中南大学学报（医学版）

2022, 47(11) http://xbyxb.csu.edu.cn

J Cent South Univ (Med Sci) 1487

DOI：10.11817/j.issn.1672-7347.2022.220501

Treatment of septate uterus

ZHANG Baiyu1, WU Susu2, ZHAO Xingping2, TAN Lin1, XU Dabao2

(1. Jiangwan Research Institute, Central South University, Changsha Jiangwan Maternity Hospital, Changsha 410008;
2. Department of Gynecology, Third Xiangya Hospital, Central South University, Changsha 410013, China)

ABSTRACT Although there is insufficient evidence supporting the link between septate uterus and
infertility, there are many studies demonstrated the effect of spetal incision on pregnancy in
women diagnosed with septate uterus associated with infertility. Hysteroscopic metroplasty
can significantly improve the reproductive performance of those with septate uterus. Some
Müllerian malformations can be healed by surgery. The accurate diagnosis and appropriate
therapeutic approch are fundamental for successful treatment. Any attempt at surgical
correction of uterine abnormalities must be aimed at preserving or improving reproductive
function. Among congenital uterine anomalies, septate uterus is the most amenable to
simple hysteroscopic treatment. The resection of the septum is performed as standard
treatment worldwide.

KEY WORDS septate uterus; metroplasty; hysteroscopy

纵隔子宫的治疗
张白玉 1，伍苏苏 2，赵行平 2，谭琳 1，徐大宝 2

（1. 中南大学江湾研究院，长沙江湾妇产医院，长沙 410008；2. 中南大学湘雅三医院妇科，长沙 410013）

[摘 要] 纵膈子宫与不孕症之间的联系尚不明确。目前许多研究对诊断为不孕症的妇女进行子宫纵隔切开，并评
估了其对妊娠的后续影响。宫腔镜子宫成形术能显著改善纵隔子宫的生育力。部分苗勒氏畸形可以通过手术治愈，
准确的诊断和选择最佳的治疗技术是成功治疗的基础。所有纠正子宫异常的手术都应以保留或改善生育力为目的。
在先天性子宫异常中，纵隔子宫最适合采用宫腔镜治疗。纵隔切开逐渐成为全世界的治疗标准。
[关键词] 纵隔子宫；子宫成形术；宫腔镜

Date of reception: 2022-09-28

First author: ZHANG Baiyu, Email: 449786037@qq.com, ORCID: 0000-0003-0630-135X; WU Susu, Email: 1066530802@qq.com, ORCID: 0000-
0002-5296-6363
Corresponding author: XU Dabao, Email: dabaoxu2022@163.com, ORCID: 0000-0002-5455-5592; TAN Lin, Email: 358680988@qq.com, ORCID:
0000-0001-8524-5311
Foundation item: This work was supported by the National Key Research and Development Program of China (2018YFC1004800).

©Journal of Central South University (Medical Science). All rights reserved.

1488
The most relevant indications for surgery of septate
uterus are repeated abortion and infertility. With the
advances in minimally invasive procedures, especially
with the advent of hysteroscopy, other relative
indications include infertility requiring special treatment
by induction of ovulation, insemination, or other
assisted reproductive technologies. Tomazevic T, et al
have reported that the presence of septate uterus
decreases the pregnancy rate and may increase the
abortion rate after embryo transfers via in vitro
fertilization/intracytoplasmic sperm injection.
negative impact of uterine anomalies on pregnancy and
on live birth rates is an important deciding factors that
should be considered when making the decision to treat
uterine anomalies in infertile women. The literature[2]
has reported that prophylactic metroplasty could
prevent adverse pregnancy outcomes, even in patients
with no prior fertility problems. In recent years, there
has been an increase in indications for treatment of
conditions associated with primary infertility. It has also
been suggested that metroplasty might be
performed during the “white balance” laparoscopy
underteken before an assisted reproductive technique to
prevent any potential obstetric accidents, especially in
patients with long-standing infertility and declining
fecundity (>35 years) [3]. This paper aims to summarize
the treatment of septate uterus and management of
operation.
1 Overview of spetate uterus
Septate uterus is usually diagnosed during an
infertility evaluation. The incidence of uterine septum is
higher in the infertile population than the general
population, which suggesst that there may be a
[4-7]
connection with infertility . However, definitive proof
of an association between septate uterus and infertility is
[8]
lacking . A septate uterus may be partial or complete,
and the septum may be thick or thin. There is also
insufficient evidence to conclude that the length or
width of the septum has a subsequent effect on
pregnancy.
Nonetheless septate uterus does appear to affect
reproductive health by impairing fertility, and increasing
©Journal of Central South University (Medical Science). All rights reserved.
中南大学学报 ( 医学版 ), 2022, 47(11) http://xbyxb.csu.edu.cn
the likehood of adverse pregnancy outcomes[4].
Compared with other uterine anomalies, septate uterus is
associated with the highest incidence of reproductive
failure and adverse obstetrical complications. It is also
associated with the poorest reproductive outcomes such
as abortion, preterm delivery and infertility, with fetal
[1]
survival rates of 6% to 28% and a high rate of
[9-11]
spontaneous miscarriage (>60%) . Others adverse
pregnancy outcomes include intrauterine growth
restriction, abnormal placentation, fetal malpresentation,
The and an increased risk of cesarean delivery[2]. But there
are many women with uterine septa who do not
experience any reproductive difficulties[12].
2 Pathophysiology of spetate uterus
Most women with Müllerian anomalies,
particularly women diagnosed with septate uterus have
good reproductive function, and only 20% to 25% may
experience recurrent spontaneous abortions[9, 13].
best There is limited evidence supporting the potential
relationship between the pathophysiology of the uterine
septum and impaired reproductive outcomes in women
with a septate uterus. The argument behind resection of
the septum is based on the hypothesis that the septum is
composed of an entirely different structure than the
normal uterine wall[14-15]. Thus, embryo implantation into
the septum would hypothetically, leading to a poorer
reproductive outcome compared to implantation into the
lateral uterine wall. To explain the negative impact of
the septum on fertility and pregnancy outcomes, some
studies[14, 16-18] have suggested that the septum is a poor
site for embryonic implantation due to the assumed poor
vascularization, decreased sensitivity to preovulatory
changes of the endometrium overlying the septum,
uncoordinated contractility of the septum, or a local
defect of vascular endothelial growth factor receptors in
the endometrium covering the septal area.
Detti L, et al[19] have reported that the implications
of uterine subseptations for infertility and adverse
pregnancy outcomes, may be the result of a combination
of several factors such as a wide and misshapen uterine
cavity, the subseptation length, and a decreased
endometrial surface.
Treatment of septate uterus ZHANG　
Baiyu, et al
3 Treatment of spetate uterus
3.1　Changes in surgical techniques　 without anesthesia/analgesia[24], a reduced risk of intra-
The treatment of the septate uterus has undergone
major changes, and many corrective surgical techniques
have been proposed. Traditionally, the uterine septum is
repaired with a laparotomy or hysteroscopic techniques.
The incisions of the uterine septum are first
performed via laparotomy and hysterotomy and only in
women with a history of repeated abortion. To preserve
the ongoing pregnancy, noninvasive techniques such as
bed rest, cervical cerclage, and tocolytic agents are
frequently used. Abdominal metroplasty procedures
performed have 3 types: the Jones technique, Bret-
Tomkins metroplasty, and the El Mahgoub approach.
The Jones technique involve transfundal
excision of the septate uterus by removing a cuneiform
portion of the fundal myometrium and septum with
[20]
subsequent repair . The Bret-Tomkins metroplasty is
performed by division of the uterus
anteroposterior plane and transverse division of the
septum in the middle without excision of myometrial
tissue. Both methods result in a viable pregnancies rate
of 70% to 80% [21-22]
. The El Mahgoub approach used
small fundal, transverse incisions in the uterus along the
septum and the transfundal removal of the uterus with
long scissors .[23]
The techniques have some complications including
postoperative reduction of the uterine cavity, formation
of postoperative adhesions, and inconveniences due to
the peritoneal incision, such as the prolongation of the
duration of hospitalization and a longer convalescence.
Moreover, transabdominal metroplasty requires
postoperative interval of 3 to 6 months before
conception, with a significant risk of uterine rupture in
the subsequent pregnancy necessitating a routine
cesarean section.
The development of the less invasive surgical
hysteroscopy techniques has considerably simplified the
therapeutic treatment. Therefore, these other invasive
procedures have largely been abandoned. Resection of
the septum improves reproductive
Hysteroscopic resection of the septum is safe and
efficient and has become the primary modality of
treatment. Currently, the preferred treatment for septate
uterus is hysteroscopic metroplasty with good results .
©Journal of Central South University (Medical Science). All rights reserved.
1489
The advantages of this minimally invasive hysteroscopic
approach are the following outpatient surgery with or
and postoperative morbidity, no risk of postoperative
pelvic adhesions, and an increased rate of vaginal
delivery[25]. Hysteroscopic metroplasty can be performed
in the operating room under anesthesia or in an office
setting. The techniques used include incision of the
septum with cold scissors and unipolar or bipolar
cautery, or laser, or resection of the septum[8]. Distending
media for the uterus include saline, glycine, sorbitol, or
mannitol, depending on the incision technique or the
energy source. To date, there is insufficient evidence to
recommend a specific instrument for the hysteroscopic
incision of the septum[8].
uterine During the procedure, the tubal ostia are the
surgical landmarks used for proper orientation. After
clear vision of the cavity and its deformity is obtained,
the septum is incised across the apex from the lower
in the margin and is gradually reduced with progressive,
upward, horizontal midline incisions until visualization
of the muscular fibers is achieved. The incision of the
septum is made equidistantly from the anterior and
posterior uterine walls, and the procedure is completed
when a restored triangular cavity occurs with free
movement of the hysteroscopy between the 2 exposure
of the muscle fibers of the fundus. Traditionally, the
most commonly used instruments are the resectoscope
fitted with an appropriately designed electrode and
hysteroscopic scissors[12].
After cervical dilatation, an electrode (monopolar
or bipolar) is activated when the resectoscope is used.
a The cutting electrode usually applied is the 90° -angled
electrode. With monopolar energy, the procedure takes
longer, and there is a risk of complications of fluid
overload[26]. With bipolar energy, isotonic saline solution
is used as the distention medium. Therefore, the risk of
complications due to intravasation is lower than with
monopolar energy. During resection, excessive bleeding
or significant amounts of cellular debris may impair
visualization of the surgical area and prohibit
[27-28]
outcomes. completion of the procedure .
Through the 5 or 7 French operative channel of an
hysteroscopy, hysteroscopic cold scissors or energy
modalities can be introduced to perform hysteroscopic
[12]
metroplasty. Anesthetic time, recovery time, pain, and
1490
blood loss are reduced[29-30]. Hysteroscopic metroplasty
has the advantages of a shorter hospital stay, and
patients are able to conceive within a shorter
[31]
postoperative period . The absence of a postoperative
uterine scar following transcervical metroplasty allows
[31]
for labor and transvaginal delivery . It has been
reported that hysteroscopic metroplasty may
[32-34]
performed in the office setting in some cases
particular when the septum is partial and thin and the
procedure can be performed in an ambulatory surgical
center. However, the unpredictable nature of this type of
procedure demands caution and careful selection to
avoid failure, frustration, and possible complications.
Although hysteroscopic metroplasty for the septate
uterus seems to be a relatively safe procedure, various
complications can occur either during the procedure or
in subsequent pregnancy and childbirth. To confirm the
uterine contour, decrease the risk of uterine perforation,
and assess complete removal of the septum and the
presence of other anomalies, laparoscopy
transabdominal ultrasound may be used during
hysteroscopic metroplasty[11]. Concomitant laparoscopic
or ultrasonic monitoring is an option to increase safety
and security during hysteroscopic incision of the septum
and may facilitate surgery by improving visibility of the
surgical area. Other techniques for hysteroscopic
metroplasty have been described, including the use of
fluoroscopy, sonographically guided septal division, and
even the tactile guidance of thin scissors[31, 35-36].
3.2　Different types of septate uterus　 been found to be less effective and precise than have
[37]
In 1996, Fedele L, et al reported that a residual
uterine septum of <1 cm after hysteroscopic metroplasty
does not adversely affect reproductive outcome. A cutoff
length for the uterine subseptations by defining a uterus
with a subseptation <10 mm in length as arcuate [American
Fertility Society (AFS) class VI] and a uterus with a
subseptation ≥10 mm in length as septate (AFS class V) .
Therefore, surgical intervention was recommended for
clinically important subseptations >10 mm. However,
Detti L, et al [19]
found that when the subseptation was ≥
5.9 mm in length, the postoperative cavity remodeling
was independent of subseptation length. Thus, they
proposed a new cutoff of ≥5.9 mm, stating that surgical
correction restores a normal uterine cavity and thereby
rectifies potential adverse implications of the septum.
©Journal of Central South University (Medical Science). All rights reserved.
中南大学学报 ( 医学版 ), 2022, 47(11) http://xbyxb.csu.edu.cn
A septate uterus with cervical septum (class U2C1)
or double cervix (class U2C2) might also be present.
Although there is no consensus on the incision of the
cervical septum in these cases of septate uterus because
of potential cervical weakness after surgery, incision of
a coexisting cervical septum is usually performed [11, 39-40].
be In cases of a double cervix and complete septate uterus,
, in unification of the cavity is only performed from the
level of the isthmus up to the fundus. Thus, incision of
the cervical septum should be avoided because of
potential trauma to the cervix, which is associated with
cervical insufficiency in subsequent pregnancies.
3.3　Complications of hysteroscopic metroplasty　
Hysteroscopic metroplasty may involve
complications such as bleeding, fluid overload, uterine
perforation, postoperative uterine adhesions, and uterine
rupture in subsequent pregnancies.
When uterine distention is insufficient for
or providing adequate visualization of the septum to enable
accompanying vessels from the uterine wall to be
deflected from the central portion of the uterine septum,
bleeding during hysteroscopic metroplasty may occur.
Additionally, when the procedure is performed in the
luteal phase of the menstrual cycle rather than in the
early follicular phase, postoperative bleeding may also
occur[36, 41]. In the echo-guided procedure, however,
bleeding is not a problem, as ultrasound is transmitted
well through liquids and can be performed on any day of
the menstrual cycle[31]. Yet, echo-guided methods have
been other methods. In addition, when the uterus is not
distended, the patient may be exposed to significant
intraoperative bleeding which may be difficult to control
and may prohibit completion of the treatment in a single
setting or stage.
When the duration of the operation is prolonged
[38]
and the fluid deficit is not closely monitored, excessive
fluid absorption may occur. This is very important,
especially when monopolar instruments are used
because the fluids used are devoid of electrolytes,
potentially leading to hyponatremia[42-44]. Candiani GB,
et al[45] have reported that there is a tendency for
minimal central fundal adhesions to form at the base of
the sectioned triangle, as contact between the
unepithelialized surfaces is inevitable due to the wide
Treatment of septate uterus ZHANG　
Baiyu, et al
area of the surgical resection.
To reduce the occurrence of intraoperative and
postoperative complications, preoperative
postoperative management are important. To date, there
is no consensus on the preoperative management of
hysteroscopic metroplasty, and there is no evidence to
support routine preoperative endometrial thinning. The
rationale behind the use of agents to thin the
endometrium prior to performing a hysteroscopy for
septal incision is that hysteroscopic visualization may be
improved when the procedure is performed early in the
menstrual cycle or with endometrial suppression[8]. In
addition, medications used to thin the endometrium
preoperatively usually create a hypoestrogenic
environment which may increase
postoperative adhesions forming. It recommend that
hysteroscopic metroplasty be scheduled in the early
proliferative phase of the menstrual cycle[8]. In
circumstances of a complete or a wide septum with
narrow uterine cavities, preoperative
thinning to facilitate visualization may be considered[6].
To prevent reformation of the
intrauterine adhesions after metroplasty, many surgeons
advocate the use of estrogen to rapidly epithelialize the
denuded endometrial cavity[3, 46-48], or use temporary
splints, such as intrauterine devices (IUD), to maintain
distension of the uterine cavity[7, 44-49]. Two studies[50-51]
have reported that IUD insertion and hormonal therapy
after hysteroscopic metroplasty do not seem to help to
prevent septal fusion. One randomized controlled trial[6]
comparing Foley balloon insertion versus no balloon
insertion following hysteroscopic metroplasty has found
that splinting the uterine cavity with a Foley catheter
yielded no benefits for septum reformation, clinical
pregnancy rate, or pregnancy outcomes.There is still no
consensus on management after
metroplasty. Moreover, no benefit of routine antibiotic
therapy during hysteroscopy has been established;
however, many surgeons use routine
prophylaxis during hysteroscopic metroplasty.
After abdominal metroplasty, the margins of the
endometrial lining are brought together when the uterine
body is reconstructed [51]
. After hysteroscopic incision of
the septum, however, wide areas in the endometrial
covering are left on the anterior and posterior walls .
[45]
Candiani GB, et al assessed the appearance of the
©Journal of Central South University (Medical Science). All rights reserved.
1491
endometrium after incision of the septum with the
correlated endometrial biopsy in 19 women who were
and randomized to follow-up hysteroscopy at different
postoperative periods (1, 2, 4, or 8 weeks). Multiple
biopsies at different intervals (7 d, 14 d, 1 month, and 2
months) after hysteroscopic septal incision in the 19
women were taken. At 2 months, the uterine cavity in
each woman was almost normal with a minimal
tendency to central fundal adhesions. Therefore, the
authors concluded that perhaps there is no reason to
delay attempts at pregnancy for more than 2 cycles after
surgery. Another study[53] evaluated the optimal waiting
period for subsequent fertility treatment after
metroplasty in 16 patients diagnosed with septate uterus.
the risk of
The research[8] reported that 100% of patients by 2
months postoperatively demonstrated a healed uterine
cavity. With respect to the time from incision of the
septum to attempt of pregnancy, there is insufficient
evidence to advocate a specific length of time before a
endometrial
woman should conceive.
After transcervical metroplasty, the rate of cesarean
septum or
section is still high despite the avoidance of laparotomy.
The label of “high-risk pregnancy” that has been
attached to pregnant women with a history of
hysteroscopic resection may explain this fact, making
them more likely to receive intensive obstetric care[30].
4 Conclusion
Although there is not sufficient evidence to indicate
that uterine septum affects fertility, resection of the
septum is performed worldwide as standard treatment in
women experiencing repeated abortion. With the
development of hysteroscopy techniques, the invasive
hysteroscopic procedures of laparotomy have largely been abandoned.
Hysteroscopic resection of the septum has become the
primary modality of treatment. However, hysteroscopic
antibiotic metroplasty may have complications, such as bleeding,
fluid overload, and postoperative uterine adhesions,
which require preoperative and postoperative
management. More evidence is required for clinicians to
reach consensus on the preoperative and postoperative
management of hysteroscopic metroplasty and the
[52]
specific length of time before a woman should conceive
following hysteroscopic metroplasty.
1492 中南大学学报 ( 医学版 ), 2022, 47(11) http://xbyxb.csu.edu.cn

Contributions: ZHANG Baiyu Conceptualized, [10] Venkata VD, Jamaluddin MFB, Goad J, et al. Development and

drafted, and edited the manuscript; WU Susu
Collected and analyzed the literature, conceptualized
and submitted the manuscript; ZHAO Xingping
Conceptualized and reviewed the manuscript; TAN Lin
Analyzed and explicated the literature; XU Dabao
Conceptualized the manuscript and supported for
research funding. All authors have approved the final
version of this manuscript.
Conflict of interest: The authors declare that they have
no conflicts of interest to disclose.
References
[1] Tomaževič T, Ban-Frangež H, Virant-Klun I, et al. Septate,
subseptate and arcuate uterus decrease pregnancy and live birth
rates in IVF/ICSI[J]. Reprod Biomed Online, 2010, 21(5): 700-
705. https://doi.org/10.1016/j.rbmo.2010.06.028.
[2] Vaz SA, Dotters-Katz SK, Kuller JA. Diagnosis and
management of congenital uterine anomalies in pregnancy[J].
Obstet Gynecol Surv, 2017, 72(3): 194-201. https://doi. org/
10.1097/OGX.0000000000000408.
[3] Rikken JFW, Kowalik CR, Emanuel MH, et al. The
randomised uterine septum transsection trial (TRUST): Design
and protocol[J]. BMC Womens Health, 2018, 18(1): 163. https://
doi.org/10.1186/s12905-018-0637-6.
[4] Akhtar MA, Saravelos SH, Li TC, et al. Reproductive
implications and management of congenital uterine anomalies
[J/OL]. BJOG, 2020, 127(5): e1-e13[2022-09-07]. https://doi.
org/10.1111/1471-0528.15968.
[5] Kim MA, Kim HS, Kim YH. Reproductive, obstetric and
neonatal outcomes in women with congenital uterine
anomalies: A systematic review and meta-analysis[J]. J Clin
Med, 2021, 10(21): 4797. https://doi.org/10.3390/jcm 10214797.
[6] Joshi B, Kaushal A, Suri V, et al. Prevalence and pregnancy
outcome of Mullerian anomalies in infertile women: A
retrospective study[J]. J Hum Reprod Sci, 2021, 14(4): 431-
435. https://doi.org/10.4103/jhrs.jhrs_3_21.
[7] Hosseinirad H, Yadegari P, Falahieh FM, et al. The impact of
congenital uterine abnormalities on pregnancy and fertility: A
literature review[J]. JBRA Assist Reprod, 2021, 25(4): 608-
616. https://doi.org/10.5935/1518-0557.20210021.
[8] Practice Committee of the American Society for Reproductive
Medicine. Uterine septum: A guideline[J]. Fertil Steril, 2016,
106(3): 530-540. https://doi. org/10.1016/j. fertnstert. 2016.
05.014.
[9] Santana González L, Artibani M, Ahmed AA. Studying
Müllerian duct anomalies from cataloguing phenotypes to
discovering causation[J]. Dis Model Mech, 2021, 14(6):
dmm047977. https://doi.org/10.1242/dmm.047977.
characterization of human fetal female reproductive tract
organoids to understand Müllerian duct anomalies[J/OL]. Proc
Natl Acad Sci USA, 2022, 119(30): e2118054119[2022-09-01].
https://doi.org/10.1073/pnas.2118054119.
[11] Passos IMPE, Britto RL. Diagnosis and treatment of müllerian
malformations[J]. Taiwan J Obstet Gynecol, 2020, 59(2): 183-
188. https://doi.org/10.1016/j.tjog.2020.01.003.
[12] Noventa M, Spagnol G, Marchetti M, et al. Uterine septum
with or without hysteroscopic metroplasty: impact on fertility
and obstetrical outcomes[J]. J Clin Med, 2022, 11(12): 3290.
https://doi.org/10.3390/jcm11123290.
[14] Bosteels J, van Wessel S, Weyers S, et al. Hysteroscopy for
treating subfertility associated with suspected major uterine
cavity abnormalities[J]. Cochrane Database Syst Rev, 2018, 12:
CD009461. https://doi.org/10.1002/14651858.CD009461.pub4.
[15] Rikken JF, Kowalik CR, Emanuel MH, et al. Septum resection
for women of reproductive age with a septate uterus[J].
Cochrane Database Syst Rev, 2017, 1: CD008576. https://doi.
org/10.1002/14651858.CD008576.pub4.
[16] Rikken J, Leeuwis-Fedorovich NE, Letteboer S, et al. The
pathophysiology of the septate uterus: A systematic review[J].
BJOG, 2019, 126(10): 1192-1199. https://doi.org/10.1111/1471-
0528.15798.
[17] Casadio P, Magnarelli G, la Rosa M, et al. Uterine fundus
remodeling after hysteroscopic metroplasty: A prospective pilot
study[J/OL]. J Clin Med, 2021, 10(2): E260[2022-09-01]. https://
doi.org/10.3390/jcm10020260.
[18] Vomstein K, Aulitzky A, Strobel L, et al. Recurrent
spontaneous miscarriage: A comparison of international
guidelines[J]. Geburtshilfe Frauenheilkd, 2021, 81(7): 769-779.
https://doi.org/10.1055/a-1380-3657.
[19] Detti L, Hickman H, Levi D, et al. Relevance of uterine
subseptations: What length should warrant hysteroscopic
resection? [J]. J Ultrasound Med, 2017, 36(4): 757-765. https://
doi.org/10.7863/ultra.15.07073.
[20] Yi SJ, Jiang JF. Clinical characteristics and management of
patients with complete septate uterus, double cervix, obstructed
hemivagina, and ipsilateral renal agenesis[J]. J Obstet
Gynaecol Res, 2021, 47(4): 1497-1501. https://doi.org/10.1111/
jog.14662.
[21] Romanski PA, Bortoletto P, Pfeifer SM. A framework approach
for hysteroscopic uterine septum incision: Partial and complete
[J]. Fertil Steril, 2022, 118(1): 205-206. https://doi.org/10.1016/
j.fertnstert.2022.04.014.
[22] Zhou QY, Saravelos S, Huang XW, et al. Laparoscopic
metroplasty for bicorporeal uterus: Surgical techniques and
outcomes[J]. Chin Med J (Engl), 2020, 134(9): 1107-1109.
https://doi.org/10.1097/CM9.0000000000001266.
[23] Musich JR, Behrman SJ. Obstetric outcome before and after
metroplasty in women with uterine anomalies[J]. Obstet
Gynecol, 1978, 52(1): 63-66.
[24] Salazar CA, Isaacson KB. Office operative hysteroscopy: An

©Journal of Central South University (Medical Science). All rights reserved.

Treatment of septate uterus ZHANG　
Baiyu, et al
update[J]. J Minim Invasive Gynecol, 2018, 25(2): 199-208.
https://doi.org/10.1016/j.jmig.2017.08.009.
[26] Roy KK, Metta S, Kansal Y, et al. A prospective randomized
study comparing unipolar versus bipolar hysteroscopic
myomectomy in infertile women[J]. J Hum Reprod Sci, 2017,
10(3): 185-193. https://doi.org/10.4103/jhrs.JHRS_134_16.
[27] Tammam AE, Ahmed HH, Abdella AH, et al. Comparative
study between monopolar electrodes and bipolar electrodes in
hysteroscopic surgery[J]. J Clin Diagn Res, 2015, 9(11): 11-13.
https://doi.org/10.7860/JCDR/2015/16476.6792.
[28] Calabrese S, DE Alberti D, Garuti G. The use of bipolar
technology in hysteroscopy[J]. Minerva Ginecol, 2016, 68(2):
133-142.
[29] The American College of Obstetricians and Gynecologists.
ACOG technology assessment no. 13: hysteroscopy[J]. Obstet
Gynecol, 2018, 131(5): 1. https://doi. org/10.1097/AOG.
0000000000002634.
[30] Mak JN, Imran A, Burnet S. Office hysteroscopy: back to the
future[J]. Climacteric, 2020, 23(4): 350-354. https://doi. org/
10.1080/13697137.2020.1750589.
[31] Marton I, Habek D, Prka M, et al. Intrapartal resection of the
double cervix and longitudinal vaginal septum after
hysteroscopic resection of the complete uterine septum,
resulting in a term vaginal delivery: A case report[J]. Case Rep
Womens Health, 2016, 11: 1-4. https://doi. org/10.1016/j. crwh.
2016.08.001.
[32] Catena U, Campo R, Bolomini G, et al. New approach for T-
shaped uterus: Metroplasty with resection of lateral
fibromuscular tissue using a 15 Fr miniresectoscope. A step-by-
step technique[J]. Facts Views Vis Obgyn, 2021, 13(1): 67-71.
https://doi.org/10.52054/FVVO.13.1.003.
[33] Esteban Manchado B, Lopez-Yarto M, Fernandez-Parra J, et al.
Office hysteroscopic metroplasty with diode laser for septate
uterus: a multicenter cohort study[J]. Minim Invasive Ther
Allied Technol, 2022, 31(3): 441-447. https://doi. org/10.1080/
13645706.2020.1837181.
[34] Nappi L, Pontis A, Sorrentino F, et al. Hysteroscopic
metroplasty for the septate uterus with diode laser: A pilot study
[J]. Eur J Obstet Gynecol Reprod Biol, 2016, 206: 32-35. https://
doi.org/10.1016/j.ejogrb.2016.08.035.
[35] Wortman M. Resectoscopic surgery part III: Advanced
resectoscopic surgery[J]. Surg Technol Int, 2022, 40: 179-189.
https://doi.org/10.52198/22.STI.40.GY1549.
[36] Wortman M. Resectoscopic surgery part II: introducing
ultrasound guidance for intermediate-level surgical procedures
[J]. Surg Technol Int, 2021, 39: 217-231. https://doi. org/
10.52198/21.STI.39.GY1481.
[37] Fedele L, Bianchi S, Marchini M, et al. Residual uterine
septum of less than 1 cm after hysteroscopic metroplasty does
not impair reproductive outcome[J]. Hum Reprod, 1996, 11(4):
727-729. https://doi.org/10.1093/oxfordjournals.humrep.a019242.
[38] Ludwin A, Martins WP, Nastri CO, et al. Congenital Uterine
Malformation by Experts (CUME): Better criteria for
©Journal of Central South University (Medical Science). All rights reserved.
1493
distinguishing between normal/arcuate and septate uterus? [J].
Ultrasound Obstet Gynecol, 2018, 51(1): 101-109. https://doi.
org/10.1002/uog.18923.
[39] Oppelt P, Binder H, Birraux J, et al. Diagnosis and therapy of
female genital malformations (part 1). guideline of the DGGG,
OEGGG and SGGG (S2k level, AWMF registry number 015/
052, may 2019) [J]. Geburtshilfe Frauenheilkd, 2021, 81(12):
1307-1328. https://doi.org/10.1055/a-1471-4781.
[40] Seljeflot EB, Nytun ØE, Kjøtrød SB, et al. A septate uterus
with double cervix during two pregnancies: pregnancy
outcome before and after cervix sparing metroplasty. A case
report[J]. Facts Views Vis Obgyn, 2020, 12(2): 149-152.
[41] Foreste V, Gallo A, Manzi A, et al. Hysteroscopy and retained
products of conception: an update[J]. Gynecol Minim Invasive
Ther, 2021, 10(4): 203-209. https://doi. org/10.4103/GMIT.
GMIT_125_20.
[42] Manchanda R, Valenti G, Rathore A, et al. Distension media
delivery systems in hysteroscopy: past, present and future[J].
Minim Invasive Ther Allied Technol, 2022, 31(1): 1-12. https://
doi.org/10.1080/13645706.2020.1763402.
[43] Lan L, Zhang YG, Wang J, et al. Dilutional hyponatremia
during hysteroscpic surgery: prevention and treatment[J]. Acta
Academiae Medicinae Sinicae, 2016, 38(4): 470-474. https://
doi.org/10.3881/j.issn.1000-503X.2016.04.018.
[44] Atieh AS, Abu Shamma OK, Abdelhafez MO, et al. Acute
severe hyponatremia following hysteroscopic procedure in a
young patient: A case report and review of the literature[J].
Case Rep Nephrol, 2021, 2021: 7195660. https://doi. org/
10.1155/2021/7195660.
[45] Candiani GB, Vercellini P, Fedele L, et al. Repair of the uterine
cavity after hysteroscopic septal incision[J]. Fertil Steril, 1990,
54(6): 991-994.
[46] Sun Y, Chen XY, Qian ZD, et al. Estradiol and intrauterine
device treatment for moderate and severe intrauterine
adhesions after transcervical resection[J]. BMC Womens
Health, 2022, 22(1): 357. https://doi. org/10.1186/s12905-022-
01940-6.
[47] Liu AZ, Zhao HG, Gao Y, et al. Effectiveness of estrogen
treatment before transcervical resection of adhesions on
moderate and severe uterine adhesion patients[J]. Gynecol
Endocrinol, 2016, 32(9): 737-740. https://doi. org/10.3109/
09513590.2016.1160375.
[48] Zheng YX, Zhu YM, Zhuge T, et al. Metabolomics analysis
discovers estrogen altering cell proliferation via the pentose
phosphate pathway in infertility patient endometria[J]. Front
Endocrinol (Lausanne), 2021, 12: 791174. https://doi. org/
10.3389/fendo.2021.791174.
[49] Lee WL, Liu CH, Cheng M, et al. Focus on the primary
prevention of intrauterine adhesions: Current concept and
vision[J]. Int J Mol Sci, 2021, 22(10): 5175. https://doi.org/10.
3390/ijms22105175.
[50] Bosteels J, Weyers S, D’Hooghe TM, et al. Anti-adhesion
therapy following operative hysteroscopy for treatment of
1494 中南大学学报 ( 医学版 ), 2022, 47(11) http://xbyxb.csu.edu.cn

female subfertility[J]. Cochrane Database Syst Rev, 2017, 11: anomaly[J/OL]. BMJ Case Rep, 2022, 15(5): e244237 [2022-
CD011110. https://doi.org/10.1002/14651858.CD011110.pub3. 09-20]. https://doi.org/10.1136/bcr-2021-244237.
[51] Aas-Eng MK, Langebrekke A, Hudelist G. Complications in [53] Fascilla FD, Resta L, Cannone R, et al. Resectoscopic

operative hysteroscopy—is prevention possible? [J]. Acta metroplasty with uterine septum excision: A histologic analysis
of the uterine septum[J]. J Minim Invasive Gynecol, 2020, 27
Obstet Gynecol Scand, 2017, 96(12): 1399-1403. https://doi.
(6): 1287-1294. https://doi.org/10.1016/j.jmig.2019.11.019.
org/10. 1111/aogs.13209.
[52] Dunphy L, Taylor S, Whitby EH, et al. Robert’s uterus
(asymmetric septate uterus): A rare congenital Müllerian duct (Edited by TIAN Pu)

本文引用：张白玉, 伍苏苏, 赵行平, 谭琳, 徐大宝 . 纵隔子宫的

治疗[J]. 中南大学学报(医学版), 2022, 47(11): 1487-1494. DOI:
10.11817/j.issn.1672-7347.2022.220501
Cite this article as: ZHANG Baiyu, WU Susu, ZHAO Xingping,
TAN Lin, XU Dabao. Treatment of septate uterus[J]. Journal of
Central South University. Medical Science, 2022, 47(11): 1487-
1494. DOI:10.11817/j.issn.1672-7347.2022.220501

©Journal of Central South University (Medical Science). All rights reserved.