DEPT OF RADIO-DIAGNOSIS

1. MULLERAIN DUCT ANOMALIES
Dr Pramod Nagure(senior resident)
Dr.D.Y.PATIL MEDICAL COLLEGE,HOSPITAL &RESEARCH INSTITUTE
KOLHAPUR

2. EMBRYOLOGY

3. Associated anomalies

4. Classification of Müllerian duct anomalies

5. The classification system of Mullerian duct anomalies used by the American Fertility Society

6. Müllerian duct anomalies are often first detected
on hysterosalpingography (HSG) during the
work-up of infertility.
HSG has a limited role in the diagnosis of MDA's
as it only gives information about the uterine
cavity and not about the external contour of the
uterus.
The next step in the diagnosis is often ultrasound
or MRI.
HSG showing abnormal uterine cavity. Differentiation
between septate and bicorporeal uterus is not possible
HYSTEROSALPINGOGRAPHY

7. • Transabdominal and transvaginal ultrasound are often the first imaging
modalities used to evaluate the internal sex organs.
When indeterminate or complex, MR imaging is used.
The transabdominal ultrasound shows a uterus with normal external
contour of the fundus.
• MRI is considered the gold standard in the classification of MDAs due
to the detailed anatomic information provided.
ULTRASOUND
MRI

8. Early developmental failure of the Mullerian ducts at around 5 weeks gestation, results in
various degrees of agenesis or hypoplasia of the uterus, cervix and upper two-thirds of
the vagina.genesis
The Mayer–Rokitansky–Kuster–Hauser syndrome consists of a combined agenesis of the
uterus, cervix and upper portion of the vagina.
Symptoms may manifest at puberty as primary amenorrhea with normal secondary sexual
characteristics, as ovarian function is preserved.
CLASS I — AGENESIS/HYPOPLASIA

9. This anomaly results from complete or near-complete arrested development of one of
the Mullerian ducts
Four possible subtypes can develop:
(i) absent rudimentary horn
(ii) non-cavitary (non-functioning rudimentary horn
(iii) cavitary communicating rudimentary horn
(iv) cavitary non-communicating rudimentary horn
CLASS II — UNICORNUATE

13. • This anomaly results from complete non-fusion of both Mullerian ducts.
• The individual horns are fully developed and almost normal in size.
• A deep fundal cleft and two cervices are present.
• A longitudinal or transverse vaginal septum may be present.
CLASS III — DIDELPHYS

18. • This class is characterized by partial non-fusion of the Mullerian ducts .
• This results in a central myometrium that may extend to the level of the internal cervical
os (bicornuate unicollis) or external os (bicornuate bicollis), with a fundal cleft 1 cm deep.
• The horns of the bicornuate uteri are not as fully developed and are smaller than those in
the didelphys uteri.
CLASS IV — BICORNUATE

21. This class of anomaly occurs when the final fibrous septum between the two Mullerian
ducts fails to resorb.
This results in the formation of a uterus that is completely or partially divided into two
cavities .
This class is associated with the poorest obstetrical outcomes . The fundal cleft is ,1 cm
deep and the intercornual distance is usually 4 cm.
The morphology of the outer fundal contour is the key to the diagnosis.
CLASS V — SEPTATE

23. • Characterized by mild indentation of the endometrium at the uterine fundus
• It is the result of near complete resorption of the uterovaginal septum.
• Currently, no definitive depth has been established to differentiate the arcuate
configuration from the septate, it is generally thought that an arcuate uterus is compatible
with normal pregnancy and delivery.
CLASS VI — ARCUATE

25. Several million women were treated with diethylstilbestrol (DES), a non-
steroidal estrogen, to prevent miscarriage between 1945 and 1970 .
The drug was promptly removed from the market when it was found that up
to 15% of newborn girls who were exposed to DES had uterine malformations
and an increased risk of vaginal clear cell carcinoma .
The uterine abnormalities include hypoplasia and a T-shaped uterine cavity .
Patients may also have abnormal transverse ridges, hoods and stenosis of the
cervix.
CLASS VII — DIETHYLSTILBESTROL RELATED

27. • Septate uterus has a normal fundal contour but is characterized by a persistent
longitudinal septum that partially divides the uterine cavity The external uterine
fundal contour may be convex, flat, or mildly (< 1 cm) concave. Bicournuate
uterus has a deep > 1 cm fundal cleft in the outer uterine contour and
intercornual distance >4 cm.
• Septate uterus has acute angle <75° between uterine cavities while an angle
of more than 105° is more consistent with a bicornuate uterus.
Septate vs bicornuate

28. SUMMARY OF THE THERAPEUTIC INTERVENTIONS PERFORMED FOR THE DIFFERENT CLASSES
OF MULLERIAN DUCT ANOMALIES : CLASS TREATMENT
I – Hypoplasia/agenesis No reproductive potential; medical intervention in the form of in vitro fertilisation
of harvested ova and implantation in a host uterus needed
II – Unicornuate Non-communicating, cavitary horn Always surgically resected, as it is associated with
dysmenorrhoea, haematometra, endometriosis and ectopic pregnancy
Non-communicating, non-cavitary horn Surgery not currently recommended. No complications of
endometriosis etc, as there is no endometrium
Communicating, cavitary horn Also surgically removed because pregnancy that implants in the rudimentary
horn rarely is viable . No horn No treatment. Reproductive potential is possible
III – Didelphys May consider metroplasty; however, full-term pregnancies have occurred
IV – Bicornuate Surgical intervention rarely needed; may consider metroplasty
V – Septate Often treated with transvaginal hysteroscopic resection of the septum. Conception is
possible 2 months after surgery

29. Presentation
Recurrent pregnancy losses. MRI to assess Mullerian
anomalies, if any
.
Patient Data
Age: 30 years
Gender: Female

30. Presentation
Patient with primary infertility, presents with severe right
adnexal tenderness and pelvic pain.
Patient Data
Age: 30 years
Gender: Female

31. Presentation
Abdominal pain.
Patient Data
Age: 30 years
Gender: Female

32. THANK YOU