Congenital and Structural Defects of the Female Reproductive Tract

Question 1

Gestational age vs embryonic age

Answer 1

Gestational age is 2 weeks longer than embryonic age because it starts at the last menstruation as opposed to fertilization

Question 2

Paramesonephric duct

Answer 2

Mullerian duct, characteristic of the female

Question 3

Mesonephric duct

Answer 3

Wolfian duct, characteristic of the male

Question 4

Because feminization proceeds without active intevention, it is called ___. Masculinization is called ___ because it requires other active agents to alter fundamental female genotype

Answer 4

Development, differentiation

Question 5

3 major steps of genital development in the female

Answer 5

Formation
Fusion
Resorption

Question 6

Mayer-rokitansky-kuster-hauser syndrome (MRKH)

Answer 6

Agenesis, a lack of development of mullerian duct at all resulting in no cervix, fallopian tubes, vagina or uterus, but still the presence of ovaries, may have blind vaginal pouch appearing normal outside but will never develop a menstrual cycle

Question 7

Lateral fusion defects

Answer 7

A lack of fusion between the 2 paramesonephric ducts resulting in a number of abnormalities including uteruse didelphys, double vagina, bicornuate uterus, septate uterus, unicornutate uterus

Question 8

Septate uterus common presentations

Answer 8

A lack of fertility due to it acting as a proverbial IUD, or many miscarriages because the uterus cannot stretch properly

Question 9

Basal vs functionalis endometrium

Answer 9

Basal remains the same throughout the menstrual cycle functioning to feed the functionalis layer, the functionalis layer grows and sloughs off each month

Question 10

Uterus didelphys

Answer 10

Presence of a double uterus with single vagina due to lack of mullerian duct fusion, usually has good pregnancy outcomes despite that

Question 11

Uterus didelphys and double vagina (complete uterus didelphys)

Answer 11

Presence of a double uterus with a double septated vagina, can cause problems with intercourse and vaginal delivery

Question 12

Bicornuate uterus

Answer 12

Heart shaped uterus resulting from partial fusion of mullerian ducts giving 2 endometrial cavities with an indented fundus, uterus has trouble stretching like it is supposed to but pregnancy outcomes close to general population

Question 13

Hysterosalpingogram radiograph

Answer 13

Visualization using contrast dye of the uterus and fallopian tubes

Question 14

Interstitial pregnancy

Answer 14

Another term for ectopic pregnancy, specifically referring to implantation in the horn of a bicornuate or unicornuate uterus

Question 15

Unicornuate uterus

Answer 15

Destruction of one mullerian duct almost ALWAYS mmissing a kidney and ureeter on same size, significant problems in pregnancy and infertility result

Question 16

When a patient has a unicornuate uterus, they almost always have what else?

Answer 16

A missing kidney and ureter on the same side

Question 17

Septate uterus

Answer 17

Most common structural defect in a female, has 2 entometrial cavities due to a defect of resorption of midline septum, associated with risk of miscarriage, can be corrected with excellent results

Question 18

What defect is found with 50% of women with mullerian defects?

Answer 18

Renal abnormalities

Question 19

Most common cause of ambiguous genitalia in female

Answer 19

Congenital adrenal hyperplasia

Question 20

3 hormones out of balance in congenital adrenal hyperplasia

Answer 20

• Too little aldoserone
• Too little cortisol
• Too many androgens resulting in masuclinization

Question 21

Hydrocolpos

Answer 21

Distension of vagina by fluid due to congenital obstruction such as imperforate hymen

Question 22

A woman with congenital and structural defects of the female reproductive tract present how (3 specifics)?

Answer 22

1) At birth when assessing the genitals
2) Asymptomatic until menstruation, sometimes if a tampon cannot obstruct flow properly
3) as an ectopic pregnancy or recurrent miscarriage

Question 23

Hysterosalpingography (HSG)

Answer 23

Speculum insertion and tenaculum grabbing of cervix, insertion of dye catheter, removal of speculum, fluoroscopic x rays

Question 24

Uterine fibroids/leiomyomas/myomas

Answer 24

Benign smooth muscle growths of the uterus present in 3/4 women in their 30’s most are assymptomatic

Question 25

Uterine fibroids/leiomyomas/myoma treatment

Answer 25

Surgical removal, sound wave destruction

Question 26

Uterine adhesions/Asherman syndrome

Answer 26

Scar tissue in the uterus resulting from surgery, endometriosis, or mullerian duct formation, can be asympomtamic or cause misscariages

Question 27

Cervical insufficiency

Answer 27

Occurs when the cervix dilates too early during pregnancy causing miscarriage or premature birth, often due to uterine dfect or surgery

Question 28

Cervical insufficiency treatment

Answer 28

Cerclage sutures keep the cervix closed and cut out near delivery

Question 29

Vertical fusion defects

Answer 29

Vaginal/cervical agenesis or dysgenesis