Hysteroscopic metroplasty – resection of an intrauterine septum using Collins knife electrode. The septum is divided by cutting towards the fundus, maintaining the symmetry of the uterine cavity throughout the procedure.
Müllerian anomalies – embryology and anatomy
- The fallopian tubes and the uterus are of müllerian origin. As the paramesonephric ducts fuse caudally in early embryonic life forming the upper part of the vagina and the uterus, the proximal upper part forms the fallopian tubes.
- This process begins at around week six of intrauterine life and is complete by week 12–14.
- Normal female development is the result of a lack of the effect of müllerian inhibiting factor (produced by the testes) on the paramesonephric (müllerian) ducts.
- The uterine septum that results from the fusion of the two paramesonephric ducts completes its reabsorption by week 20.
- Failure of this process results in the development of septate uterus (parial or complete).
- This does not affect the uterine body, which is uniform externally in the case of a septate uterus compared with a bicornuate uterus. The primary difference, therefore, between a bicornuate and septate uterus is the appearance of the uterine fundus.
- Uterine septae vary in length and width. This results in the following anomalies:
- partial septate uterus – the septum divides the uterine cavity partially
- complete septate uterus – when the septum extends the entire length of the uterine corpus
- complete with septate uterus and cervix – when the septum extends to the entire length of the cervix.
- A vaginal septum is present in 25% of these people.
- Urinary tract anomalies may co-exist.