CONGENITAL UTERINE SEPTUM: CLINICAL SIGNIFICANCE, DIAGNOSIS AND TREATMENT RESULTS.

Abstract

A congenital uterine septum is the most common variant of malformations caused by a disturbance of the embryogenesis of the Mullerian ducts and is regarded as one of the significant factors of reproductive loss. The relevance of this pathology is determined by its high prevalence among women with fertility disorders and an unfavourable course of pregnancy. The aim of the present review was to summarise and critically analyse current views on the clinical significance of the uterine septum, the diagnostic possibilities and the results of therapeutic interventions on the basis of up-to-date scientific data. The review was carried out on the basis of an analysis of international clinical guidelines, systematic reviews, meta-analyses and original studies published in authoritative scientific journals on obstetrics, gynaecology and reproductive medicine. The work covers the key aspects of the embryological formation of the uterine septum, the features of the prevalence of this anomaly, and also the influence of the various morphological variants of the septum on the reproductive prognosis. A comparative assessment of diagnostic methods was carried out, including hysterosalpingography, two-dimensional and three-dimensional transvaginal ultrasound examination, magnetic resonance imaging and endoscopic methods, with an emphasis on their diagnostic accuracy, clinical informativeness and the limitations of their practical application. Current data indicate that three-dimensional transvaginal ultrasound examination, with or without saline infusion and Doppler imaging, is the most reliable and economically feasible non-invasive tool for differentiating a septate uterus from other anomalies of Mullerian duct development. An analysis of the results of surgical treatment showed that hysteroscopic resection of the uterine septum is accompanied by a substantial reduction in the frequency of reproductive losses and an improvement in the rates of achieving and carrying a pregnancy, especially in patients with recurrent miscarriage. At the same time, the question of the justification of prophylactic surgical intervention in women without clinical manifestations remains open and requires further study. Thus, the results of the review emphasise the need for a unified approach to diagnosis, the strict selection of patients for surgical treatment and the application of personalised, evidence-based management strategies. The integration of modern clinical and imaging methods contributes to more accurate diagnosis and to the optimisation of therapeutic tactics in congenital uterine septum in the practice of modern reproductive medicine.