Uterus II - Congenital Malformations

What percentage of women experience congenital uterine anomalies?

5%

Class III: Didelphys

A double uterus results from complete failure of two mullerian ducts to fuse together. Each uterus develops into a separate uterus each of which has a narrower than a normal uterus and only has one horn

How is the widening achieved when a uterus is fully developed and is wider at top than the bottom?

An expansion of the top part of the 'central wall'. As the wall grows, the tube becomes wider at the top forming the part of the uterus known as the "fundus."

What is similar to a septum uterus but considered a normal variant?

Arcuate uterus

What happens to the mullerian ducts during development?

At the end closest to the head of the embryo (top), these two tubes become fallopian tubes-remain separated at a distance. The other end of the tubes which are closest to the embryo's bottom lie side by side, close together and form the uterus by fusing together to become one structure

Infundibulopelvic ligament

Attaches ovary to the lateral pelvic wall and contain the neruovascular bundle

Hematometrocolpos

Blood-filled vagina and uterus

How do congenital uterine anomalies occur?

Defects in paired mullerian duct development, fusion, or respiration.

What happens when a class III: didelpys is complete?

Duplication of uterus, cervix, and vagina. 2 fundi, 2 cervix, 2 agina. Not usually associated with fertility problems

What happens in class IV: Bicornuate Uterus?

Duplications of the uterus, sometimes cervix. It's the most common uterine anomaly. Results from failure of mullerian duct from the top.

Class II: Unicornuate

Failure of the development of one half of the uterus May be associated with a rudimentary horn from the contralateral duct Related to infertility and pregnancy loss

Hydrometrocolpos

Fluid-filled vagina and uterus

What is a partial bicornuate uterus?

Fusion between the mullerian duct occurs at the bottom, not at the top- results in a single uterine cavity at the bottom with a single cervix but it branches into two distinct horns at the top.

Class I: Agenesis or hypoplasia: segmental or complete

Incomplete vaginal canalization, transverse septum or vaginal atresia. Young girl reaches puberty without menstruation.

Where does the right ovarian vein drain?

Into IVC near renal vein

Where does the left ovarian vein drain?

Into left renal vein

What are the fallopian tube divisions?

Intramural, infundibulum, isthmus and ampulla

What are the three subcomponents of the broad ligament?

Mesometrium, the mesentery of the uterus; largest portion of the broad ligament Mesosalpinx, the mesentery of the fallopian tube Mesovarium, the mesentery of the ovaries

What secretes estrogen?

One or more mature follicles surrounding mature oocytes

Fimbria

Ovarian fimbria attaches to vary

Where does ovulation occur?

Peritoneal cavity

What happens in a class VII; DES related?

Related to exposure to drug Diethlystilbestrol (DES) in utero, T shaped cavity with irregular contour. Daughters of mothers who were exposed to DES during pregnancy are predisposed to uterine abnormalities, 2/3 have small, incomplete formed uterus, t shaped cavity, or 1/2 have cervical defects.

Corpora lutea

Remains of follicle after ovulation, secretes estrogen and progesterone.

What is a partial septate uterus?

Resportion of the lower part of the median septum, but the top of the septum fails to dissolve. There is a single cervix and uterine cavity at the bottom but at the top that cavity divids into 2 distinct horns.

What is a complete bicornuate uterus?

Results in a two seperate single horn uterine bodies sharing one cervix

Ovarian ligament

Runs within broad ligament form inferior medical pole of each ovary to the uterus in vicinity of cornu

How are ovaries measured?

Sag, trans, and AP

Corpora albicantia

Scars of regressed corpora lutea

Which class has the highest incidence of fertility problems?

Septum uterus

How does the uterus form?

Structures which give rise to the uterus are a pair of tubes called mullerian ducts

What is the internal structure of the ovaries?

The cortex, functional part. Medulla, contains connective tissue and vasculature

What kind of procedure can help with a septum uterus?

The septum may be hysteroscopically removed

What happens in a class VI: arcuate uterus?

The uterus is esentially normal in shape with a small, midline indentation in the uterine fundus. Results from failure to completely dissolve the median septum, does not seem to have any negative effects on pregnancy.

What happens in a class V: septate uterus?

Two mullerian ducts fuse normally, there is failure in degeneration of the median septum.

What are the US findings for a class II: unicornuate?

Uterus long and slender (cigar shaped), deviated to one side

How do you get the volume of ovaries?

Volume = sag x AP x Trans / 2

What is a complete septate uterus?

When a median septum persists in the entire uterus separating the uterine cavity into two single-horned uteri which share one cervix

Ovarian arteries

arise from the aorta near renal arteries and run inferiorly in suspensory ligament and mesovarium

Mesovarium

attaches each ovary to broad ligament

Hydrocolpos

fluid filled vagina