gyn defects Flashcards
What is saline ultrasound used for
to image the uterine cavity and is important to assess the acquired defects such as polyps, intrauterine adhesions and fibroids
What is MRI used for
Diagnose mullerian anomalies, obstructive disorders and to identify functioning endometrium and blood
List the cardinal steps in mullerian development
1) elongation of the ducts, 2) fusion of the ducts, 3) canalization of the ducts, and 4) septal resorption between the ducts.
Which renal structures develop from the mesonephric system
ureters, renal calyces and collecting tubules
List the mullerian developmental stage defect for each of the following conditions: Mullerian agenesis, unicornuate uterus, uterine didelphys, vaginal agenesis, septate uterus
Mullerian agenesis: failure of bilateral elongation of ducts. Unicornuate uterus: failure of unilateral elongation of ducts. Uterine didelphys: failure of Fusion of ducts. Vaginal agenesis: failure of canalization. Septate uterus:failure of septal resorption
list the American Fertility Society classifications of mullerian anomalies
class 1: hypoplasia/agenesis. Class 2: unicornuate. Class 3: didelphus. Class 4: bicornuate. Class V: septate. Class VI: Arcuate. Class VII: DES drug related
List the transverse Mullerian defects
Failure of fusion of Mullerian system (upper 2/3 of vagina) with urogenital sinus (lower 1/3 of vagina) causes transverse vaginal septum. Failure of union can rsult in complete vaginal atresia.
Transverse vaginal septum presentation
Obstructive- No menses and periodic lower abdominal pain (due to accumulation of blood above obstruction known as hematocolpos). A growing abdomino-pelvic mass may occur.
Transverse vaginal septum diagnosis/ treatment
PE: blind upper vaginal pouch. MRI to assess septal thicknes. Treatment: surgery if pain is sufficient. Skin grafts may be necessary if septum is thick to prevent strictures and allow for good mucosal healing
Imperforate hymen
obstructive- not mullerian defect. Cyclic pain and growing abdominopelvic mass.
Most common type of mullerian hypoplasia- presentation and concerns
Combined agenesis where the uterus, upper vagina and cervix are all missing. Presents with primary amenorrhea. Concerns include sexual function and reproduction
Vaginal agenesis treatment
A neovagina is created by opening the potential space btw bladder and rectum. A skin graft is placed in this space and allowed to graft to underlying tissues
unicornate uterus Sx
Non-communicating will have obstructive Sx. renal agenesis on same side as missing duct, high rate of spontaneous abortions (most likely due to poor vascularity)
Rudimentary horn
Unilateral elongation defect which is only partial. Can be cavitary (contain functional endometrium) and/or communicating with properly formed horn. Pregnancies that implant in this horn can rupture causing maternal death in 1st or 2nd trimester. They should be removed. A cavitary horn that does not communicate can accumulate blood and lead to obstructive symptoms
How does an ectopic gestation occur in a non-communicating rudimentary horn
Sperm can get to the rudimentary horn by going around the dominant cavity, to the peritoneum and into the rudimentary horn. If the rudimentary horn has functioning endometrium, ectopic gestation can result
