Uterine Septum
The most frequent type of congenital uterine anomaly is the septate uterus, which is caused by the imperfect or complete failure of Müllerian duct fusion. The complete septate uterus, in which the septum separates the entire uterine cavity, and the subseptate uterus, in which a partial split of the uterine cavity does not reach the cervix, are both described. Failure of fusion may occur at a lower level, resulting in the presence of two cervices and even a vaginal septum. A new revised classification system for congenital uterine defects has been created by the European Society of Human Reproduction and Embryology (ESHRE) and the European Society for Gynecological Endoscopy (ESGE). The uterine septum was defined as a uterus that has a regular shape and an inner depression at the fundal centerline that was greater than half the thickness of the uterine wall. This indentation is known as a septum, and it can partition the uterine chamber partially or fully, including the cervix and/or vaginal canal in some circumstances (cervical and vaginal coexistent anomalies). In the general population, the true prevalence of Müllerian abnormalities is unknown. The paucity of diagnostic instruments hampered early investigations on congenital uterine defects, which were primarily focused on clinical examination. A meta-analysis of 94 observational studies involving approximately 91,000 women found a prevalence of 5% in the general population, 8.5 percent in infertile women, 13 percent in women who have had a miscarriage, and 24 percent in women who have had a miscarriage and are infertile. Canalization anomalies (subseptate or septate uteri) were also seen in 3% of the general population but were found substantially more commonly among women who had previously miscarried. Furthermore, a septate uterus is linked to a higher rate of abortion in the first and second trimesters, as well as premature labor, atypical labor, intrauterine growth restriction, and infertility. Reduced blood supply, uterine cavity deformation, increased intrauterine pressure with resulting cervical insufficiency, and altered estrogen and progesterone receptor expression are all possible causes of these disorders. When indications exist, surgical repair of a septate uterus should be regarded as a first-line treatment.