1. Congenital Flashcards
The uterus in a neonate
cervix often larger than the fundus.
The uterus in prepuberty
tube-like, with the cervix and uterus the same size.
The uterus in puberty
(pear-like) - with the fundus larger than the cervix
visible endometrium
Turner syndrome
45 XO + CoA + Horseshoe Kidney +
+ Prepuberty uterus (cervix = uterus) + Streaky Ovaries
The mullerian ducts make up these parts
Uterus + Upper 2/3 of the vagina
What grows up to meet the mullerian duct and make the bottom 1/3 of the vagina?
Urogenital sinus
This ducts regress completely in girls
Wolffian
Mullerian ducts
Uterus
Fallopian Tubes
Upper 2/3 of the vagina
Wolffian Ducts
Vas Deferens
Seminal Vesicles
Epididymis
Urogenital sinus
Prostate
Bottom 1/3 of the vagina
3 ways the whole process of embryology gets screwed up
- Failure to form
- Fail to fuse
- Fail to cleave
Explain the concept of embryology?
Failure to form conditions:
- Mullerian agenesis
- Unicornuate Uterus
Failure to Fuse
Uteru Didelphys
Bicronuate uterus
T-shaped uterus
Failure to cleave conditions
Septate
Arcuate Uterus
Mullerian Agenesis ahs three features:
- Vaginal atresia
- Absent or rudimentary uterus (unicornuate or bicronuate
- Normal ovaries
Kidneys have isssues in 50% of cases
Cornus =
Collis =
Cornus = uterus
Collis = cervical
Mullerian agenesis AKA
Mayer-Rokitansky-Kuster-Hauser syndrome
4 variants of Unicronuate uterus
Most common unicronate uterus subtype
ISolated unicronuate
If you see a unicomuate utems the classic teaching is to
Look for a rudimentary horn
Rudimentary horns have endometrium - phantom female belly pain = risk of miscarriege
Risk of non-communicating unicornuate subtype?
Rudimentary horn rupture (life threatening bleeding
Most common abdnormality in unicronute uterus
Ipsilateral renal agenesis contralateral to main uterin horn (Ipsilateral to rudimentary horn)
This is a complete uterine duplication (two cervices, two uteri, and two upper 1/3 vagina).
Uterus Didelphys
Bicornuate comes in 2 flavors”
Unicollis - 1 cervix
Bicollis - 2 cervix
what separates the uterus in bicornuate?
Myometrial cleft
The Diethylstilbestrol related anoaly
T-shaped
DES was a synthetic estrogen given to prevent miscarriage in the 1940s.
This one has two endometrial canals separated by a fibrous (or muscular) septum.
Septate
This is the most common Mullerian duct anomaly associated with miscarriage.
Septate
This is improved with resection of the septum.
Mild smooth concavity of the uterine fundus (instead of normal straight or convex)
Arcuate Uterus
Arcuate Uterus
“NORMAL VARIANT”
NOT associated with infertility or obstetric complications.
Arcuate Uterus
- “Heart Shaped” - Fundal contour is less than 5 mm above the tubal ostia
- No significant infertility issues
- Resection of the “septum” results in poor outcomes
Bicornuate
- Fundal contour is Normal; more than
5 mm above the tubal ostia - Legit infertility issues - implantation fails on the septum (it’s a blood supply thing)
- Resection of the septum can help
Septate
T shaped uterus
Hysterosalpingogram (HSG) indications
- VIsualized noraml uterine cavity
- Make sure tubes are patent
Evaluation of uterine bleeding should be done with
Ultrasound
MRI
When shoud Hysterosalpingogram (HSG) be done?
Proliferative phase (D7-12) - endometrium is the thinnest (pregnancy least likley)
Contraindication of Hysterosalpingogram (HSG)
- Pregnancy
- ACtive Pelvic Infection
- Active bleeding
- Contrast Allergy
Hysterosalpingogram (HSG)
Irregular filling defect = Most common cause?
Synechia/Scarring/Intrauterine adhesion
trauma from prior curretage
Infection
Hysterosalpingogram (HSG)
Scars/adhesions + clinical infertility =
Asherman’s syndrome
Hysterosalpingogram (HSG)
Round/Oval Filling defects
Endometrial polyps of Fibroids
Hysterosalpingogram (HSG)
Tubal Occlusions
Infection/PID
A. Abrupt Cut off
B. Dilated tube
