The document provides information about congenital anomalies of the uterus and cervix. It discusses various types of anomalies that can occur due to incomplete fusion of the paramesonephric ducts or dissolution of the midline fusion, including uterus didelphys, bicornuate uterus, septate uterus, and unicornuate uterus. It notes that these anomalies can cause issues like infertility, early pregnancy loss, dysmenorrhea, and dyspareunia. The document provides details on associated conditions, diagnostic evaluation, clinical manifestations, epidemiology, and treatment considerations for congenital anomalies of the female reproductive system.

1. Program: B.Sc Nursing, 3rd Year
BNSG-501 MSN
Unit No.4.
Topic- Congenital anomalies of Uterus and Cervix
Lecture No. 7
Dr. Sudharani B Banappagoudar
Professor, SONS/OBG
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2. Outline
 Introduction
 Congenital anomalies of Uterus and Cervix
 Learning outcomes
 Exercise
 References
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3. TOPIC-REPRODUCTIVE TRACT ANAMOLIES
INTRODUCTION
Congenital anomalies of Uterus and Cervix
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4. Objectives
• The student will be able to Explain
• Congenital anomalies of Uterus and Cervix
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5. Congenital Anomalies Of Female Reproductive System
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9. The most common anomalies of the uterus result from either :
1. Incomplete fusion of the paramesonephric Ducts.
2.Incomplete dissolution of the midline fusion of those ducts
3. formation failures
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10. EPIDEMIOLOGY
• Are extremely rare
• There is an increased incidence of müllerian anomalies in women who were exposed in
utero to diethylstilbestrol (DES) from 1940 to 1971 (Fig. 14-3).
• DES was a synthetic nonsteroidal estrogen that was indicated for gonorrheal vaginitis,
atrophic vaginitis, menopausal symptoms, postpartum lactation, miscarriage
prevention, and for advanced prostate and breast cancer.
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11. CLINICAL MANIFESTATIONS
• Discovered incidentally in the workup for common obstetrical and gynecologic
complaints at the onset of menache, onset of coitus, or attempts at childbearing.
• Menstrual abnormalities
• Dysmenorrhea
• Dyspareunia, cyclic and noncyclic pelvic pain, infertility, and recurrent miscarriage
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12. Uterus didelphys
Two separate uterine bodies, each with its own cervix and attached fallopian tube and vagina
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13. A bicornuate uterus witha rudimentary horn
Represents a fusion failure
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14. Bicornuate uterus with or without double cervices
• Bicornuate and unicornuate uteri are associated with second-trimester pregnancy
loss, malpresentation, and preterm labor and delivery
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15. Septate uterus
• Incomplete dissolution of the midline fusion of the paramesonephrica
• 25% of women with uterine septa may suffer from recurrent first-trimester
pregnancy loss.
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16. Unicornuate uterus Failure of formation
• Normal karyotypic and phenotypic females + anomalies of the urinary system such as a
horseshoe or pelvic kidney
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17. Clinical significant
• Woman’s risk for infertility
• Early pregnancy Loss
• Dysmenorrhea and dyspareunia
• Anomalies within uterine vascular system, such as anAVM
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18. • Spontaneously Always .. But may also be caused by early maternal exposure to certain
drugs
• The most notable of these drugs is diethylstilbestrol (DES) (is a synthetic nonsteroidal estrogen
that was first synthesized in 1938 )
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19. DES-exposed female’s infant
• T-shaped endometrial cavity
• cervical collar deformity
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20. Diagnostic Evaluation
• pelvic ultrasound, CT, MRI, sonohistogram, hysterosalpingogram, hysteroscopy, and
laparoscopy
• Keep in mind that uterine septa and bicornuate uteri may appear identical on hysteroscopic
evaluation
• Because there is an increased incidence of renal anomalies (unilateral renal agenesis, pelvic or
horseshoe kidneys, or irregularities in the collecting system), additional radiologic evaluation
should be pursued in the setting of a congenital Müllerian anomaly
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21. Unicornuate
Septate Uteri
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24. Treatment
• Many uterine anomalies require no treatment.
• When the defect causes significant symptoms such as pain , menstrual irregularities, or
infertility, treatment options should be explored.
• Uterine septa can be excised with operative hysteroscopy once bicornuate uterus has been ruled
out
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25. • Many women with a bicornuate uterus are able to carry a pregnancy to fruition, although preterm
labor and delivery is a significant risk
• When a viable pregnancy cannot be achieved in a patient with a bicornuate uterus, viable
pregnancies have been achieved with surgical unification procedures.
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28. External genitalia
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29. CONGENITAL ANOMALIES OFTHE VULVA
• Ambiguous genitalia:
 may appear as a large clitoris or a small penis. Thus a child may be born with a typically female
appearance, but with a large clitoris ( clitoral hypertrophy ) or typically male with a small penis
that is open on its ventral surface ( hypospadius).
• Clitoral agenesis : failure of the genital tubercle to develop
• IMPERFORATE HYMEN
• Vaginal agenesis, also known as Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH).
• Vaginal atresia (also known as agenesis of the lower vagina) is often confused with
imperforate hymen or transverse vaginal septum.
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32. Ambiguous genitalia
• Physical examination
• Pelvic ultrasonography
• Hormonal studies
• Examination of a buccal smear for sex chromatin
• Karyotyping
• And consultation with specialists
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33. Female pseudohermaphroditism
• Genetic females (45,XX)
• Ovaries but with secondary sexual characteristics or external genitalia resembling those of
a male
• Caused by masculinization occurring in utero (Androgens)
• Presenting with ambiguous genitalia.
• Ex. Congenital adrenal hyperplasia
 Defect in production of cortisol.
 Excessive adrenal androgens must be produced to overcome the decrease in cortisol
production.
 Enlargement of the clitoris is the most conspicuous abnormality
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37. the diagnosis is not suspected until signs of salt-wasting develop a week later, due in particular
to the lack of aldosterone.
When the external genitalia are ambiguous is necessary to investigate for the presence of a uterus
and ovaries. The diagnosis can be confirmed when levels of serum testosterone result to be
extensively increased while anti mullerian hormone is not present.
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38. True hermaphroditism
• Dual gonadal development occurs, either in the form of an ovotestis or as a separate ovary and
testis
• Most true hermaphrodites have some degree of both female and male development internally
and externally
• The extent to which masculinization occurs depends on the relative amount of testicular tissue
and its relative contribution of testosterone
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40. EXERCISE
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 Explain the Congenital anomalies of Uterus and Cervix

41. LEARNING OUTCOMES
BNSG 701 41
The student explain about
Congenital anomalies of Uterus and Cervix

42. Student effective learning outcome
1.Application of concepts of topic & it’s technological application.
2. Critical and innovative thinking skills
3.Life long learning ability
4.Ability to observe and develop sense making , logical skills for abstract concepts.
5.Ability to understand subject related concepts clearly along with contemporary issues
6.Ability to collaborate
7.Ability to be a lifelong learner
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43. REFERENCES
• Sara Howard (2013) Midwifery retrieved April 17, 2014 from www.powershow.com
• CordeliaS.H.(2014) A brief History Of Midwifery in America. Retrieved April 11, 2014 from
wholisticmaternalnewbornhealth.org/professio nal-education/history-of-midwifery
• midwifeinsight.com/articles/a-short-history-of- midwifery/,retrieved April 18,2014.
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