Congenital Mullarian Abnormalities

Question 1

Vertical fusion defects

Answer 1

Result from problems with fusion of structures in the vertical plane

• Transverse vaginal septum
• Cervical agenesis (failure of dev)
• Cervical dysgenesis
• Mullerian agenesis/vaginal agenesis
• Imperforate or microperforate hymen

Question 2

Lateral fusion defects

Answer 2

Caused by defects of midline fusion of mullerian ducts, often associated with renal def/agenesis

• Uterus didelphys
• Bicornuate uterus
• Septate uterus
• Obstructed hemi-uteri
• Uterus didelphys with hemi-obstructed vagina

Question 3

Uterus didelphys

Answer 3

Uterus has two uteri (hemi), 2 cervices, a vaginal septum

• can have obstructed hemi vagina
• can have blind uterine horn also

Question 4

Bicornuate uterus

Answer 4

2 Uterine horns, 1 cervix
-With obstructed hemiurterus: may have menses, but cyclic pain and renal agenesis occurs…makes you think of a mullerian anomaly

Question 5

Septate uterus

Answer 5

No resorption of the uterine septum during dev leads to large fibrotic septum in the middle of the uterus

• ->Most common abnormality
• Second trimester miscarriages and preterm deliveries, uterus is not large enough to support full fetal growth
• treat by removing septum

Question 6

Mullerian Agenesis

Answer 6

• Absent uterus, cervix and vagina
• Intact ovaries
• 36% also have absence of one kidney