Uterine Anomalies OB/GYN

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Uterine Anomalies:

Uterine Anomalies

Introduction:

Introduction Uterine anomalies are quite often asymptomatic and so are hard to recognize There is no universal classification of defects, however the American Fertility Society (ASRM) sorted m üllerian defects into 7 categories 2-4% of fertile women with normal reproductive outcomes have uterine defects 90% are Septate 5% are Bicornate 5% are Didelphic Women with a history of miscarriage, pre-term deliveries, etc., have a higher incidence of anomalies

Clinical Presentation:

Clinical Presentation Uterine anomalies are often an incidental diagnosis while seeing the patient for a different complaint The Patient can present with: Pelvic pain (cyclic or non-cyclic) Dysmenorrhea Abnormal vaginal bleeding Vaginal pain Uterine rupture during pregnancy Recurrent pregnancy loss Patient may have a concurrent renal abnormalities

Diagonosis:

Diagonosis Gynecologic Ultrasonography Pelvic MRI :MRI is considered the preferred modality due to its multiplanar capabilities as well as its ability to evaluate the uterine outline, junctional zone, and other pelvic anatomy Hysterosalpingography : Unable to outline the exterior surface of the uterus. Laparoscopy Hysteroscopy

Types of Anomalies:

Types of Anomalies Agenesis (AFS Type I) Mayer-Rokitansky-K üster-Hauser Syndrome Lateral Fusion Defects Septate/Arcuate (AFS Type V) Unicornate (AFS Type II) Bicornate (AFS Type IV) Didelphic (AFS Type III) Vertical Fusion Defects DES Induced Defects (AFS Type VI)

Uterine Agenesis:

Uterine Agenesis Can be complete or variable Mayer- Rokitansky - K üster -Hauser syndrome A congenital absence of the vagina with a variable degree of uterine development Caused by a failure of the Müllerian ducts to form properly Treatment: The Vecchietti procedure Emotional Suport

Mullerian Agenesis:

Mullerian Agenesis

Lateral Fusion Defects 1:

Lateral Fusion Defects 1 These are the most common type of uterine anomalies Usually a failure of formation of one M üllerian duct, failure of migration of a duct, failure of fusion of a duct or a failure of the intervening uterine septum to absorp Septate anomalies predominate

Lateral Fusion Defects 2:

Lateral Fusion Defects 2 Septate Uterus Contains 2 endometrial cavities but with a normal external surface Arcuate Uterus ( Ddx ) has a small Septum which can be seen externally as a small indentation at the uterine fundus Treatment : The septum can be resected surgically if it is the patient’s choice.

Lateral Fusion Defects 3:

Lateral Fusion Defects 3 Unicornate Uterus An asymmetrical lateral fusion defect The affected m üllerian duct does not develop at all or may become a horn of the uterus ( communicating or non-communicating) If obstructed, the unicornate uterus will cause cyclic or chronic pelvic pain Can be associated with an an ectopic ovary This is important with women who are being induced to ovulate Is a 40% incidence of renal abnormalities as well Higher risk of infertility, endometriosis, premature labor and breech presentations

Lateral Fusion Defects 4:

Lateral Fusion Defects 4 Bicornate Uterus Has two cavities with an indented fundus greater than or equal to 1 cm. Caused by the partial fusion of the m üllerian ducts Can exist a varying degree of separation Outcome of pregnancy has been reported to be similar to that of the general population with a normal uterus

Lateral Fusion Defects 5:

Lateral Fusion Defects 5 Didelphys Considered a “double uterus” in which 2 m üllerian ducts fail to fuse forming 2 uterine cavities. Limited to the uterus and cervix (no vaginal involvement) 15-20% of patients also have other unilateral anomalies Ipsilateral renal agenesis for an example. Triplet-Birth with Uterine Didelphys

Vertical Fusion Defects:

Vertical Fusion Defects Can be caused by: defective fusion of the caudal m üllerian duct and urogenital sinus Abnormal vaginal canalization Symptoms will depend on degree of obstruction of the defect

Diethylstilbestrol:

Diethylstilbestrol A synthetic estrogen that was used from 1949-1971 Caused Vaginal adenosis among others… DES induced anomalies of the uterus T-shape uterine cavity Hypoplastic uterus Midfundal constriction Filling defects Endometrial cavity adhesions

Treatment:

Treatment Surgical intervention depend on patients’ condition and choice. In the case of a didelphic uterus, surgery is not recommended. However a uterine septum can be resected in an outpatient procedure. This procedure reduces the risk of the miscarriages in patients. As the anomalies occur due to the abnormal development of Mullerian ducts, it cannot be prevented.

References:

References http://radiology.rsnajnls.org/content/vol233/issue1/images/large/r04oc03g02x.jpeg http:// encyclopedia.tfd.com/uterus+didelphys http:// encyclopedia.tfd.com/Uterine+malformation http ://en.wikipedia.org/wiki/Uterine_malformation+uterine+malformation

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