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Uterine Septum Resection (Hysteroscopic Metroplasty)

Hysteroscopic Treatment of Septate Uterus

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Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

References (5)

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Kadın Hastalıkları ve Doğum department. Book Appointment →

What is Uterine Septum Resection (Hysteroscopic Metroplasty)?

Septate uterus is the most common congenital uterine anomaly (1-3% of women, 35% of Müllerian anomalies) caused by failed resorption of the midline septum after Müllerian duct fusion.

Classification (ESHRE/ESGE): partial septate uterus (septum less than 50% of cavity length) or complete septate uterus (septum extends to internal os or cervix).

Pathophysiology: poor vascularization of the septum impairs implantation, increases miscarriage risk, and is associated with preterm birth.

Hysteroscopic metroplasty: outpatient transcervical procedure dividing the septum using scissors, monopolar/bipolar electrosurgery, or laser.

No abdominal incision; complete preservation of myometrial integrity (unlike older Tompkins/Strassmann abdominal procedures).

Reproductive outcomes: miscarriage rate decreases from 80-90% (untreated) to 15-20% (post-resection); live birth rate improves from 5-30% to 70-85%.

Symptoms

Recurrent pregnancy loss (especially first trimester miscarriages, 2 or more consecutive).
Primary or secondary infertility with normal hormonal evaluation.
Previous preterm delivery before 32 weeks.
Malpresentation (breech, transverse) at term.
Cervical incompetence with second trimester loss.
Septate uterus diagnosed incidentally during routine pelvic imaging.
Asymptomatic septate uterus considering pregnancy (selective indication based on septum size and history).

Risk Factors

Family history of Müllerian anomalies (rare genetic forms).
Renal anomalies (10-30% of Müllerian anomalies have associated renal abnormalities).
Diethylstilbestrol (DES) exposure in utero (T-shaped uterus, not septate).
Other Müllerian anomalies in same patient (bicornuate, didelphys differential).
Hysteroscopic risks: uterine perforation, fluid overload, intrauterine adhesions, cervical injury.

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Two or more first-trimester miscarriages.
  • Infertility evaluation with normal hormonal and male factor workup.
  • Recurrent pregnancy loss after recurrent IVF failures.
  • Second-trimester miscarriage or preterm birth before 28 weeks.
  • Müllerian anomaly identified on hysterosalpingography or ultrasound.
  • Genetic counseling referral for cascade evaluation if multiple anomalies.

Treatment Methods

01
Pre-operative imaging: 3D transvaginal ultrasound (gold standard for diagnosis), saline-infusion sonography, MRI for complex cases (differentiation from bicornuate).
02
Timing: early follicular phase preferred (thin endometrium, better visualization).
03
Anesthesia: general or spinal; outpatient procedure typically 30-60 minutes.
04
Cervical dilation, hysteroscope insertion (rigid or flexible 5-10mm).
05
Distention media: saline (bipolar electrosurgery, scissors), glycine (monopolar), or CO2.
06
Septum division: hysteroscopic scissors (cold technique), monopolar resectoscope loop, bipolar (Versapoint), or laser (Nd:YAG, KTP).
07
Endpoint: complete fundal resorption with smooth fundal contour; visible bilateral tubal ostia.
08
Postoperative: estrogen therapy (estradiol 2-4 mg/day x 3-4 weeks) ± copper IUD or balloon catheter to prevent adhesions.
09
Second-look hysteroscopy at 2-4 months to confirm complete resection and absence of synechiae.
10
Conception advice: 2-3 months delay before pregnancy attempt to allow complete healing.
11
Outcomes monitoring: pregnancy outcome, term delivery rate, NICU admissions.
12
Complications management: uterine perforation (1-3%), intrauterine adhesions (5-15%), incomplete resection requiring reoperation.

Which Department to Visit?

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.