specific reproductive-tract abnormalities. hese included vaginal clear cell adenocarcinoma, cervical intraepithelial neoplasia, small-cell cervical carcinoma, and vaginal adenosis. Afected women had identiiable structural variations in the cervix and vagina that include transverse septa, circumferential ridges, and cervical collars. Uteri potentially had smaller cavities, shortened upper uterine segments, or T-shaped and other irregular cavities (see Fig. 3-5) (Kaufman, 1984).
These women sufer impaired conception rates and higher rates of miscarriage, ectopic pregnancy, and preterm delivery, especially in those with structural abnormalities (Kaufman, 2000; Palmer, 2001). Now, more than 50 years after DES use was proscribed, most afected women are past childbearing age, but higher rates of earlier menopause, cervical intraepithelial neoplasia, and breast cancer are reported in exposed women (Hatch, 2006; Hoover, 2011; Troisi, 2016).