Diagnostic Approach and Treatment of Septate Uterus

Diagnostic Workup

MRI is the gold standard for diagnosing and classifying septate uterus with 100% accuracy in surgically proven Müllerian duct anomalies (MDAs), as recommended by the American College of Radiology 1, 2
3D transvaginal ultrasound (TVUS) is an excellent alternative with 92% accuracy in classification of MDAs, according to the American College of Radiology 1, 3
Hysterosalpingography (HSG) has poor accuracy (only 16.7%) in characterizing MDAs and cannot reliably differentiate between septate and bicornuate uterus, as stated by the American College of Radiology 1, 2
On both TVUS and MRI, a fundal cleft <1 cm indicates septate uterus while a cleft >1 cm suggests bicornuate uterus, as per the American College of Radiology 1, 3
A fundal indentation <5 mm above the interostial line also helps identify septate versus bicornuate uterus, according to the American College of Radiology 2, 3

Hysteroscopic septoplasty improves fertility and obstetrical outcomes by increasing pregnancy rates, as reported by the American College of Radiology 2

The American College of Radiology recommends 3D transvaginal ultrasound (TVUS) as an excellent alternative to MRI for diagnosing and classifying septate uterus, with 92% accuracy in classification of Müllerian duct anomalies 4
Proper terminology should specify the location of the gestational sac relative to the uterine Müllerian duct anomaly, such as "GS in right horn of septate uterus", as described by the Radiology society 5

The Radiology society suggests avoiding terms like "unicornuate pregnancy" or "bicornuate pregnancy" when describing gestational sacs in septate uteri, instead describing the GS location relative to the uterine Müllerian duct anomaly 5