The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan.

Literature Review Article

The pregnancy outcome in women with incidental diagnosis of septate uterus at first trimester scan. Ghi T, De Musso F, Maroni E, Youssef A, Savelli L, Farina A, Casadio P, Filicori M, Pilu G, Rizzo N. Hum Reprod 2012; 27(9): 2671-5.

Dr. John Preston Parry, M.D., M.P.H.

Multiple studies for uterine septa have retrospectively assessed subsequent obstetrical outcomes. The authors of this study prospectively tracked reproductive outcomes in 24 women in the first trimester of their first pregnancy with both a singleton gestation and a septate or subseptate uterus. The authors defined a subseptate uterus as a <1.5 cm depression below the interostial line and a septate uterus as >1.5 cm. Among the patients referred to the center due to a suspected uterine anomaly in the first trimester, 41.7% already had early pregnancy failure at the time of enrollment (20.8% had an empty sac and 20.8% lacked cardiac activity). In the remaining 14 pregnancies, only 8 led to a live birth, with 3 having subsequent first trimester loss (21.4% of those viable at enrollment) and 3 having second trimester loss (21.4% of those viable at enrollment). All second trimester losses occurred by 16 weeks. Also, of the initial 24 women enrolled, 10 (41.7%) presented with vaginal bleeding, including 5 of the 14 (35.7%) with potentially viable pregnancies. Of the 8 pregnancies that led to a live birth, 6 were at term, and 4 of these 6 required Cesarean for intrapartum dystocia or non-vertex presentation. Though limited by the lack of a direct control group, the authors reasonably conclude that septate and subseptate uteri are associated with elevated risks for first trimester bleeding as well as early and late miscarriage. In potentially viable first trimester pregnancies with a septate or subseptate uterus, the likelihood of a term spontaneous vaginal delivery is low.

The study provides prospective information (rare for this topic) on reproductive outcomes in septate uteri for the first pregnancy, though there remains the confounding issue of referral bias.

Dr. Steven R. Lindheim, M.D.

This prospective study on a small group of patients incidentally found to have a uterine septum in the first trimester concluded that there is a high risk of miscarriage or adverse pregnancy outcome.  If confirmed in larger studies, perhaps septum resection may be considered in patients without a history of recurrent abortion. 

The above review and commentary on this article were written by SRS members. Publication of these summaries does not reflect endorsement of any particular procedure or treatment. Views expressed in these summaries do not necessarily reflect the views of SRS or ASRM.



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