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Surgical management of congenital uterine anomalies

Ronald E Iverson, Jr, MD
Alan H DeCherney, MD
Marc R Laufer, MD
Section Editor
Robert L Barbieri, MD
Deputy Editor
Sandy J Falk, MD, FACOG


Congenital uterine anomalies are associated with a variety of gynecological and obstetrical problems [1,2]. Restoration of normal uterine architecture and preservation of fertility are the goals of surgical treatment of uterine anomalies (table 1 and figure 1). However, normal or near-normal architecture cannot always be achieved and merely creating a normal uterine cavity may not be therapeutic because uterine vascularization and myometrial and cervical function may also be abnormal.

Surgical management of congenital uterine anomalies is reviewed here. The evaluation and diagnosis of women with congenital uterine anomalies is discussed separately. (See "Clinical manifestations and diagnosis of congenital anomalies of the uterus".)


Surgical repair of congenital uterine anomalies is primarily directed toward women with uterine septa, bicornuate uteri, and obstructed hemi-uteri. Women with unicornuate or arcuate uteri are generally not candidates for reconstructive procedures because surgery does not improve pregnancy outcome [3].

The most common indications for repair of congenital uterine anomalies are pelvic pain and repetitive pregnancy loss. Prior to surgical intervention, however, other causes of these problems should be excluded. (See "Evaluation of couples with recurrent pregnancy loss".)

Dysmenorrhea in women with septate uteri may be considered an indication for hysteroscopic metroplasty if medical therapy is not effective. Laparoscopic evaluation for coexistent endometriosis (common in women with structural abnormalities of the reproductive tract) should be undertaken.


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Literature review current through: Sep 2016. | This topic last updated: Apr 13, 2016.
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  1. Arleo EK, Troiano RN. Complex mullerian duct anomalies defying traditional classification: Lessons learned. J IVF Reprod Med Genet 2013; 1:1000115.
  2. Grimbizis GF, Gordts S, Di Spiezio Sardo A, et al. The ESHRE/ESGE consensus on the classification of female genital tract congenital anomalies. Hum Reprod 2013; 28:2032.
  3. Acién P, Acién M, Sánchez-Ferrer M. Complex malformations of the female genital tract. New types and revision of classification. Hum Reprod 2004; 19:2377.
  4. Musich JR, Behrman SJ. Obstetric outcome before and after metroplasty in women with uterine anomalies. Obstet Gynecol 1978; 52:63.
  5. Lin PC, Bhatnagar KP, Nettleton GS, Nakajima ST. Female genital anomalies affecting reproduction. Fertil Steril 2002; 78:899.
  6. Heinonen PK, Pystynen PP. Primary infertility and uterine anomalies. Fertil Steril 1983; 40:311.
  7. Kirschner R, Löfstrand T, Mark J. Pregnancy in a non-communicating, rudimentary uterine horn. A reason for failed therapeutic second trimester abortion. Acta Obstet Gynecol Scand 1979; 58:499.
  8. Laufer MR. Laparoscopic resection of obstructed hemi-uteri in a series of adolescents. J Pediatr Adolesc Gynecol 1997; 10:163.
  9. Candiani GB, Vercellini P, Fedele L, et al. Argon laser versus microscissors for hysteroscopic incision of uterine septa. Am J Obstet Gynecol 1991; 164:87.
  10. Vercellini P, Vendola N, Colombo A, et al. Hysteroscopic metroplasty with resectoscope or microscissors for the correction of septate uterus. Surg Gynecol Obstet 1993; 176:439.
  11. Colacurci N, De Franciscis P, Mollo A, et al. Small-diameter hysteroscopy with Versapoint versus resectoscopy with a unipolar knife for the treatment of septate uterus: a prospective randomized study. J Minim Invasive Gynecol 2007; 14:622.
  12. Fedele L, Bianchi S, Gruft L, et al. Danazol versus a gonadotropin-releasing hormone agonist as preoperative preparation for hysteroscopic metroplasty. Fertil Steril 1996; 65:186.
  13. Vercellini P, Fedele L, Arcaini L, et al. Value of intrauterine device insertion and estrogen administration after hysteroscopic metroplasty. J Reprod Med 1989; 34:447.
  14. Candiani GB, Vercellini P, Fedele L, et al. Repair of the uterine cavity after hysteroscopic septal incision. Fertil Steril 1990; 54:991.
  15. Fedele L, Arcaini L, Parazzini F, et al. Reproductive prognosis after hysteroscopic metroplasty in 102 women: life-table analysis. Fertil Steril 1993; 59:768.
  16. Valle RF, Ekpo GE. Hysteroscopic metroplasty for the septate uterus: review and meta-analysis. J Minim Invasive Gynecol 2013; 20:22.
  17. Lefkowitz A, Edwards M, Balayla J. The Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Transpl Int 2012; 25:439.
  18. Lefkowitz A, Edwards M, Balayla J. Ethical considerations in the era of the uterine transplant: an update of the Montreal Criteria for the Ethical Feasibility of Uterine Transplantation. Fertil Steril 2013; 100:924.
  19. Grynberg M, Ayoubi JM, Bulletti C, et al. Uterine transplantation: a promising surrogate to surrogacy? Ann N Y Acad Sci 2011; 1221:47.
  20. Hansen A. Swedish surgeons report world's first uterus transplantations from mother to daughter. BMJ 2012; 345:e6357.
  21. Ozkan O, Akar ME, Ozkan O, et al. Preliminary results of the first human uterus transplantation from a multiorgan donor. Fertil Steril 2013; 99:470.
  22. Erman Akar M, Ozkan O, Aydinuraz B, et al. Clinical pregnancy after uterus transplantation. Fertil Steril 2013; 100:1358.
  23. Brännström M, Johannesson L, Bokström H, et al. Livebirth after uterus transplantation. Lancet 2015; 385:607.
  24. Gauthier T, Piver P, Pichon N, et al. Uterus retrieval process from brain dead donors. Fertil Steril 2014; 102:476.
  25. Fageeh W, Raffa H, Jabbad H, Marzouki A. Transplantation of the human uterus. Int J Gynaecol Obstet 2002; 76:245.
  26. March CM, Israel R. Hysteroscopic management of recurrent abortion caused by septate uterus. Am J Obstet Gynecol 1987; 156:834.
  27. Valle RF, Sciarra JJ. Hysteroscopic treatment of the septate uterus. Obstet Gynecol 1986; 67:253.
  28. Fayez JA. Comparison between abdominal and hysteroscopic metroplasty. Obstet Gynecol 1986; 68:399.
  29. Choe JK, Baggish MS. Hysteroscopic treatment of septate uterus with Neodymium-YAG laser. Fertil Steril 1992; 57:81.
  30. Heinonen PK, Saarikoski S, Pystynen P. Reproductive performance of women with uterine anomalies. An evaluation of 182 cases. Acta Obstet Gynecol Scand 1982; 61:157.
  31. Patton PE, Novy MJ, Lee DM, Hickok LR. The diagnosis and reproductive outcome after surgical treatment of the complete septate uterus, duplicated cervix and vaginal septum. Am J Obstet Gynecol 2004; 190:1669.
  32. Rock JA, Jones HW Jr. The clinical management of the double uterus. Fertil Steril 1977; 28:798.
  33. Khalifa E, Toner JP, Jones HW Jr. The role of abdominal metroplasty in the era of operative hysteroscopy. Surg Gynecol Obstet 1993; 176:208.
  34. Candiani GB, Fedele L, Parazzini F, Zamberletti D. Reproductive prognosis after abdominal metroplasty in bicornuate or septate uterus: a life table analysis. Br J Obstet Gynaecol 1990; 97:613.
  35. Ayhan A, Yücel I, Tuncer ZS, Kişnişçi HA. Reproductive performance after conventional metroplasty: an evaluation of 102 cases. Fertil Steril 1992; 57:1194.
  36. Capraro VJ, Chuang JT, Randall CL. Improved fetal salvage after metroplasty. Obstet Gynecol 1968; 31:97.
  37. Papp Z, Mezei G, Gávai M, et al. Reproductive performance after transabdominal metroplasty: a review of 157 consecutive cases. J Reprod Med 2006; 51:544.
  38. Kirk EP, Chuong CJ, Coulam CB, Williams TJ. Pregnancy after metroplasty for uterine anomalies. Fertil Steril 1993; 59:1164.
  39. Pabuçcu R, Gomel V. Reproductive outcome after hysteroscopic metroplasty in women with septate uterus and otherwise unexplained infertility. Fertil Steril 2004; 81:1675.
  40. Daly DC, Maier D, Soto-Albors C. Hysteroscopic metroplasty: six years' experience. Obstet Gynecol 1989; 73:201.
  41. Heinonen PK. Reproductive performance of women with uterine anomalies after abdominal or hysteroscopic metroplasty or no surgical treatment. J Am Assoc Gynecol Laparosc 1997; 4:311.
  42. Fedele L, Bianchi S, Bocciolone L, et al. Relief of dysmenorrhea associated with septate uteri after abdominal or hysteroscopic metroplasty. Acta Obstet Gynecol Scand 1994; 73:56.
  43. Halvorson LM, Aserkoff RD, Oskowitz SP. Spontaneous uterine rupture after hysteroscopic metroplasty with uterine perforation. A case report. J Reprod Med 1993; 38:236.
  44. Lobaugh ML, Bammel BM, Duke D, Webster BW. Uterine rupture during pregnancy in a patient with a history of hysteroscopic metroplasty. Obstet Gynecol 1994; 83:838.
  45. Angell NF, Tan Domingo J, Siddiqi N. Uterine rupture at term after uncomplicated hysteroscopic metroplasty. Obstet Gynecol 2002; 100:1098.