Complete Septate Uterus (Hysterosalpingography)
A complete septate uterus is a congenital Müllerian duct anomaly caused by complete failure of resorption of the midline septum after fusion of the Müllerian ducts. The septum extends from the uterine fundus to the internal cervical os and may continue into the cervix or vagina. On hysterosalpingography, the uterine cavity is divided into two separate, symmetric hemicavities with a single external uterine contour. This anomaly is strongly associated with infertility, recurrent pregnancy loss, and adverse obstetric outcomes (Fig. 1).
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| Fig-1 |
Findings: The uterine cavity is completely divided by a central septum extending from the fundus to the internal os. Both hemicavities are symmetric with smooth margins. A single cervix is present. Fallopian tubes may arise from either hemicavity.
Conclusion: Imaging findings are consistent with a complete septate uterus. Further evaluation with 3D ultrasound or MRI is recommended to assess septal composition and confirm a normal external uterine contour.
Patient Symptoms
Patients commonly present with recurrent first-trimester pregnancy loss, infertility, preterm labor, or malpresentation. Some patients may be asymptomatic and diagnosed incidentally.
Procedure (Hysterosalpingography)
Hysterosalpingography is performed in the early proliferative phase of the menstrual cycle. Under aseptic precautions, a cervical cannula or balloon catheter is introduced. Contrast is injected slowly under fluoroscopic guidance to opacify both hemicavities and assess tubal patency.
Contrast Medium & Administration
A water-soluble iodinated contrast agent such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used with the patient in the lithotomy position. A total contrast volume of 10–14 mL may be required to adequately fill both hemicavities.
Instruments Used
- Sterile vaginal speculum (Cusco’s or Sims’)
- Uterine tenaculum (if required)
- Leech–Wilkinson cannula
- Rubin cannula
- Balloon HSG catheter
- 10–20 mL sterile Luer-lock syringe
- Sterile connecting tubing
- Antiseptic solution
- Fluoroscopy unit
Safety Considerations
Careful, low-pressure contrast injection is required to avoid uterine spasm and false-negative filling of one hemicavity. Pregnancy and active pelvic infection must be excluded prior to the procedure. HSG cannot assess the external uterine fundal contour; complementary imaging is necessary.
Related Conditions
Differential diagnoses include partial septate uterus, bicornuate uterus, uterus didelphys, and arcuate uterus. MRI or 3D ultrasound is essential for accurate classification and management planning.
Declaration
This case is presented for educational purposes only. Patient identity has been anonymized, and no personally identifiable information is disclosed.
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