It's interesting seminar of HO Class...

1. Congenital malformation of female
genital tract
Dr Abenezer G.(R-II)
Moderator: Dr Amenu(urogynecology and
pelvic reconstructive surgeon)
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genital tract
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2. OUTLINE
• Introduction
• Common anomalies
• Diagnosis
• Managment
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3. • There are four common developmental defects of the mullerian
system to consider:
 Agenesis of both ducts
 Unilateral maturation of one müllerian duct
 Absent/ faulty midline fusion of the ducts; or
 Defective canalization.
• Include Agenesis(MRKH) and specific parts.
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Congenital malformation of female
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DEVELOPMENTAL DEFECTS:

4. ANOMALIES OF THE HYMEN
• Results from incomplete degeneration of central
portion of the hymen.
• Anatomic variants include imperforate, microperforate,
septate, and cribriform hymens
• Include imperforate hymen and incomplete hymenal
fenestration.
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6. Imperforate hymen
• Most common obstructive lesions of the genital tract.
• Presentation: bulging introitus & cyclic pain and
hematocolpos
• Timing: At birth, infants or adolescent girl.
• Rx: Hymectomy/Cruciate incision
Timing: Newborn, postpubertal, or premenarchal.
Give certificate to child
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8. Incomplete hymenal fenestration
• Incomplete fenestration of the hymenal opening.
• Presentation: inability to insert tampons, douches, or
vaginal creams, or because of difficulty with coitus.
• Rx: Resection of the excess hymenal tissue.
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9. Anomalies of vagina
• May be isolated or associated with other müllerian anomalies.
• Include MRKH, MURCS (müllerian duct aplasia, renal aplasia,
and cervico-thoracic somite dysplasia).
• Obstetrical significance depends on degree of obstruction.
• Complete vaginal agenesis, unless corrected surgically,
precludes pregnancy by vaginal intercourse.
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10. 1. Transverse vaginal septum
2. Longitudinal vaginal septum
3. Obstructed hemi-vagina
4. Agenesis of vagina
5. Agenesis of lower vagina
6. Vaginal cyst
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Congenital malformation of female
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11. Transverse vaginal septum:
Definition:
• Failure of fusion and/or canalization of the
urogenital sinus and müllerian ducts.
Depending on the site:
• Upper vagina(46%)
• Middle portion(35-40%)
• Lower vagina(15-20%)
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Congenital malformation of female
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13. Anomalies of Cervix
• Include agenesis, duplication,or a longitudinal dividing
septum.
• Complete agenesis is incompatible with pregnancy.
• IVF with gestational surrogacy or with transmyometrial
embryo transfer are options.
• Uterovaginal anastomosis??
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14. Anomalies of uterus
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Congenital malformation of female
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• Prevalence, 0.4 to 10 percent.
• Arcuate->septate->bicornuate->didelphic->unicornuate.
• Pose greater risk for miscarriage, malpresentation,
preterm birth, and poor fetal growth.
 Sonography, HSG, MRI, laparoscopy, and hysteroscopy
may also be diagnostic.

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Congenital malformation of female
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Müllerian Agenesis (Class I)
• Caused by müllerian hypoplasia or agenesis as
• Can affect the vagina, cervix, uterus, or fallopian tubes
• Can also be isolated or may coexist with other müllerian
anomalies.

19. Unicornuate Uterus (Class II)
• Incidence of 1 case in 4000 women.
• Detected accidentally during fertility evaluation by HSG.
• Include Main horn and Rudimentary horn.
• Can be communicating & Non-communicating.
• Main obstetrical significance is cornual px,
• Rx: surgical removal of rudimentary horn and in situ
pregnancy.
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20. Uterine Didelphys (Class III)
• Results from incomplete fusion.
• Suspected on PV by identification of longitudinal vaginal
septum and two cervices.
• HSG: shows two separate endocervical canals.
• Each separate cavities have a solitary fallopian tube.
• Rx: Surgical Metroplasty.
- Scheduled delivery is recomended after Rx.
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21. Bicornuate Uterus (Class IV)
• Results in two hemiuteri.
• Central myometrium runs either partially or completely
to the cervix.
• Can be bicornuate unicollis or bicornuate bicollis.
• Radiological discrimination of a bicornuate from a septate
uterus is challenging.
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23. Septate Uterus (Class V)
• Results from resorption defect with persistent complete
or partial longitudinal uterine septum.
• Many Dxsed during evaluation of infertility or RPL.
• 3D TVS or MR imaging is required to differentiate
septate and bicornuate uteri.
• Rx: Hysteroscopic septal resection.
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24. Arcuate Uterus (Class VI)
• Mild deviation of normally developed uterus.
• Most consider this anomaly benign
• Obstetrical significance : 2nd Px losses, preterm labor,
and malpresentation.
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25. Cesarean Delivery
• Failed TOLAC or risk of rupture may stem from
Smaller than normal cavity size,
Abnormal propagation of myometrial action potentials
Weaker scar site due to altered vascular anatomy.
• ECV is reasonable to avoid primary C/S.
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26. Treatment with Cerclage
• Indication:
• RPL after 1st TM.
• Partial cervical atresia or hypoplasia.
• Candidacy for cervical length is similar with general population.
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27. DES-related Abnormalities (Class VII)
• Exposed women show a cervix or vagina with
transverse septum.
• Uteri are potentially smaller or have a T-shaped cavity.
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28. Anomalies of Fallopian Tube
• Develop from unpaired distal ends of the müllerian ducts.
• Includes accessory ostia, complete or segmental tubal
agenesis, and several embryonic cystic remnants.
• The most common—the hydatid of Morgagni.
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29. Obstetric complications
• Miscarriage,
• Prematurity,
• IUGR
• APH &PPH
• Cervical
incompetence
• Malpresentati
on
• HDP
• Cesarean delivery
• RPL
• Preterm delivery
• Uterine rupture
 Most common, uterine
septum and least common,
arcuate uterus.
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30. Diagnosis
• Hx: Pain, Pelvic mass, Dysmenorrhea, Dyspareunia,
Infertility, or recurrent pregnancy loss.
• Ix: Ultrasound
• Hysterosalphingography
• MRI
• Laparascopy
• Hysteroscopy
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31. Managment
• Directs to type of Anomalies part.
• Can be
» Surgical or
» Non-surgical.
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