Examination Methods for Uterine Septum

Uterine septum is one of the major causes of recurrent miscarriage 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 can reveal the shape of the septum—typically Y-shaped—and offers a relatively high diagnostic accuracy, with reported detection rates of approximately 70%. However, suboptimal image resolution may lead to misdiagnosis, particularly because TVUS cannot reliably differentiate between complete and incomplete uterine septa.

② Hysteroscopy

Hysteroscopy allows direct visualization of the intrauterine cavity and enables precise classification of uterine septum type. When combined with TVUS, hysteroscopy—using bladder distension and intrauterine distension fluid as contrast media—enhances acoustic window clarity, permitting clear delineation of uterine contour, width, septal length, and fundal morphology.

③ Hysterosalpingography (HSG)

HSG can identify a completely septate uterus but cannot reliably distinguish it from bicornuate or didelphic uterus. Despite this limitation, HSG remains moderately accurate for diagnosing uterine septum, with an overall diagnostic accuracy of approximately 60%.