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A septate uterus is the most common Müllerian duct anomaly, resulting from incomplete resorption of the medial septum after fusion of the paired Müllerian ducts. It is a congenital anomaly associated with a high risk of miscarriage and infertility, but is surgically correctable, making accurate diagnosis crucial.

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Embryology

During embryogenesis, the Müllerian ducts fuse in the midline to form the uterus.
The central fibrous or fibromuscular septum between them should resorb by the end of the 1st trimester.
Failure of resorption leads to a septate uterus with a single external fundal contour but two endometrial cavities separated by a septum.

Associated anomalies:

Mild association with renal anomalies (unlike unicornuate/didelphys)
Occasionally seen with cervical duplication

Classification

Type	Description
Complete septate uterus	Septum extends from fundus to internal os (or cervix)
Partial septate uterus	Septum partially divides endometrial canal, not reaching os
Subseptate uterus	Minor indentation of the endometrial cavity; debated as a variant

![Classification of MDAs on the basis of the American Society for Reproductive Medicine system.

Image courtesy of Joanna Culley, BA Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian Duct Anomalies. RadioGraphics. 2012;32(6):E233-E250. doi:https://doi.org/10.1148/rg.326125515](https://s3-us-west-2.amazonaws.com/secure.notion-static.com/52442e06-da2c-4a76-a12a-1613cb93ba39/Untitled.png)

Classification of MDAs on the basis of the American Society for Reproductive Medicine system.

Image courtesy of Joanna Culley, BA Behr SC, Courtier JL, Qayyum A. Imaging of Müllerian Duct Anomalies. RadioGraphics. 2012;32(6):E233-E250. doi:https://doi.org/10.1148/rg.326125515

Clinical Features

Recurrent first-trimester miscarriages (most common)
Infertility
Premature labor, fetal malpresentation
Usually asymptomatic in adolescence (normal menstruation)

Embryology

Classification

Clinical Features

Radiology