Uterine Septum
A uterine septum is a wall of tissue that divides the cavity of the uterus. It forms before birth. Early in development, two tubes join to form the uterus. The tissue between them normally disappears. When it does not, a wall remains. A uterus with this wall is a septate uterus. When the wall extends only partway down, the uterus is subseptate. Both terms describe the same problem. The wall narrows or divides the space where a pregnancy must implant and grow. A uterine septum is the most common congenital difference in uterine shape.1 The outer shape of the uterus remains normal. This feature distinguishes it from a bicornuate uterus.2
The wall is a poor site for a pregnancy to establish itself. It has a smaller blood supply than the normal lining. A smaller blood supply is thought to make implantation and placental growth more difficult.3 Many septa cause no symptoms. They appear by chance on a scan done for another reason.4 When a septum does come to attention, recurrent pregnancy loss is the most common reason.5 Some women also have preterm labor, or a baby in an abnormal position late in pregnancy.6
Two tests can detect a septum. One is 3D transvaginal ultrasound. The other is saline infusion sonohysterography, which fills the cavity with fluid for a clearer image.7 Guidance from a major professional society recommends 3D transvaginal ultrasound, with or without saline infusion, as the preferred nonsurgical test.8 Saline helps in some cases. It is not necessary in every case. Operative hysteroscopy is the accepted surgical method to correct a septum.9 The first purpose of testing is to confirm a septum and rule out a different uterine anomaly before any repair is planned.2
In a repair, the surgeon works through the cervix and divides the wall. The repair leaves a single cavity and spares the muscle of the uterus.9 This operation is hysteroscopic metroplasty. It has replaced the older open abdominal surgery as the standard of care.10 Cohort studies report that more pregnancies continue after repair in women with a confirmed septum and a prior loss.11 Those studies had no untreated comparison group. They cannot separate the effect of surgery from the favorable odds of a normal next pregnancy after a single loss. One randomized trial compared repair with watchful waiting and found no live birth advantage.12 Randomized evidence on this question remains limited.1314 Clinicians therefore offer repair selectively. It goes most often to couples with a confirmed septum and recurrent loss, rather than to every woman with a septum.15 It also carries meaningful risks, including perforation of the uterine wall and scar tissue inside the cavity.16
A uterine septum is a structural problem, and surgery can correct it. A restorative evaluation looks for a septum, and for other causes, before a couple continues trying to conceive. The goal is for the couple to know what may be affecting their pregnancies, instead of proceeding without that information. Other conditions merit evaluation at the same time. Intrauterine scar tissue (intrauterine adhesions) can form after any procedure inside the cavity.17 Submucosal fibroids can occur alongside a septum and further distort the shape of the cavity.18
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/
- Practice Committee of the American Society for Reproductive Medicine. Evidence-based diagnosis and treatment for uterine septum: a guideline. Fertility and Sterility. 2024;122(2):251-265. https://pubmed.ncbi.nlm.nih.gov/38556964/
- 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/
- 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/
- Rikken JFW, Kowalik CR, Emanuel MH, Bongers MY, et al. Septum resection versus expectant management in women with a septate uterus: an international multicentre open-label randomized controlled trial. Human Reproduction. 2021;36(5):1260-1267. https://pubmed.ncbi.nlm.nih.gov/33793794/
- 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/
- 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.