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?