In hysteroscopic assessment of the uterine cavity during infertility workup, an arcuate uterus is distinguished from a subseptate uterus by which feature?

• A Arcuate uterus has a fundal indentation >1 cm with convex fundal contour on HSG
• B Arcuate uterus shows a shallow smooth concave fundal indentation <1 cm with a fundal angle <90° ✓
• C Subseptate uterus has a septum not reaching the internal os while arcuate does not extend to the cavity
• D The distinction is made by the presence of two cornua on hysteroscopy

Explanation

Arcuate uterus is a normal variant characterized by a shallow convex (smooth) impression on the uterine fundus with indentation <1 cm and a fundal angle >90°. It is generally not associated with reproductive failure and does not require intervention. Subseptate uterus has a fibromuscular septum extending downward from the fundus that does not reach the internal os (partial septum), with the fundal angle typically <90° and indentation >1 cm. Complete septum extends to or beyond the internal os. Hysteroscopic metroplasty is indicated for septate uteri, not arcuate.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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