Embryology / Mullerian Anomalies

Question 1

Paramesonephric ducts give rise to

Answer 1

Mullerian:
Fallopian tubes
Uterus
Upper 1/3 vagina

Question 2

Mesonephric ducts give rise to

Answer 2

Wolffian:
Seminal vesicle
Vas deferens
Epididymis

Question 3

Sexual differentiation begins at

Answer 3

6-8 weeks

Question 4

Metanephros gives rise to

Answer 4

Kidney

Question 5

___ are essential to Mullerian duct formation; they provide migrational template

Answer 5

Wolffian (Mesonephric) ducts

Question 5

___ required for ipsilateral Wolffian duct to differentiate

Answer 5

High local concentration of testosterone
(In absence of high local T&raquo_space; Wolffian structure regression)

Question 6

Testosterone production starts in the early testes at ___ and peaks at ___

Answer 6

starts at 8 weeks gestation,
peaks at 18 weeks gestation

Question 7

Paramesonephric/mesonephric differentiation complete by

Answer 7

10 weeks gestation

Question 8

Cannulization of vagina occurs by

Answer 8

20-22 weeks gestation

Question 9

Critical factors from the testes (name specific cells) determining sex differentiation

Answer 9

Sertoli cells –> AMH&raquo_space; Mullerian duct regression

Leydig cells –> testosterone&raquo_space; Wollfian duct maintenance

Testosterone –> DHT (via 5 alpha reductase)&raquo_space; virilization of UG sinus (bladder, prostate, urethra, bulbourethral glands) and external genitalia (penis, scrotum)

Question 10

Vecchietti
McIndoe/Davydov
Williams vulvovaginoplasty

Answer 10

Vecchietti - acrylic “olive” used in vaginal dimple space to progressively create a neo-vagina under pressure, requires abdominal entry for surgical placement of olive (modified from open > laparoscopic)

McIndoe/Davydov - creation of neo-vagina between rectum and urethra using grafted tissue, does NOT require abdominal entry

Williams - no longer performed because ineffective, suturing labia majora to perineal pouch

Question 11

What is the Strassman procedure?

Answer 11

Unification of didelphys uterus (not performed anymore)

Question 12

Define bicornuate uterus vs
Arcuate uterus vs
Septate uterus

Answer 12

Bicornuate: depth of fundal contour indentation > 1 cm

Arcuate: flat fundal contour, depth of endometrial indentation < 1 cm, angle of indentation > 90 deg

Septate: flat fundal contour, depth of endometrial indentation > 1.5 cm, angle of indentation < 90 deg
*ESHRE: “> 50% of the thickness of the fundus”

Question 13

There is/is not sufficient evidence that septum is associated with infertility

What are septum associated with?

Answer 13

Insufficient evidence that septum is associated with infertility

• Preterm birth
• Miscarriage

OB outcomes:
- Malpresentation
- IUGR
- Placental abruption
- Perinatal mortality

Question 14

Bicornuate uterus associated with what risks?

Answer 14

20% preterm labor, malpresentation, Cesarean section

• SAB
• Retained placenta