Congenital malformations of the uterus can be diagnosed by imaging techniques like ultrasonography, CT or MRI. Ultrasonography is noninvasive and economical. So it is often done as one of the many tests done for gynecological disorders. CT and MRI are used only if some anatomical abnormality is suspected and cannot be diagnosed accurately by using ultrasonography.. So uterine malformations may not be diagnosed when a woman presents with infertility and her clinical findings are normal. Such patients are subjected to hysteroscopy and laparoscopy to detect causes of infertility. Hysteroscopy detects uterine septa and bicornuate uteri coincidentally, the conditions not being responsible for the infertility. Laparoscopy detects bicurnuate uteri and may help suspect presence of a septate uterus.
We had one such patient. Hysteroscopy was done by a junior resident and a junior consultant. They could not visualize the uterine cavity very well owing to failure to achieve a good distension of the uterine cavity. Then they performed a laparoscopy on her. When I looked at the screen of the endoscopy monitor, I remarked,
"That looks like a septate uterus. The two parts of the uterus are seen separated by a groove running between them in the sagittal plane."
"....." they were not totally convinced. But one does not usually disagree with the boss, I suppose. It looked like the following model, except that the groove was a little less pronounced.
"I cannot put in a hysteroscope now. You did not have good distension, and hence you did not even connect the camera to the endoscope. So I may not get satisfactory distension too. Besides there will be some bleeding from endometrial trauma by the uterine manipulator that you are using. That will make the fluid turbid and obscure vision. Now we have to feel the inside of the fundus with a curette when you curette out the endometrium."
The junior consultant tried that after chromopertubation test was done and was found to be positive.
"The contour of the funds is smooth" he said. "There is no septum inside."
I was convinced there would be a septum in there. So I took over. I put the curette in the left cornual area, and slowly moved it along the inside of the fundus towards the right cornu. It dipped in the midline and then traveled up again to the right cornu. The path was as shown below.
"There is a septum in there" I said. "Watch the movement of the handle of the curette that is seen from the outside."
They watched intently. The handle did move as the tip moved inside the uterine cavity.
"Yes, there is a septum" they agreed.
"This is the tactile method of diagnosing a septate or bicornuate uterus" I said.
We had one such patient. Hysteroscopy was done by a junior resident and a junior consultant. They could not visualize the uterine cavity very well owing to failure to achieve a good distension of the uterine cavity. Then they performed a laparoscopy on her. When I looked at the screen of the endoscopy monitor, I remarked,
"That looks like a septate uterus. The two parts of the uterus are seen separated by a groove running between them in the sagittal plane."
"....." they were not totally convinced. But one does not usually disagree with the boss, I suppose. It looked like the following model, except that the groove was a little less pronounced.
"I cannot put in a hysteroscope now. You did not have good distension, and hence you did not even connect the camera to the endoscope. So I may not get satisfactory distension too. Besides there will be some bleeding from endometrial trauma by the uterine manipulator that you are using. That will make the fluid turbid and obscure vision. Now we have to feel the inside of the fundus with a curette when you curette out the endometrium."
The junior consultant tried that after chromopertubation test was done and was found to be positive.
"The contour of the funds is smooth" he said. "There is no septum inside."
I was convinced there would be a septum in there. So I took over. I put the curette in the left cornual area, and slowly moved it along the inside of the fundus towards the right cornu. It dipped in the midline and then traveled up again to the right cornu. The path was as shown below.
"There is a septum in there" I said. "Watch the movement of the handle of the curette that is seen from the outside."
They watched intently. The handle did move as the tip moved inside the uterine cavity.
"Yes, there is a septum" they agreed.
"This is the tactile method of diagnosing a septate or bicornuate uterus" I said.
