Background: We describe a patient presenting with recurrent pregnancy loss secondary to concurrent uterine factors. Case: The patient was a 31-year-old white female who presented with recurrent pregnancy loss on two occasions. The couple had a normal work-up for recurrent miscarriages except for a fundal type II submucosal fibroid on transvaginal 3D ultrasound (US) with saline infusion hysterosonogram (SIH). Laparoscopic myomectomy and repair of the myometrial defect was performed. At the conclusion of the procedure, a diagnostic hysteroscopy suggested a possible concurrent incomplete short uterine septum, which could not be corrected for fear of cutting the myomectomy sutures. The patient did not appear for follow up, which led her to have three more miscarriages and one chemical pregnancy. The presence of a short uterine septum was confirmed on SIH with 3D US. The patient underwent hysteroscopic division of the short uterine septum. Results: Postoperative SIH showed a normal uterine cavity, and currently the patient is trying to conceive. Conclusion: Coexistence of a type II submucous fibroid in the fundal region of the uterus and an incomplete uterine septum presents both a diagnostic and management challenge. Surgical management of such coexisting uterine pathology cannot be performed in a single session. (J GYNECOL SURG 29:165)
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