Uterine Septum
A uterine septum is a fibromuscular band of tissue that partially or completely divides the uterine cavity, arising when the midline septal tissue of the fused Mullerian (paramesonephric) ducts fails to resorb during fetal development. A uterus with this band is called a septate uterus. When the division is partial rather than complete, the term subseptate uterus applies. Both describe the same underlying structural defect: a septum in the uterus that narrows or bisects the space where a pregnancy must implant and grow. A uterine septum is the most common congenital uterine anomaly.1 It does not alter the external uterine contour, which distinguishes it from a bicornuate uterus.2
The septum offers a poor implantation surface, with reduced vascular support thought to impair embryo implantation and placentation.3 Many uterine septa are asymptomatic and found incidentally;4 when a septum does present, recurrent pregnancy loss is the most common reason it comes to attention.5 Some women also experience preterm labor or abnormal fetal position in later pregnancy.6
Saline infusion sonohysterography and 3D transvaginal ultrasound are standard first-line imaging.7 Operative hysteroscopy is the accepted approach for definitive surgical correction of a uterine septum.8 The diagnostic goal is to confirm a septum rather than a different Mullerian anomaly before planning repair.2
Where resection is chosen, hysteroscopic septal resection removes the septum and restores a single cavity while preserving the myometrium;8 hysteroscopic metroplasty is the established operative approach for uterine septum, having displaced open abdominal metroplasty as the standard of care.9 Observational cohorts report higher pregnancy continuation after resection in women with a confirmed septum and prior loss, though these designs cannot separate the surgery's effect from background spontaneous resolution rates after a single loss; randomized data on whether resection improves live birth remain limited.1011 Resection is therefore offered selectively, most often to couples with a confirmed septum and recurrent loss rather than to every woman in whom a septum is found,12 and it carries procedural risks including uterine perforation and the potential for intrauterine adhesion formation.13
A uterine septum is a structural, surgically correctable contributor to pregnancy loss: hysteroscopic resection significantly reduces abortion rates and improves term delivery rates across septum sizes.14 A restorative evaluation looks for the septum and for other contributing factors before a conception attempt, so that a couple understands what may be affecting their pregnancies rather than proceeding without that picture. Evaluation for co-existing conditions is also appropriate: intrauterine adhesions can develop after any uterine instrumentation,15 and submucosal fibroids may coexist and compound cavity distortion.16
Cited in this entry
- Grimbizis GF, Camus M, Tarlatzis BC, Bontis JN, Devroey P Clinical implications of uterine malformations and hysteroscopic treatment results. Human reproduction update. 2001. https://pubmed.ncbi.nlm.nih.gov/11284660/
- Grimbizis GF, Gordts S, Di Spiezio Sardo A, Brucker S, De Angelis C, Gergolet M et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Human reproduction (Oxford, England). 2013. https://pubmed.ncbi.nlm.nih.gov/23771171/
- Rikken J, Leeuwis-Fedorovich NE, Letteboer S, Emanuel MH, Limpens J, van der Veen F et al. The pathophysiology of the septate uterus: a systematic review. BJOG : an international journal of obstetrics and gynaecology. 2019. https://pubmed.ncbi.nlm.nih.gov/31004459/
- Saravelos SH, Cocksedge KA, Li TC Prevalence and diagnosis of congenital uterine anomalies in women with reproductive failure: a critical appraisal. Human reproduction update. 2008. https://pubmed.ncbi.nlm.nih.gov/18539641/
- Chan YY, Jayaprakasan K, Zamora J, Thornton JG, Raine-Fenning N, Coomarasamy A The prevalence of congenital uterine anomalies in unselected and high-risk populations: a systematic review. Human reproduction update. 2011. https://pubmed.ncbi.nlm.nih.gov/21705770/
- Caballero Campo M, Pérez Milán F, Carrera Roig M, Moratalla Bartolomé E, Domínguez Arroyo JA, Alcázar Zambrano JL et al. Impact of congenital uterine anomalies on obstetric and perinatal outcomes: systematic review and meta-analysis. Facts, views & vision in ObGyn. 2024. https://pubmed.ncbi.nlm.nih.gov/38551471/
- Grimbizis GF, Di Spiezio Sardo A, Saravelos SH, Gordts S, Exacoustos C, Van Schoubroeck D et al. The Thessaloniki ESHRE/ESGE consensus on diagnosis of female genital anomalies. Human reproduction (Oxford, England). 2016. https://pubmed.ncbi.nlm.nih.gov/26537921/
- Rikken JF, Kowalik CR, Emanuel MH, Mol BW, Van der Veen F, van Wely M et al. Septum resection for women of reproductive age with a septate uterus. The Cochrane database of systematic reviews. 2017. https://pubmed.ncbi.nlm.nih.gov/28093720/
- Carrera M, Pérez Millan F, Alcázar JL, Alonso L, Caballero M, Carugno J et al. Effect of Hysteroscopic Metroplasty on Reproductive Outcomes in Women with Septate Uterus: Systematic Review and Meta-Analysis. Journal of minimally invasive gynecology. 2022. https://pubmed.ncbi.nlm.nih.gov/34648934/
- Carbonnel M, Balaya V, Carvalho C, et al. Impact of hysteroscopic septum resection on pregnancy outcomes: a 20-year retrospective monocentric study. Eur J Obstet Gynecol Reprod Biol. 2025 Nov. https://pubmed.ncbi.nlm.nih.gov/40882453/
- The Use of Hysteroscopy for the Diagnosis and Treatment of Intrauterine Pathology. https://www.acog.org/clinical/clinical-guidance/committee-opinion/articles/2020/03/the-use-of-hysteroscopy-for-the-diagnosis-and-treatment-of-intrauterine-pathology
- Practice Committee of the American Society for Reproductive Medicine. Electronic address: asrm@asrm.org Evidence-based diagnosis and treatment for uterine septum: a guideline. Fertility and sterility. 2024. https://pubmed.ncbi.nlm.nih.gov/38556964/
- Piriyev E, Schiermeier S, Römer T Electrosurgical hysteroscopic metroplasty for septate uterus: a single-center retrospective analysis of safety, adhesion rates, and perioperative outcomes. Archives of gynecology and obstetrics. 2025. https://pubmed.ncbi.nlm.nih.gov/40906210/
- Wang X, Hou H, Yu Q Fertility and pregnancy outcomes following hysteroscopic metroplasty of different sized uterine septa: A retrospective cohort study protocol. Medicine. 2019. https://pubmed.ncbi.nlm.nih.gov/31348312/
- Khan Z Etiology, Risk Factors, and Management of Asherman Syndrome. Obstetrics and gynecology. 2023. https://pubmed.ncbi.nlm.nih.gov/37490750/
- Abuzeid O, Ibrahim M, Joseph S, Herbert J, Abuzeid M Safety and efficacy of hysteroscopic resection of uterine leiomyoma embedded at the base of a uterine septum. Facts, views & vision in ObGyn. 2021. https://pubmed.ncbi.nlm.nih.gov/33575676/
Authoritative References
How other clinical authorities define this term. RRM Academy curates these verbatim or under fair use so the medical consensus is visible alongside our RRM-contextualized definition above.
- MeSH D000093665
A congenital duplication of the UTERUS in which a septum is formed separating the uterus. The partitioning septum can also separate the CERVIX and VAGINA.
- Wikipedia Uterine_septum
A uterine septum is a congenital uterine malformation where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape. The wedge-like partition may involve only the superior part of the cavity resulting in an incomplete septum or a subseptate uterus, or less frequently the total length of the cavity and the cervix resulting in a double cervix. The septation may also continue caudally into the vagina resulting in a "double vagina".
This content is for educational purposes only and does not constitute medical advice. Consult an RRM clinician or healthcare provider for guidance specific to your situation.