Genetic sex determined at fertilization . Gender become apparent in normal fetus by the 12th week of development

1. EMBERYOLOGY AND CONGINITAL
ANOMALIES OF FEMALE GENITAL
TRACT

2. • Genetic sex determined at fertilization .
• Gender become apparent in normal fetus by the 12th week
of development .
• By 6th week of life the following structure start to develop
either side of midline :-
• Genital ridge ( induced by primordial germ cell from yolk
sac.
• Mesonephric ( walffian duct ) lateral to genital ridge .
• Paramesonephric duct ( müllerian ) duct lateral to
mesonephric duct .
• By 6th week " Y " OR " X " chromosome produce their effect
leading to differention of gonads into either testis or
ovaries.

6. Testis Produce :-
1)Müllerian inhibiting factor ( MIF ) that inhibits
development of müllerian system .
2)Testosterone that cause development of
(WALFFIAN SYSTEM ).
3)In absence of " Y " chromosome there is lack
of MIF and walffian system regress .

7. • In female fetus the mesonephric duct regress ,
the paramesonephric duct go on to develop into
:-
• Fallopian tube ( upper & middle part of the duct
• Uterus develop from intermediate horizontal
part of the two müllerian duct which fuses
together in the midline .
• Cervix and upper vagina develop from the
caudal part of two müllerian ducts .

8. • Development of lower 1/3 of the vagina the caudal
parts of the two müllerian duct come in contact with
urogenital sinus and produce elevation called müllerian
tubercle , the epithelium overlying the tubercle
proliferate to form 2 small masses called sino-vaginal
bulbs .
• Growth of sino-vaginal bulbs leads to formation of
solid cord called vaginal plate .
• Conalizaton of vaginal plate communicates above with
the caudal part of müllerian ducts and below with
urogenital sinus to forms the lower 1/3 of vagina

9. • Hymen is formed at the point of the origin of
sino-vaginal bulbs (at the junction of vagina
and the urogenital sinus ).
• Development of the external genitalia .
• Clitoris develops from genital tubercle .
• Labia majora develop from the genital
swellings .
• Labia minora lie medial to labia majora
and develop from the genital folds .

10. • The ovary develops from 3 sources :-
1- Coelomic epithelium it consist of mesothelial cells
which lines the coelomic ( peritoneal cavity ) .
These cells cover the genital ridge and forms primitive sex
cords , these sex cords break into separate clusters .
To form primordial follicles .
2- Primordial germ ( sex ) cells : these cell are endodermal
in origin and arise from yolk sac .
They migrate along the hindgut and its mesentery to
reach genital ridge they give rise to oogonia then primary
oocytes and become arrested until puberty .

11. 3- Intermediate mesoderm : it forms the connective
tissue of the ovary .
• The ovary is attached by (gubernaculum ) which
is fibromuscular band of mesodermal origin
which travers the inquinal canal to get attached
to labia majora.
• The gubernaculum is necessary for the descent of
the ovary in the pelvis .
• The gubernaculum forms the ovarian ligament
and the round ligament of the uterus .

12. Conginital Anomalies of Female
Genital System
1- The Ovary :-
* Gonadal agenesis the primordial germ cells
fail to migrate to genital ridge , the ovary is
completely absent , the ovary is represented by
fibrous tissue ( streak gonadal as in turner's
syndrome ).
* Hermaphroditism :-
• True hermaphroditism gonads and external
genitilia of both sexes are present .
• Pseudohermaphroditism gonads of one sex
and external genitilia of other sex .

13. 2- The Uterus :-
• Uterine aplasia or müllerian agenesis " Mayer –
Rokitansky – Kauster – Hauser Syndrome ".
• Uterine hypoplasia .
• Unicornate ulerus uterus with one horn only
with uterine tube , the other horn may present
but rudimentary.
• Uterus didelphys " double uterus " due to
complete failure of fusion of 2 müllerian ducts ,
each duct forms aseperate uterus with its own
vagina

14. • Bicornuate uterus  incomplete fusion of 2
müllerian ducts.
• Bicornate uterus with double cervix (uterus bicornis
bicolis)  the uterus has 2 horns double cervix and
single vagina .
• Bicornuate uterus with single cervix ( uterus bicornis
unicollis) the uterus has 2 horns but with single
cervix and vagina .
• Septate uterus :- the uterine cavity divided by septum
into 2 compartment after fusion of the two duct , there
is failure of resorption of midline septum ( it differs
from bicornuate uterus in having a normal fundus ).

16. Clinical significance of uterine
anomalies
• Müllerian agenesis ( absent uterus ) primary
amenorrhea and infertility .
• Septate uterus  recurrant pregnancy loss 65%
• Unicornuate uterus  50% pregnancy loss .
• Bicornuate uterus and didelphys 40% loss .
• Cervical cerculage improve pregnancy out come in
unicornuate and bicornuate uterus .
• Septate uterus corrected by hystroscopic septoplasty (
septum resection).
• Rudimentary horn  ectopic pregnancy .
• Fetal malpresentation

17. 3- The Vagina :-
• Atresia of the vagina due to failure of the vaginal
plate canalization .
• Imperforate hymen due to the vaginal
communication between the vaginal lumen and
urogenital sinus ( crypto menorrhea ) .
• Double vagina due to failure of fusion of coudal
of the 2 müllerian ducts
• Vaginal septum  either longitudinal or
transverse .