mullerian duct anaomalies
T-shaped uterus
-DES exposure -small, T shaped uterine cavity -increases risk of spontaneous abortion, preterm delivery, and incompetent cervix -difficult ultrasound diagnosis (better in 3D)
agenesis/hypoplasia complications
-Hydrocolpos -Hematocolpos -Hydrometrocolpos -hematometrocolpos
types of mullerian anomalies
-Unicornuate uterus -uterine didelphys -bicornuate uterus -septate uterus (Subseptus uterus) -arcuate uterus -T-shaped uterus (DES exposure) -uterine aplasia / vaginal atresia
Unicornuate uterus
-arrested development of one of the mullerian ducts -single uterine horn with one fallopian tube -rudimentary horn may be present and may be filled with blood -most commonly associated with renal anomalies
agenesis/hypoplasia
-arrested development of the mullerian ducts vaginal agenesis -absence of the vagina is often associated with absence of the uterus -MRKH
uterine didelphys
-complete failure of mullerian duct fusion -two uteri(horns) each with an endometrial cavity and cervix -upper third of the vagina is also duplicated -no connection of the endometrial cavities
septate / subseptate
-failure of reabsorption of the septum following fusion of the mullerian ducts (most common pregnancy complication) -subseptate is partial reabsorption -normal external contour (no heart shape) -two endometrial cavities
bicornuate uterus
-incomplete or partial fusion of the mullerian ducts -external cleft (heart shaped uterus) -may have single cervix or 2 cervices (bicollis or unicollis) -always one vagina
arcuate uterus
-normal variant -normal external contour -slight indentation of fundal region of the uterine cavity
clinical signs of agenesis/hypoplasia
-primary amenorrhea -cyclic pelvic pain
clinical complications of mullerian duct anomalies
-recurrent pregnancy loss -preterm labor / preterm birth -high association with renal anomalies -second trimester loss -poor fetal growth
agenesis/hypoplasia ultrasound findings
-uterine agenesis -vaginal agenesis -vaginal atreasoa or septum
mullerian duct complications
___________________ lead to an increased incidence of pregnancy loss and infertility
Mayer-Rokitansky-Kuster-Hauser syndrome (MRKH)
absent uterus and deformed or missing vagina
hematometrocolpos
blood filled uterus and vagina
hematocolpos
blood filled vaginas
mullerian anomalies
congenital uterine anomalies as a result of -lack of development of the mullerian ducts -improper fusion of the mullerian ducts -failure of the absorption of the uterine septum that forms during fusion
hydrometrocolpos
fluid filled uterus and vagina
Hydrocolpos
fluid filled vagina
renal
mullerian duct anomalies are associated with coexisting _________ anomalies
vaginal agenesis
the absence or hypoplasia of the vagina
5%
the incidence of a mullerian anomaly is less than _________%
puberty or adulthood
when is a mullerian anomaly usually diagnosed?