Septate Uterus: A Brief History/Anatomy Lesson

My Müllerian anomaly journey began during my first pregnancy. At my first appointment I managed to talk my OB into doing an ultrasound (I was 8 weeks pregnant and they normally didn't do them until 12 weeks). During the ultrasound the technician asked if anyone had ever mentioned anything about a bicornuate uterus to me before. Since I had never had an ultrasound the obvious answer was no. She and my OB explained to me the basics I needed to know about bicornuate uteruses. They're shaped funny, can sometimes contribute to fertility issues, and are often unwilling to stretch for the baby, which can lead to preterm labor. I was briefed on the signs of preterm labor and told to call if any of those signs occurred.

At each appointment I was reminded of the signs of preterm labor and I began to have cervical checks around 28 weeks. I measured ahead by one to two months from about 24 weeks on and my OB was quietly paranoid that I would need bed rest and would have preterm labor. As I progressed and nothing was happening with my cervix he began to doubt if I really had a bicornuate uterus. Then my water broke at 36 weeks and two hours later preterm labor began. You've no doubt read that whole story before.

Jump forward to April 2014. I finally schedule a regular check up with an OBGYN in the new area where I'm living (we moved from NY to WV when Jr. was 4 weeks old). While at this appointment I obviously bring up the possible bicornuate uterus and I also mention something my OB in NY had discovered at my 36 week appointment: my vaginal septum. I wanted to discuss surgical options to remove said septum and after seeing another doctor in the practice I was referred to a reproductive enchronologist. They felt he would have the skills to deal with the septum should I choose to remove it. 

Dr. T wanted to get the best possible picture of what was going on at that appointment. So after some discuss of my first pregnancy and what I hope to achieve in this appointment, I was given a thorough pelvic exam and ultrasound. Without a baby in there it was easy (for him) to see what was going on. He told me more than once that I did not read the reproductive textbook when I was in my mother's womb.

All Müllerian anomalies occur when you are being formed in your mother's womb. Often it just happens without help from genetics. (There are anomalies that can be created due to drug use, but I haven't researched that to know if it's due to hard drugs or prescription drugs.) In the early stages of development some cells come together and create the Müllerian tubes or ducts. In a female they will later form the Fallopian tubes, uterus, cervix, and upper one-third of the vagina. These tubes get lost in males. During the change from tubes to reproductive organs things can go wrong.

Dr. T determined that I had a septate uterus. This means that there is a wall of uteran tissue dividing my uterus leaving me with two horns, as they are termed. Septate uteruses can be either fully divided (all the way through the cervix) or partially. In my case, though I have an abnormality, I hit the jackpot because it could be way worse and this is why. Normally the presence of a vaginal septum would strongly indicate that the uterus is complete divided and potentially there are two cervixes. I am very lucky because my vaginal septum creates a little pocket and stops just short of my cervix. After a thorough exam it was concluded that I only have one cervix (yay only one Pap smear at a time!) and the ultrasound seemed to show that the two uteran horns meet before the cervical canal which is great news for attempting a vaginal birth. 

The other main thing to know about septate uteruses is that the septum can be either vascular (with a blood supply) or avascular (without a blood supply), and each has their complications. Women with an avascular septum will experience fertility issues and miscarriages. This is due to the lack of a blood supply to the septum, which prohibits an embryo from implanting and thriving on the septum. BUT there's good news!! Doctors should be willing to do a surgical procedure to "remove" it. During this procedure they simply snip it down the middle and it springs back to the sides. This will help considerably with the aforementioned problems because it decreases the area within the uterus that does not have a blood supply. Women who have a vascular septum will be at an increased risk for premature rupture of the membranes (PROM), preterm labor (PTL), and abnormal fetal position (increasing your chances of a c-section). Another downside is that doctors tend to not recommend surgery because it's difficult to control bleeding after surgery and can often become very complicated. 

The next post will focus on my first OB appointment with this pregnancy.

Below is a picture of Müllerian anomalies, which I found via radiologypics.com.