Saturday, December 1, 2007

Back to the business at hand - BU & SU Primer

I want this blog to tell my story, but also be a resource for those who may have just found out that they have a uterine anomaly, like a Septate or Bicornuate Uterus. So I will just take a minute to provide you with my knowledge -- which you should know is based on my own experience and research. I am not a Doctor, though sometimes I feel like I know more than one about my condition.
  • Bicornute (BU) and Septate Uteri (SU) can look nearly the same on the inside. The interior uterine cavity is divided in two by a kind of wall, which can be made of a vascular or non-vascular material. The wall can sometimes extend through the entire length of the cavity, bisecting it completely. Other times it may only partially divide the cavity.
  • Bicornuate and Septate Uteri look very different from the outside. A Septate uterus has a "normal" or domed FUNDUS (the fundus is the top of the uterus, opposite the cervix). A bicornuate uterus has a cleft fundus, following the contour or the interior. A bicornuate uterus looks heart-shaped both inside and out, while a septate uterus has a "normal" shape outside and a heart shape inside
  • Bicornuate Uteri are less common and have a relatively good reproductive track record. Issues range from breech positioning to incompetent cervix. I have read that 2nd trimester is the time to be most attentive, when the the fetuses weight is resting on the cervix, not the pelvis.
  • Septate Uteri and the most common MA and have one of the worst reproductive outcomes of the MA's, but if threated properly can become statistically normal in pregnancy outcomes. Treatment involves a Lap/Hyst - where a surgeon can physically see the outside of the uterus to ensure it is not cleft, while at the same time, cutting away the septum hysteroscopically. It is an out-patient procedure with about a week recovery time. Doctor's will give you the OK to TTC anywhere from 1-3 months post-op.
  • Bicornuate uteri are sometimes, but rarely operated on. This procedure is a major surgery.
  • Ultrasound is an exceptionally poor diagnostic tool for determining the difference between a Bicornuate and Septate Uterus.
  • MRI can be effective at diagnosing the difference.
  • Lap/Hyst is the only SURE way to know what you got.
  • A diagnosis of Bicornuate is the "catch-all". If you are told this is what you have via ultrasound, do not proceed with TTC. Make yourself an appointment with a reputable RE and request an MRI followed by a Lap/Hyst.
I had/have a uterine septum. I was told I was BU after a first trimester loss. Found out I was SU by MRI after second loss. Resected Nov. 14, 2007. Still waiting to find out if it was a success.

Please feel free to post comments to me if you are new to the whole MA thing and have questions. I know how scary and confusing it can be.

17 comments:

Carissa said...

That really helps me out. I was diagnosed with BU during my c-section at 38w5d back in August '07. I have yet to see pics or talk with my doctor more about it. I'm hoping it's not TOO bad since I held onto a pregnancy for that long with little to no complications. Thanks for the info!

Anonymous said...

I have a question. I had a septum resectioned a few months ago. After a few failed IUI's, they did an additional HSG to ensure the resection was successful. I never saw the second HSG and the doctors just said it looked 'fine.'

Recently I had the lab send me the films for my HSGs, because I am seeing a different doctor. To me the second one doesn't look much better than the first. I was expecting a nice, clear open triangular shaped uterus but it is still v-shaped just not as badly.

In your experience, is this a normal result after resection, or should it look like those images of 'normal' hsg's with uteri that have never had an issue?

I don't have a google account so I'll leave my email wilsonsrt@excite.com

Anonymous said...

I had an ovarian cyst back in 2000-when I was 21. I had a vaginal us done and my septum was found during that visit. At the time I wasn't married or planning to get pregnant. I got married in May 2007, and 'accidentally' conceived in August. I only carried 'til 8 weeks--had elective D&E in October. Conceived again in December '08, again, carried to 8 weeks, had another elective D&E Feb. '08. Obvoiusly, I am EXTREMELY fertile, but I just can't seem to hold on to my pg's. I had an MRI today to r/o bicornuate uterus. I am 99% sure it is septate, but we shall see. I am hoping to have my septum resected once my doc reviews my MRI. I am also awaiting antiphospholipid antibody results.

Anonymous said...

I first got pregnant in March of 2007 and lost that one at 6-7 weeks. The doctors were able to tell just by the ultrasound that I had some sort of tissue bridge in my uterus. My sister was told she had a septum or bicornuate uterus and I told my doctors this and they went ahead and did an MRI (also to check out a cyst which turned out to be nothing). My MRI clearly showed that I had a partial septum. In June of 2007 I went to see an RE specialist. He said that the septum was a third of the way down and not too terribly bad and it's not clear what caused the miscarriage. He said that I could elect to have the septum resected or go ahead and try again and see what happens. My husband and I choose to try again only because we did not want to have surgery unless we knew it was the probable cause of the miscarriage. In November of 2007, we got pregnant again!! We too have had no problems getting pregnant (first time both times). At 8 weeks, we once again lost the baby. I had elective D&E's with both miscarriages. My doctor went ahead and did a full Recurrent Pregnancy Loss workup. Almost all the tests seemed to come back ok. I have a few other issues (thyroid antibodies which will eventually lead to thyroid disease) but my doctor seemed to think the septum is the number one thing to be concerned with. In Jan '08 we scheduled a septum resection surgery for April (first one available!!). I went on birth control for about 2 months to thin out the lining of my uterus so there would not be too much blood during surgery. This past Tuesday I had the surgery done. It wasn't really that bad at all. My doctor inserted a catheter in my uterus (filled with water) to keep the shape of my uterus in tact and so the walls don't mesh together. I get to remove this on Tuesday. I am also on antibiotics for a week and hormones for 25 days to thicken the lining of my uterus back up. The catheter is more of a nuisance than anything else but will be worth it!! I have my follow-up on May 5 and my doctor said everything seemed to go well right after the surgery. I guess we shall wait and see... we were told we'd be able to start trying again in June!

Anonymous said...

I was diagnosed with a possible Bicornuate uterus or septum when I was 6 weeks pregnant. At that time they just told me I'd be high risk and may deliver early. At my 10 week checkup, there was no heartbeat. I had a D&E two days later. This was my first pregnancy and miscarriage so it was really difficult....and still is... About a month after the D&E, I went to a specialist who after an internal ultrasound diagnosed me with a septum and then immediately scheduled me for a hysteroscopy and septum resection. I was extremely nervous to have this procedures in the dr's office, without any kind of anesthesia, etc. but the dr. assured me that I'd be ok and that he thought I'd be able to tolerate the procedure. I just had the procedure about an hour ago and I made out ok. I watched the whole thing on the monitor. The worst part was having the hysteroscopy scope inserted and moved around. It looked like a radio antenna! I was extremely fearful of the cutting away of the septum but it wasn't as bad as I imagined. The septum really didn't bleed much. It did hurt a little but it was probably moreso because I was so tense, etc. Now I just have some cramping, but I'm doing ok. The doctor wants us to try again this month. He said there is a chance of another miscarriage, but because he was able to cut pretty far into the septum he felt that he increased the surface area of the uterus and we should TTC again before we moved on to the 2nd surgical procedure being an operation with larascopy, etc. So that's my story so far. Just wanted to share my experience of the septum resection.

Anonymous said...

The girl who posted after me has such a similar story! My mom had a septate uterus like your sister. From everything I have read, it's never attributed to genetics, but obviously it has some genetic connection. I also have hypothyroid due to antithyroid antibodies! I take synthroid daily and my Thyroid levels are fine.
I just had my septum resected on May 27th, and honestly the worst part is the effects of anesthesia. My chest hurts terribly from the breathing tube, every muscle in my abdomen aches! I woke up in pain, but I've only needed motrin since. I had some bleeding afterward, had a pediatric catheter in my uterus for 2 days--never had to drain the cath bag--minimal blood loss.
Of course, now, I am worried about uterine adhesions. I guess I will fear the worst and hope for the best throughout this whole process.
Please add any info you may have in reference to the outcome of this surgery! Thank you!!

Anonymous said...

Thanks for having this blog, this really helps me out. I was diagnosed with a septate uterus after 2 miscarriages. I have a consult appt to have it removed in a few weeks!

Anonymous said...

Thanks for having this blog, this really helps me out. I was diagnosed with a septate uterus after 2 miscarriages. I have a consult appt to have it removed in a few weeks!

Jenn said...

Thank you! It's been 3 days since the HSG, and I feel like I've been reading for the past 48 hours. That diagram brought tears to my eyes. It finally makes sense to me.
Your blog is wonderful.

Anonymous said...

I was reading a post from April 12, 2008 and it sounded exactly like my story and then I realized I had posted it! How time flies. Just an update..my resection went really well. It showed no scarring at all and healed correctly so we tried again in July and got pregnant! I am now 26 weeks pregnant and due in March. I am so glad I got the surgery done-- so far this pregnancy has been worry-free and no complications!

Rebecca said...

I found your blog today and thank f'n God that I did. I was so moved and thankful that I myself blogged about your blog:
http://ndbexcreations.net/2009/03/20/wow/
I hope you don't mind. If you didn't have this blog out there, I would still feel horribly alone. I had an MRI today and next week I'll find out if it's a septum or bicornate.

Anonymous said...

Hello - I am thankful to have found these entries. I am scheduled to have a hysteroscopic septum resection in a few weeks. I am very nervous. Could someone please give me details about what specifically happens the day of the procedure, how long it may take, what pain there might be during and after, and how long (hours/days) in terms of recovery? I have 'hospital' info, but would like to hear from people who have experienced this and can give me insight. Thank you very much!

admin said...

This is a great resource and should answer some of your question: http://mulleriananomalies.blogspot.com/

My hysteroscopy was pretty smooth. The procedure itself was only an hour or so, but then you have to spend time in recovery. I took pain killers the first day then switched to ibuprofen. I had the surgery on a thrusday and was back to work on Monday with no problems. It is a simple procedure with a pretty short recovery. I would say a week at most.

You should also join the Mullerian Anomalies Yahoo group. The women there are wonderful and many have been through this.
http://health.groups.yahoo.com/group/MullerianAnomalies/

Good luck to you.

Anonymous said...

My husband and I were TTC with our first and I miscarried at 9weeks. The ultrasound picked up what looked like a SU and I just left my appointment for my MRI and am back at work. The whole process has been an incredible struggle for me emotionally. I am glad I found your blog, as I can't tell you what a comfort it feels to hear others experiences. Thanks for starting it.

Colleen said...

When I was finally diagnosed with a septate uterus after 3 miscarriages in one year I was so grateful to find this website with such a straightforward and clear explanation. Also, the stories of other women helped me feel at last that there are others out there like me.
So I wanted to take a moment to share my experience with having the lap/hyst surgery to remove the septum in case it will help other women who haven't gone through it yet.
I had the surgery this Wednesday and it is now Saturday. I was nervous going in, but the prep was smooth and I remember nothing of the surgery. It lasted 50 minutes and they were able to provide before and after photos of the uterus from both the inside and outside. We have to wait a month to do an SIS test to confirm they removed it all, but they think they did. No real soreness in the vaginal area, but I was surprised how tender my belly and my belly button were after the procedure. I had the incision for the lap. camera in my belly button plus a second small incision on my left side to help guide the camera. The belly was inflated with gas to make room for the camera in my stomach and that has not quite fully deflated yet. Bleeding from the belly button continued into the 2nd day with contact from jeans, but only minimally. The secondary incision hasn't bled at all. They said I could resume normal activity the next day, but I didn't feel up to it until Friday afternoon at best, so be sure to give yourself time for self care after the surgery and don't rush back into life. Your body has plenty of healing to do!
I hope this helps. I'm looking forward to experiencing a full-term pregnancy and I really believe this is going to make it possible.

Colleen said...

Also, my mom probably had a bicornuate uterus (she's had a hysterectomy so no way to tell if it was BI or septate now) and my aunt's uterus was divided into almost 2 separate chambers because what was probably a septum was so extended.
My miscarriages were:
Twins at 6.5 wks (no heartbeat) Pills to clear (5 wks bleeding) & D&C
Boy at 10.5 wks (nothing wrong genetically) D&C
Blighted ovum discovered at 8 wks(pills to clear)
We are able to get pregant on the first try every time after the 2-3 month waiting period after miscarriage using 2.5mg of Femara. Typically have 2 eggs sized for fertilization at LH positive.

Anonymous said...

My daughter has a SU dicovered at 6 week scan. Miscarried at 8 weeks.
Had further investigation after MC and also found POCS .She is now almost 30 weeks pregnant and doing well.Baby implanted on the right side wall of uterus, away from the septum. (thank goodness.)
Very closely monitored and scanned, and she is having steroid injections in 2 days to develop the babies lungs.They dont think she will carry to fullterm and it will be a C.section. Bubs has been breech for over 12 weeks...not enough room.
A bit scary seeing the babies feet under the septum on the last scan.Doctors are very pleased with her progress..but she isnt out of the woods yet.She has passed many milestones along the way, including a major bleed, so things are looking good.
Just want bubs to hang in there for a few more weeks. Good luck to everyone that has these annomalies and never give up....anything is possible. xxx first time grandma to be.