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Uterine anomalies are a relatively common congenital abnormality, with uterine septum being the most common (Table 8.1.1). This is even truer in patients with recurrent pregnancy loss, in whom rates of uterine abnormalities may approach 15% to 27%. Historically, the uterine septum has been approached via laparotomy through either a Tompkins or Jones procedure. These successful but highly morbid procedures required laparotomy, significant hospital stays, and subsequent cesarean delivery and had a high risk of adhesion formation. More recently, this surgery has been supplanted by hysteroscopic or other minimally invasive methodologies for treatment. This section focuses on the embryologic development of the genital tract that may lead to mullerian abnormalities, discusses the work-up of patients before treatment, evaluates the appropriate candidates for surgical procedures, and discusses the technical aspects of the procedure itself, postoperative recommendations, and results of various modalities of treatment. In addition, complications specific to these procedures are reviewed.
It is unclear what the exact rate of mullerian abnormalities is in the general population as there have been no good cross-sectional studies of normal patients. It is believed that the incidence is in the range of 1% to 6%, and there are numerous variations. The American Fertility Society (now the American Society for Reproductive Medicine) has published a classification system to standardize the nomenclature among surgeons (Tables 8.1.1, 8.1.2).