How is the interal female genitalia formed?
In the absence of AMH, Mullerian ducts persist and fuse to form the tubes, uterus, cervix and upper 2/3 vagina
NOTE: Lower vagina is formed from invagination of perineal body
When does fusion of mullerian ducts occur in females?
Fusion of ducts occurs 6-11 weeks gestation. During the first 6 weeks of development male and female fetuses are instinguishable
•The intervening uterovaginal septum resorbs at 9-12 weeks gestation. Reabsorption process takes place in the cranial and caudally
Women with the condition may be asymptomatic and unaware of having a uniconuate uterus; normal pregnancy may occur. In a review of the literature Reichman et al. analyzed the data on pregnancy outcome of 290 women with a unicornuate uterus. 175 women had conceived for a total of 468 pregnancies. They found that about 50% of patients delivered a live baby. The rates for ectopic pregnancy was 2.7%, for miscarriage 34%, and for preterm delivery 20%, while the intrauterine demise rate was 10%. Thus patients with a unicornuate uterus are at a higher risk for pregnancy loss and obstetrical complications.
•May have rudimentary uterine horn on other side- may or may not communicate with dominant horn
T or F. Renal complications are common in women with unicornuate uteri
T. Renal anomalies 40% of time on ipsilateral side
Other complications include: preterm labor, malpresentation (breech)
What causes a uterus didelphys?
This results from complete failure of duct fusion. As a result, there is a double uterus with two separate cervices, and sometimes a double vagina as well
This condition is fairly rare
What are the potential complications of a didelphic uterus?
Patients with a double uterus may need special attention during pregnancy as premature birth and malpresentation are common. Cesarean section was performed in 82% of patients
Uterus didelphys has also been found associated with higher rate of infertility, miscarriage, intrauterine growth retardation, and postpartum bleed
Unilateral renal agenesis may occur as well
NOTE: Uterus didelphys is often confused with a complete uterine septum. Often more than one method of investigation is necessary to accurately diagnose the condition. Correct diagnosis is crucial as treatment for these two conditions is very different. Whereas most doctors recommend removal of a uterine septum, they generally concur that it is better not to operate on a uterus didelphys
What is the most common MDA?
Septated uterus- A uterine septum is a form of a congenital malformation where the uterine cavity is partitioned by a longitudinal septum; the outside of the uterus has a normal typical shape
The wedge-like partition may involve only the superior part of the cavity resulting in an incomplete septum or a subseptate uterus, or less frequently the total length of the cavity (complete septum) and the cervix resulting in a double cervix. The septation may also continue caudally into the vagina resulting in a "double vagina"
What causes a septated uterus?
The uterus is formed during embryogenesis by the fusion of the two Müllerian ducts. During this fusion a resorption process eliminates the partition between the two ducts to create a single cavity. This process begins caudally and advances cranially, thus a complete septum formation represents an earlier disturbance of this absorption than the incomplete form. Causes for incomplete absorption are not known.
How does a septated uterus present?
The condition may not be known to the affected individual and not result in any reproductive problems; thus normal pregnancies may occur. However, it is associated with a higher risk for miscarriage, premature birth, and malpresentation.
According to the classical study by Buttram there is a 60% risk of a spontaneous abortion, this being more common in the second than in the first trimester (debatable)
The condition is also associated with abnormalities of the renal system. Further, skeletal abnormalities have been linked to the condition
How are septated uteri usually managed?
A septum can be resected with surgery. Hysteroscopic removal of a uterine septum is generally the preferred method, as the intervention is relatively minor and safe in experienced hands.
It is not considered necessary to remove a septum that has not caused problems, especially in women who are not considering pregnancy. There is controversy over whether a septum should be removed prophylactically to reduce the risk of pregnancy loss prior to a pregnancy or infertilitytreatment.
What is a bicornate uterus?
A cleft occurs in the external contour of uterine fundus (so the outside is not smooth like in a septated uterus!)
What is this?
a congenital disorder where a hymen without an opening completely obstructs the vagina. It is caused by a failure of the hymen to perforate during fetal development. It is most often diagnosed in adolescent girls when menstrual blood accumulates in the vagina and sometimes also in the uterus.
How does an Imperforate hymen present?
Presents with amenorrhea, cyclic pain, abdominal mass
How would an imperforate hymen present?
Hymenectomy- It is treated by surgical incision of the hymen.