Uterine septum [Müllerian malformations]
#KnowledgeIsSuccess and the 1st step for an accomplished dream is having the correct diagnosis. One in twenty women has some type of abnormality in the uterus from birth, these are known as Müllerian malformations and include uteri with a single tube, narrow cavities, bicornuate, only half a uterus or even no uterus.
This 36-year-old patient attended a gynecological consultation and had not been diagnosed despite previous pregnancy losses. Thanks to his experience and advanced ultrasound equipment, Dr. Arturo Valdés detected a uterine septum or septum, which consists of a fibrous growth in the uterine cavity and he shares a little about this case with us.
The uterine development when it is embryonic, sometimes has small alterations or malformations, such as it can make two uteri or make a uterus with a complete septum or make only a half uterine cavity.
These are called Müllerian alterations, the most important or the most common are the uterine partitions or septa, that is to say that the cavity, if we see it as a square or a triangle in the middle part, is divided by fibrous tissue because it could not reabsorb and then the cavity makes it more or less like this, instead of being a completely wide cavity.
This little patient is 36 years old and she came to me for an issue of wanting to get pregnant, but her main problem on the first visit was gynecological, so she came for that, I did an assessment, but when doing the questioning, this patient had a history of 3 pregnancies. The first had been a preterm pregnancy and the child had died and then she had two miscarriages, so when doing the vaginal ultrasound assessment we found that she had a uterine septum, when I make a cross section instead of seeing the cavity completely wide it looked like we say owl eyes and slightly separated that cavity. So, we proposed a hysteroscopy.
Hysteroscopy
Hysteroscopy is one of the most important diagnostic and obviously therapeutic tools we have in assisted reproduction. Why? Because it is a minimally invasive mini-surgery, completely outpatient, the patient enters in the morning and leaves two or three hours later because we enter through the vagina and then through the cervical canal into the cavity and when we do the hysteroscopy we realize You will see what the partition has in the video as we are cutting.
It is called with a cold cut, that is, with scissors, because it can also be removed with coagulation. Normally, we do not like to remove it with heat because when making a cut with heat, many times you can favor fibrosis and the cavity becomes glued back, but the most What is important for the patient to know is that Müllerian pathologies of the uterine cavity, such as what I was saying about the septum and other pathologies such as polyps like last time, or a submucosal fibroid can be addressed vaginally with a surgery that is called minimally invasive, surgical hysteroscopy and that also the patient does not need a rest because the only thing we are doing is resecting what is inside but we are not opening or making an incision.
