Uterine/Vaginal/Hymen Anomalies

Question 1

What mullerian anomaly is most common among patients with recurrent pregnancy loss?

Answer 1

Septate Uterus

Miscarriage rate of 65%

Question 2

What mullerian anomaly is most common overall?

Answer 2

Septate Uterus

Question 3

Uterine anomalies are associated with what percent of recurrent pregnancy losses?

Answer 3

15%

Question 4

What percentage of patients with mullerian anomalies will also have renal anomalies?

Answer 4

20-30%

Question 5

When do mullerian (paramesonephric) ducts begin to elongate?

Answer 5

6 w gestation

Question 6

What GA do mullerian ducts begin to fuse?

Answer 6

12 w gestation

Question 7

What GA is the midline septum absorption complete?

Answer 7

20 w gestation

Question 8

How do you differentiate MRKH Syndrome and Androgen IS?

Answer 8

AIS = 46XY karyotype, elevated testosterone

MRKH = 46XX Karyotype, with normal testosterone

Question 9

Describe lateral fusion defects

Answer 9

your two arms don’t come together “elbows to hands” normally

Longitudinal vaginal/uterine septum, bicornuate, didelphys

Question 10

Describe vertical fusion defects

Answer 10

TRANSVERSE vaginal septum, partial vaginal agenesis, and/or cervical agenesis

Failure of the canalization of the vaginal plate or failed Mullerian duct fusion

Question 11

What congenital uterine anomaly is associated with the highest pregnancy risk?

Answer 11

Septate Uterus

Question 12

A narrow angle between 2 endometrial cavities, ≤75º, and a fundal shape with notch ≤1 cm

Caused by failure of medial regression during fusion of the Müllerian ducts

Answer 12

Septate Uterus

Question 13

A wide angle between 2 endometrial cavities, ≥105º, and a fundal shape with notch ≥1 cm

Incomplete fusion of the Müllerian ducts results in 2 distinct but communicating endometrial cavities

Answer 13

Bicornuate Uterus

Question 14

well-defined elliptical-shaped uterus

HSG w/ banana-like uterine cavity

Hysteroscopy w/ single uterine cavity with deviation to one side and single tubal ostium

Answer 14

Unicornuate

Question 15

Two separate divergent uterine horns with a deep fundal cleft between the 2 hemiuteri and a widened angle between 2 endometrial cavities

Answer 15

Didelphys

Question 16

Uterine anomaly with BEST pregnancy outcomes?

Answer 16

Didelphys

Question 17

OB complications of uterine anomalies?

Answer 17

PTB
Malpresentation
CS
PROM
FGR
Abruption

Question 18

Up to a 1 cm dip in the fundal contour of the uterine cavity

Answer 18

“Arcuate” = considered normal variant

Question 19

Blind vaginal pouch
Shortened vagina
Normal breasts
Normal pubic hair
46, XY
Normal testosterone level

Answer 19

MRKH Syndrome

Question 20

What strucutres form the fallopian tubes, uterus, cervix, and upper vagina?

Answer 20

Mullerian ducts

Question 21

What forms the urethra and distal vagina?

Answer 21

Urogenital singus

Question 22

What causes cervical atresia, transverse vaginal septum or distal vaginal atresia?

Answer 22

Incomplete fusion of the caudal mullerian duct with sinovaginal bulbs

Question 23

Should you ever I&D hematocolpos?

Answer 23

NO! Can cause ascending infection and sepsis!

Question 24

When should your surgically resect an imperforate hymen?

Answer 24

After puberty (so tissue is estrogenized) and before pain starts

Question 25

Embryology of Hymen

Answer 25

vaginal lumen is separated from the urogenital sinus by the hymenal membrane. The hymen usually ruptures before birth due to degeneration of the central epithelial cells. However, a thin fold of mucous membrane persists around the vaginal introitus

Question 26

Answer 26

Normal Hymen

Question 27

Answer 27

Imperforate Hymen

Question 28

Answer 28

Microperforate Hymen

Question 29

Answer 29

Cribriform Hymen

Question 30

Answer 30

Septate Hymen

Question 31

Answer 31

Vaginal Atresia