Ch 3a (congenital anomalies) Flashcards
What % of women have congenital anomalies?
5%
What are the 3 reasons why uterine + vaginal malformations occur?
-Failure to develop the paramesonephric (mullerian) ducts
-Failure of fusion of mullerian ducts
-Failure of resorption of median septum
What 3 malformations occur when there is a failure to form the mullerian ducts?
-Agenesis of vagina/uterus
-Hypoplasia (small) of vagina/uterus
-Uterus unicornis unicollis
What 3 malformations occur when there is a failure of fusion of the mullerian ducts?
-Uterus bicornis bicollis
-Uterus bicornis unicollis
-Uterus didelphys
What 2 malformations occur when there is a failure of resorption of the mullerian ducts?
-Septate uterus (complete failure)
-Subseptate uterus (partial failure)
What does cornis mean?
Uterus (think corn/horn)
Unicornis: 1 uterine horn
Bicornis: 2 uterine horns
What does collis mean?
Cervix (think collar)
Unicollis: 1 cervix
Bicollis: 2 cervices
What does didelphys mean?
Double system - 2 vag, 2 cervix, 2 uterine horns
What is a sonohysterography / saline infused sonography?
Saline injection to distend uterine cavity, which separates the walls of the uterus + highlights any defects
What is an imperforate hymen?
-When the hymen covers the whole opening of the vagina
-You are born with this
-Sign this may be occurring if a girl has not gotten her 1st period yet (menarche)
(normal hymen typically ruptures during perinatal period)
What symptoms occur that make of think of an imperfornate hymen?
-Pelvic discomfort
-Bulging vaginal membrane
-No menstrual bleeding
What structures create the interface that then produces the hymen?
Uterovaginal canal is separated from sinovaginal bulb + horizontal vaginal membrane. The vaginal membrane then interfaces with the urogenital sinus to produce the hymen.
What is hematometrocolpos?
Combination of menstrual blood, fluid + secretions in the vagina/uterus
Is u/s good at viewing hematometrocolpos?
Yes
What % of mullerin duct anomalies are due to arrested/failure of development of mullerian ducts?
5-10%
(produces hypoplasia/partial or agenesis/complete)
Signs of agenesis/hypoplasia of uterus/vagina?
-Amenorrhea
-Severe cyclic/cycle pelvic pain
-Hematometra (collection blood in uterus)
(secondary sexual characteristics are present which indicate normal ovarian function)
What can defects of vertical vagina fusion/vaginal septum abnormalities result in?
Transverse vaginal septum
(this causes obstruction + produces hematocolpos - which is when the vagina is pooled with menstrual blood leading to the blockage of menstrual blood flow)
Are vaginal anomalies hard to image with u/s? Which two?
Yes, TRV septa + duplicated vagina are included
What does an absent vagina look like on u/s?
-Missing normal central vaginal echoes
How is u/s helpful to identify a partial vaginal agenesis?
-Can identify the certain areas where there is no central echoes visualized
Can we see a trv septum on u/s?
Not always possible, hard b/c of accumulations of blood in vagina or endo canal
What is uterus unicornis + why does it occur?
-Failure of 1 mullerian duct to elongate/fuse (other duct develops normally)
-Typically unicornuate uterus is right sided
-Only 1 half/horn of uterus is developed
-Only connected to 1 ovary + tube
What often occurs on the other side/horn when a uterus unicornis is present?
Rudimentary horn (what’s left of uterine tissue that was absorbed, looks like little uterus w/o tube or ovary)
What can a rudimentary horn have?
-uterine cavity with functional endometrium
-communication b/w endometrium of main horn + rudimentary horn
-pt’s may experience endometriosis + hematometria (collection of blood in uterus) of rudimentary horn
(remember not always, but sometimes)
