OB/GYN Penny Chapter 17 Key Terms

Congenital Uterine Anomalies

-agenesis of the uterus is uncommon -bicornuate uterus is common -congenital malformations have been linked to menstrual disorders, infertility, and obstetric complications -septate uterus has an explicit connection to spontaneous abortion -can be seen in 2D but 3D is helpful for detection

Uterine Leiomyomas

-benign smooth muscle tumors of the uterus (fibroids) -most common benign tumors -leading cause of hysterectomy and gynecologic surgery -vary in sizes and may alter shape of uterus, and sonographic appearances -risk factors: obese, black, nonsmokers, and perimenopausal -clinical findings: pelvic pressure, menorrhagia, palpable abdominal mass, enlarged uterus, urinary frequency, dysuria, constipation, and possible infertility -fibroids appear solid hypoechoic masses that create posterior shadowing -degenerating fibroids may have calcifications or cystic components, multiple fibroids may cause diffuse uterine enlargement and heterogenicity -distorted uterus by fibroids is called fibroid uterus -also described by location: most common being intramural (within myometrium) -some may extend into cervix when pedunculated and may prolapsed into vagina as well

Congenital Malformation of the Vagina

-can lead to accumulation of fluid within the female genital tract secondary to an obstruction (vaginal atresia, vaginal septum, or an imperforate hymen) -could lead to distension of vagina, cervix, uterus, and fallopian tubes with fluid or blood (hydrocolpos, hydrometrocolpos) -palpable mass in pelvic or abdomen as a result of excessive buildup of vaginal secretions in utero -may have blood components from menstruation retained in uterine cavity or vagina (hematometra, hematocolpos) -hematometrocolpos -clinically will present with amenorrhea, cyclic abdominal pain, abdominal mass, enlarged uterus, and possibly urinary retention

Clinical Findings of Vaginal Obstruction

-cyclic pelvic pain (at the time of menses in adolescent girls) -enlarged uterus -abdominal pain -urinary retention -amenorrhea -sonography: distension of uterus, vagina, or both with anechoic or complex fluid

Uterine Size and Shape

-depends on age, parity, and presence of pathology or congenital anomalies -normal neonatal uterus is tubular in appearance and may have distinct endometrial echoes in the first week of life as a result of maternal hormone stimulation -after neonatal, the cervical anteroposterior diameter is equal to or slightly greater than that of uterine fundus. This is normal prepubertal uterus. -prepubertal cervix-uterus ratio is 2:1, uterus grows minimally -puberty: the uterine fundus becomes much larger than cervix creating pear shaped appearance -menopause: the uterus typically becomes much smaller

Adenomyosis Pathology

-invasion of endometrial tissue into myometrium for unknown reasons -basal layer can distend into myometrium depths of at least 2.5mm -may be focal or diffuse and is typically found in fundus or posterior portion of uterus -mass is called adenomyoma -uterus will appear diffusely enlarged and heterogeneous -indistinct hypoechoic or echogenic myometrial cysts -thickening of posterior myometrium -often present in uterus with fibroid tumors -25% of patients will have endometriosis also -clinical findings are varied and nonspecific: dyschezia, dysmenorrhea, menometrorrhagia, pelvic pain, and dyspareunia -patients often have boggy, enlarges, and tender uterus physical examination. MRI is important examination -treatment: hysterectomy or hormone therapy -younger tends to have fertility problems, patients are often older and multiparous

Cervical Carcinoma and Cervical Stenosis

-most common female malignancy in women younger than 50 -not routinely diagnosed with sonography when seen it is often inhomogenous bulky enlarged cervix or a local mass within cervix -loss of normal cervical canal may occur, the width should not exceed 4 cm (4.4cm in patients who had hysterectomy vaginal cuff shouldn't exceed 2 cm) -TV and TR imaging -mass may obstruct the cervix leading to hydrometra or hematometra -cervical stenosis often leads to abnormal quantity of fluid in endocervical or endometrial canals, can be result of tumor in cervix; cervical fibroid; cervical atrophy; polyp; infection; or scarring of cervix -asymptomatic, absent flow if still menstruating, enlarged uterus (cervical stenosis)

Gartner Duct Cyst

-noted within vagina -located along the wall of vagina and often small -often asymptomatic

Physiology of Uterus and Vagina

-primary function of the uterus is to provide a place for the products of conception to implant and develop -thickness of the basal layer is consistent although minimal changes may occur throughout the menstrual cycle -the functional layer is the component that is shed during menstruation, changes through cycle as a result of hormonal stimulation

Precocious Puberty

-pubertal development before the age of 8 -delayed puberty is absent or incomplete breast development after the age of 12 -endocrinologic workup to evaluate gonadotropin levels -associated with intracranial tumors or idiopathic -pseudoprecocious puberty has been linked to ovarian, adrenal, and liver tumors -uterus may appear enlarged with postpubertal shape and contain a prominent endometrial stripe -ovary/ovaries may be enlarged, and a functional ovarian cyst or mass may be seen

Embryologic Development of Female Urogenital Tract

-the uterus and kidneys develop at the same time -congenital anomalies recognized on sonogram of the uterus, coexisting anomalies may be in kidneys -Complete, partial fusion, agenesis of the Mullerian ducts will result in anatomic variant of the uterus, cervix, and/or vagina recognized by sonography -these are known as congenital malformations or Mullerian anomalies

Anatomy of the Uterus and Vagina

-the uterus is pear-shaped, retroperitoneal organ anterior to the rectum, posterior to the urinary bladder, bounded by the broad ligaments -divided into four major divisions: fundus, corpus, isthmus, and cervix. Fundus is the most superior and widest portion -Fallopian tubes attach to either side of the uterus to the cornua -largest portion of the uterus is the corpus or body which is inferior to the fundus -the isthmus is located between the corpus and the cervix. Is AKA as LUS during pregnancy -the cervix is marked superiorly by the internal os (contact with isthmus) and inferiorly by the external os (contact with vagina) -the vagina is a tubular organ that extends from external os to the external genitalia. Vaginal fornices enevlop the inferior aspect of the cervix. -the vagina is composed of three layers: inner mucosal, middle muscular, and outer layer (adventitia) -The uterine wall consists of three layers: serosal layer/perimetrium (outermost) continuous with fascia of the pelvis, myometrium (middle layer) muscular, endometrium (inner mucosal) -the endometrium is divided into deep/basal layer and superficial/functional layer

Uterine Myoma

Leiomyoma

Gartner Duct Cyst

a benign cyst located within the vagina

leiomyoma of the uterus

a benign smooth muscle tumor of the uterus may also be referred to as a fibroid or uterine myoma

Bicornuate Uterus

a common uterine anomaly in which the endometrium divides into two horns; also referred to as bicornis unicollis

Virilization

a condition in which a female develops physical changes that are associated with male hormones (androgens) such as hair growth

Diethylstillbestrol (DES)

a drug administered to pregnant women from the 1940s-1970s to treat threatened abortions and premature labor that has been linked with uterine malformations in the exposed fetus

Magnetic Resonance Imaging-Guided High Intensity Focused Ultrasound

a fibroid treatment that utilizes focused high-energy ultrasound guided by magnetic resonance imaging to heat and destroy fibroid tissue

Adenomyoma

a focal mass of adenomyosis

Submucosal (Fibroid)

a leiomyoma that distorts the shape of the endometrium adjacent to the endometrial cavity often distorting the shape of the endometrium

Intracavitary (Fibroid)

a leiomyoma within the uterine cavity usually lead to abnormal uterine bleeding because of their location in relationship to the endometrium

Hysterosalpingography

a radiographic procedure that uses a dye instilled into the endometrial cavity and fallopian tubes to evaluate for internal abnormalities

Saline Infusion Sonohysterography

a sonographic procedure that uses saline instillation into the endometrial cavity and possibly fallopian tubes to evaluate for internal abnormalities also referred to as sonohysterography

Imperforate Hymen

a vaginal anomaly in which the hymen has no opening, therefore resulting in an obstruction of the vagina

Menorrhagia

abnormally heavy and prolonged bleeding

Isthmus (Uterus)

area of the uterus between the corpus and the cervix

Endometrial Cavity

area that lies between the two functional layers of the endometrium, may also be referred to as the uterine cavity this cavity is contiguous with the lumen of the fallopian tubes laterally and the cervix inferiorly

Cornua

areas just inferior to the fundus of the uterus where the fallopian tubes are attaches bilaterally

Fibroid Growth

associated with estrogen stimulation and their size may increase during pregnancy and reduce during menopause may affect fertility based on size and location (higher incidence of spontaneous abortion) may affect contractile motion of uterine muscles affecting sperm migration may prevent cervical dilation during pregnancy causing c-section

Nabothian Cysts

benign cysts located within the cervix

Hematometra

blood accumulation within the uterine cavity

Hematometrocolpos

blood accumulation within the uterus and vagina

Hematocolpos

blood accumulation within the vagina

Secondary Sexual Characteristics

body changes typically occurring at puberty such as enlargement of breasts and growth of pubic hair

Uterine Positions

can be variable within the pelvis normal position is considered anterversion or anteflexion

Premature Thelarche

characterized by isolated breast development with normal prepubertal hormones

Premature Adrenarche

characterized by isolated pubic hair development and increased levels of adrenal androgens

Septate Uterus

common congenital malformation of the uterus that results in a single septum that separates two endometrial cavities

Nabothian Cysts

common findings on routine sonography retention cysts within the cervix may cause cervix enlargement on physical examination classically simple but may have some debris or septations which may represent hemorrhage or infection asymptomatic and may be multiple

Subseptate Uterus

congenital malformation of the uterus that results in a normal uterine contour with an endometrium that branches into two horns

Unicornuate Uterus

congenital malformation of the uterus that results in a uterus with one horn

Uterine Didelphys

congenital malformation of the uterus that results in the complete duplication of the uterus, cervix, and vagina

Dyschezia

difficult or painful defecation

Dyspareunia

difficult or painful intercourse

Dysmenorrhea

difficult or painful menstruation

Isosexual Precocity

early development of secondary sexual characteristics with menses ovulation and elevated gonadotropin levels

Menometrorrhagia

excessive and prolonged bleeding at irregular intervals

Agenesis

failure of an organ or structure to grow during embryologic development

Hydrometrocolpos

fluid accumulation within the uterus and vagina

Hydrocolpos

fluid accumulation within the vagina

Multiparous

having birthed more than one child

Treatment for Fibroids

hormone therapy which results in reduction of tumor size surgical treatment may be either hysterectomy or myomectomy uterine artery embolization magnetic resonance imaging-guided high intensity focused ultrasound

Fibroid

leiomyoma

Boggy

limp

Subserosal (Fibroid)

location of a leiomyoma in which the tumor grows outward and distorts the contour of the uterus that are pedunculated or associated with broad ligament could resemble adnexal masses and may undergo torsion leading to necrosis

Intramural (Fibroid)

location of leiomyoma within the myometrium of the uterus most common site

Leiomyosarcoma

malignant counterpart of the normally benign leiomyoma rapid increase in growth over short period of time commonly found in perimenopausal or postmenopausal women sonographic appearance is variable and may be similar to benign fibroid with some evidence of degeneration may be asymptomatic or present with same symptoms as benign leiomyoma

Vaginal Atresia

occlusion or imperforation of the vagina can be congenital or acquired

Mullerian Ducts

paired embryonic ducts that develop into the female urogenital tract

Broad Ligaments

pelvic ligament that extends from the lateral aspect of the uterus to the side walls of the pelvis

Congenital Malformations

physical defects that are present in a person at birth; may also be referred to as congenital anomalies

Uterine Artery Embolization

procedure used to block the blood supply to a leiomyoma (fibroid)

Precocious Puberty

pubertal development before the age of 8; the early development of pubic hair, breast, or genitials

Vaginal Fornices

recesses of the vagina

Pseudoprecocious Puberty

secondary sexual development induced by sex steroids or from other sources such as ovarian tumors, adrenal tumors, or steroid use

Pedunculated

something that grows off of a stalk

Amenorrhea

the absence of menstruation

Adenomyosis

the benign invasion of endometrial tissue into the myometrium of the uterus

Neonatal

the first 4 weeks (28 days) after birth

Functional Layer (Endometrium)

the functional inner layer of the endometrium that is altered by the hormones of menstrual cycles

External Os

the inferior portion of the cervix that is in close contact with the vagina

Endometrium

the inner mucosal layer of the uterus

Levoverted Uterus

the long axis of the uterus deviating to the left of the midline

Dextroverted Uterus

the long axis of the uterus deviating to the right of the midline

Leiomyosarcoma

the malignant manifestation of a leiomyoma

fundus of stomach

the most superior and widest portion of the uterus

Myometrium

the muscular layer of the uterus

Basal Layer (Endometrium)

the nonfunctional outer layer of the endometrium

Perimetrium

the outer layer of the uterus; may also be referred to as the serosal layer

Serosal Layer (Uterus)

the outermost layer of the uterus may also be reffered to as the perimetrium

Vaginal Cuff

the portion of the vagina remaining after a hysterectomy

Cervix

the rigid region of the uterus located between the isthmus and the vagina

Internal Os

the superior portion of the cervix closest to the isthmus

Myomectomy

the surgical removal of a myoma (fibroid) of the uterus

Hysterectomy (Uterectomy)

the surgical removal of the uterus

Hysteroscopic Uterine Septoplasty

the surgical repair of a uterine septum in a septate uterus using a hysteroscopy

Lower Uterine Segment

the term used for the isthmus of the uterus during pregnancy

Parity

the total number of pregnancies in which the patient has given birth to a fetus at or beyond 20 weeks gestational age or an infant weighing more than 500 grams

Anteversion

the typical version of the uterus where the uterine body tilts forward, forming a 90-degree angle with the cervix

Retroflexion

the uterine body tilts backwards and comes in contact with the cervix, forming an acute angle between the body and the cervix

Retroversion

the uterine body tilts backwards without a bend where the cervix and body meet

Anteflexion

the uterine body tilts forwards and comes in contact with the cervix, forming an acute angle between the body and the cervix

Torsion

twisting