Uterine Septum Removal (Hysteroscopic Metroplasty) for Recurrent Miscarriage

In short: A uterine septum is a wall of muscle or fibrous tissue that divides the cavity of the uterus in two, and is linked to a higher risk of recurrent miscarriage and preterm birth. It is removed by hysteroscopy, with no cut in the abdomen, restoring the normal shape of the cavity. Complications are few: perforation of the uterus in about 1% of cases and adhesions in about 2%. A caesarean is not obligatory in a later pregnancy.

A uterine septum is a congenital condition present from birth, in which a muscular or fibrous wall divides the inside of the uterus, creating two separate cavities instead of one.

The septum may be complete or incomplete, depending on how far it extends into the uterine cavity.

This condition is more commonly found in women who experience primary infertility or recurrent miscarriages, and identifying it can be an important step in understanding your reproductive health.

Hysteroscopic uterine septum resection Videos

Surgical removal of the septum — a procedure called metroplasty — is usually considered for women who have a septate uterus along with a history of repeated miscarriages (defined by European guidelines as 2 or more pregnancy losses, and by UK guidelines as 3 or more) or preterm deliveries.

A hysteroscopic approach is a minimally invasive way to perform this surgery, done through the vagina and cervix without external incisions, which helps reduce discomfort and shorten recovery time.

The goal of the procedure is to restore a more normal-shaped uterine cavity by carefully removing the septum. Observational studies suggested fewer miscarriages afterwards, but a recent randomised trial (TRUST, 2021) did not show a higher live-birth rate, so current European guidance (ESHRE 2022) recommends deciding case by case after careful discussion with your doctor.

The procedure may be performed with the guidance of ultrasound or laparoscopy to improve safety and precision. If a patient has recently had a miscarriage, doctors usually wait at least 6 weeks before performing a hysteroscopic metroplasty, to allow the uterus to heal.

hysteroscopy-videos

Unlike traditional transabdominal metroplasty (an open surgical approach), a caesarean section is not automatically required for patients who become pregnant after a hysteroscopic metroplasty — though your doctor will guide delivery decisions based on your individual case.

Hysteroscopic uterine septum Photos

Complications :

Uterine perforation during hysteroscopic metroplasty (1% )

Uterine synechiae (scar tissue) after hysteroscopic metroplasty ( 2%)

If you have experienced recurrent miscarriage or unexplained infertility, discussing your case with an experienced gynecologist can help you understand whether a uterine septum may be a contributing factor, and whether treatment options such as hysteroscopic metroplasty could be suitable for you.

Dr Najeeb Layyous F.R.C.O.G

Consultant Obstetrician, Gynecologist and Infertility Specialist