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A uterine septum and a bicornuate uterus are types of congenital uterine anomalies caused by improper fusion or resorption during fetal development. A uterine septum is a fibrous or muscular partition dividing the uterine cavity into two parts, resulting from incomplete resorption of the dividing wall between the two Müllerian ducts. This condition often leads to infertility, recurrent miscarriages, or pregnancy complications but can be successfully treated through hysteroscopic surgical removal of the septum.

In contrast, a bicornuate uterus results from incomplete fusion of the upper parts of the Müllerian ducts, leading to a uterus with two distinct horns and a deep fundal cleft, sometimes resembling a heart shape. It may have one cervix (bicornuate unicollis) or two cervices (bicornuate bicollis). Though many women with this anomaly remain asymptomatic, it is associated with pregnancy risks such as preterm labor, fetal malpresentation, and recurrent loss. Unlike a septate uterus, surgical correction of a bicornuate uterus is complex and less commonly performed.

The key clinical importance lies in differentiating these two conditions since a septate uterus carries a higher risk of miscarriage and can be effectively treated, whereas a bicornuate uterus often requires management focused on pregnancy monitoring rather than surgery.