What is a septated cervix?

What is a Septated Cervix?

A septated cervix is a rare congenital anomaly where the cervix is divided by a septum (wall of tissue), resulting from incomplete resorption of the midline septum during embryologic development of the female reproductive tract. This condition is part of a spectrum of Müllerian duct anomalies that can affect the uterus, cervix, and vagina 1.

Anatomy and Classification

A septated cervix can present in several forms:

• Cervical septum (C1): A single cervix divided by a septum
• Double cervix (C2): Two distinct cervical canals with separate external openings

The septated cervix is often associated with other reproductive tract anomalies:

1. Complete uterine septum with cervical septum (Class U2bC1V1 according to European Society of Human Reproduction and Embryology/European Society for Gynaecological Endoscopy classification) 2
2. Septate uterus with double cervix (Class U2bC2) 3
3. Longitudinal vaginal septum (V1) - frequently coexists with cervical septum 2

Diagnosis

Diagnosis of a septated cervix requires careful evaluation and can be challenging, particularly differentiating between a single cervix with a septum versus a true double cervix. The most effective diagnostic approach combines:

• Transvaginal ultrasound: Can identify the presence of a septum 1
• 3D ultrasound: Provides better visualization of the cervical anatomy 2
• Hysteroscopy: Direct visualization of the cervical canal(s) 2
• MRI: Offers detailed imaging of the reproductive tract anatomy 1

During speculum examination, the cervix may appear abnormal with either:

• A single external os with a visible septum
• Two distinct cervical openings 1

Clinical Significance

The clinical significance of a septated cervix includes:

1. Reproductive implications:

   • May be associated with higher rates of miscarriage 4
   • Can contribute to infertility 5
   • May affect pregnancy outcomes 4

2. Symptoms:

   • Dyspareunia (painful intercourse) 2
   • Menstrual irregularities
   • Difficulty with gynecological procedures (like Pap tests or IUD insertion) 1

3. Pregnancy complications:

   • Potential increased risk of preterm birth 1
   • May affect cervical dilation during labor

Management

Management depends on symptoms and reproductive goals:

• Asymptomatic patients: May not require intervention
• Symptomatic patients: Surgical correction may be considered, especially with:
  • History of pregnancy loss
  • Infertility
  • Significant dyspareunia 2

Surgical approaches include:

• Hysteroscopic resection of the cervical septum 2
• Excision of associated vaginal septum if present 5
• Combined approach with laparoscopy and hysteroscopy for complex cases 6

Important Considerations

• The diagnosis of a septated cervix requires careful differentiation from other cervical anomalies
• The condition is rare, with limited data on prevalence and outcomes
• Management should be based on symptoms and reproductive goals
• Surgical correction has shown improved reproductive outcomes in symptomatic patients 4
• During gynecologic examinations, awareness of this anomaly is important for proper specimen collection and evaluation 1

A septated cervix represents a developmental variation that may significantly impact reproductive health and requires specialized evaluation and management by providers with expertise in complex gynecologic anomalies.