Examination Methods for Uterine Septum

Uterine septum is one of the major causes of recurrent pregnancy loss in women. Diagnostic modalities include transvaginal ultrasound (TVUS), hysteroscopy, and hysterosalpingography (HSG).

① Transvaginal Ultrasound (TVUS)

TVUS is a simple and widely used method for detecting uterine septum. It allows visualization of the septum’s morphology—typically appearing Y-shaped—and offers a relatively high diagnostic accuracy for uterine septum, with reported detection rates of approximately 70%. However, suboptimal image resolution may lead to misdiagnosis, particularly as TVUS cannot reliably distinguish between complete and incomplete uterine septa.

② Hysteroscopy

Hysteroscopy provides direct, real-time visualization of the intrauterine cavity, enabling precise classification of uterine septum type. When combined with TVUS, bladder filling and intrauterine distension with saline solution enhance contrast, improving visualization of the uterine contour, width, septal length, and fundal morphology.

③ Hysterosalpingography (HSG)

HSG can identify a complete uterine septum by revealing a characteristic “double-uterine-cavity” appearance. However, it cannot reliably differentiate uterine septum from other Müllerian anomalies such as didelphys uterus or bicornuate uterus. Despite this limitation, HSG maintains relatively high diagnostic accuracy for uterine septum, with an overall accuracy rate of approximately 60%.