Gynaecology Flashcards
What is an abnormal formation of the female organs?
It refers to congenital anomalies or malformations in the development of the female reproductive tract, often due to incomplete fusion, resorption, or development of the Müllerian ducts.
How are abnormalities of female organ formation classified?
Hypoplasia or Agenesis (e.g., Mayer-Rokitansky-Küster-Hauser syndrome)
Unicornuate Uterus: Failure of one duct to develop.
Uterus Didelphys: Failure of duct fusion, resulting in two uteri.
Bicornuate Uterus: Partial failure of duct fusion.
Septate Uterus: Incomplete resorption of the uterine septum.
Arcuate Uterus: Mild anomaly with a concave uterine fundus.
Diethylstilbestrol-Related Anomaly: Caused by in utero exposure to DES.
What embryological structure is responsible for forming the female reproductive tract?
The Müllerian (paramesonephric) ducts form the fallopian tubes, uterus, cervix, and upper two-thirds of the vagina.
What are common symptoms of abnormal formation of female organs?
Primary amenorrhea (in agenesis or hypoplasia)
Recurrent miscarriage or infertility (in structural anomalies like septate or bicornuate uterus)
Dysmenorrhea or cyclical pain
Abnormal uterine bleeding
Dyspareunia (painful intercourse)
What tools are used to diagnose abnormalities in the formation of female organs?
Ultrasound: Initial imaging for anatomical anomalies.
MRI: Detailed visualization of uterine anomalies.
Hysterosalpingography (HSG): Assess uterine cavity and tubal patency.
Laparoscopy and Hysteroscopy: Diagnostic and therapeutic.
___________ is the gold standard imaging modality for detailed visualization of uterine anomalies.
MRI
Name a syndrome associated with agenesis of the uterus.
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome.
How is hypoplasia or agenesis of the uterus managed?
Psychological support and counseling.
Vaginal dilation or reconstructive surgery for MRKH syndrome.
Assisted reproduction techniques like surrogacy for fertility options.
What is the treatment for a septate uterus?
Surgical removal of the septum via hysteroscopic metroplasty.
True/False
Q: Bicornuate uterus results from incomplete resorption of the uterine septum.
False. It results from partial failure of the Müllerian duct fusion.
What complications are associated with a unicornuate uterus?
Increased risk of miscarriage and preterm labor.
Higher risk of renal anomalies due to parallel development.
What is the impact of in utero exposure to diethylstilbestrol (DES)?
Uterine hypoplasia or a “T-shaped” uterus.
Increased risk of miscarriage, infertility, and preterm birth.
In uterine anomalies, failure of ___________ leads to a didelphys uterus.
Müllerian duct fusion
Why is early diagnosis of uterine anomalies important?
To address infertility, prevent obstetric complications, and manage symptoms effectively.
How does an arcuate uterus differ from a septate uterus?
An arcuate uterus has a mild indentation of the uterine fundus, whereas a septate uterus has a fibrous or muscular septum dividing the uterine cavity.
What is Androgen Insensitivity Syndrome (AIS)?
AIS is a genetic condition where individuals with a 46,XY karyotype have a resistance to androgens due to mutations in the androgen receptor gene, leading to varying degrees of undervirilization despite normal or elevated androgen levels.
What are the two main types of AIS?
Complete Androgen Insensitivity Syndrome (CAIS): Complete inability to respond to androgens.
Partial Androgen Insensitivity Syndrome (PAIS): Partial response to androgens, leading to a spectrum of phenotypes.
What is the genetic basis of AIS?
AIS is caused by mutations in the androgen receptor (AR) gene, located on the X chromosome. It follows an X-linked recessive inheritance pattern.
What are the clinical features of Complete AIS (CAIS)?
Female external genitalia with absent or rudimentary internal female reproductive organs (uterus, fallopian tubes).
Undescended testes (often located in the abdomen or inguinal canal).
Primary amenorrhea.
Breast development at puberty (due to aromatization of androgens to estrogens).
Sparse or absent pubic and axillary hair.
What are the clinical features of Partial AIS (PAIS)?
Ambiguous genitalia at birth (e.g., clitoromegaly, micropenis, or hypospadias).
Undescended testes.
Variable breast development and body hair.
Infertility.
How is AIS diagnosed?
Karyotyping: Reveals a 46,XY genotype.
Hormonal profile:
Elevated luteinizing hormone (LH) and testosterone levels.
Normal or elevated estrogen levels.
Pelvic ultrasound: Absence of uterus and ovaries; presence of undescended testes.
Genetic testing: Confirmation of mutations in the androgen receptor (AR) gene.
In AIS, the karyotype is __________, but the external genitalia are typically __________ in CAIS.
46,XY; female
What is the management approach for Complete AIS (CAIS)?
Psychological support for patients and families.
Gonadectomy: Removal of undescended testes to prevent malignancy, typically after puberty to allow spontaneous feminization.
Hormone replacement therapy (HRT): Estrogen replacement after gonadectomy.
Vaginal dilation or surgical creation of a neovagina: To allow for sexual function if required.
What is the management approach for Partial AIS (PAIS)?
Individualized surgical management of ambiguous genitalia.
Gonadectomy if testes are nonfunctional or at high risk of malignancy.
Hormonal therapy based on the patient’s gender identity and clinical needs.