e&c fem gen

__ systems develop in tandem

Kidneys and reproductive

Both male and female embryos start with _ sets of genital ducts

two

Wolffian Duct (aka Mesonephric Duct)-

male genital duct

Mullerian Ducts (aka Paramesonephric Duct) -

female genital duct

WEEK 5-6: PRIMORDIAL GERM CELLS MIGRATE TO THE___

GONADAL RIDGE

Primordial germ cells are cells that express _

gonadal development

@ 5W, primordial germ cells travel through vitelline duct to gonadal ridges (precursor to ___)

ovaries or testes

@ 5W the primordial germ cells travel through vitelline duct to gonadal ridges (precursor to ovaries or testes) and Arrives week _

6

PGCs differentiate gonadal ridges and thus start of the formation of the

reproductive system

PGCs also differentiate themselves into ___ or ___

sperm , oocytes

Up until 7 weeks, the embryo has been in the ___ ____ stage

indifferent gonad

At 7W – in absence of male hormone from PGC, ____ form (from maternal hormones) and mesonephric ducts regress

ovaries and uterus

Oogonia (eggs) form approx. 1 million at birth total! Most degenerate, which leaves ~_________ primordial follicles by puberty

500,000

Sonographers should evaluate the urinary tract in all cases of ___ anomalies

uterine

Ovaries do not develop from the Mullerian ducts, therefore both ovaries are generally normal in the presence of ____ anomalies

Mullerian

What other structures form in the pelvis with the genital tract?

Kidneys

What type of cells do the ovaries originate from?

Germ cells from the yolk sac

Mullerian ducts begin to fuse ____ to ____ (direction)

inferiorly , superiorly

The mullerian ducts begin to fuse at _to_ __ weeks

7-10

The Mullerian ducts fuse together and form the ___ ___

urogenital sinus

The midline septum in the uterus disappears by ~_ wks and the uterus and cervix are formed

12

The remaining segments of Mullerian ducts = the ___ ___

fallopiant tubes

The uterus, fallopian tubes, and upper 1/3 vagina develops from the

Mullerian ducts

The lower 2/3 of the vagina develops from the ___ ___

urogenital sinus

Step 1 of vagina formation

Uterovaginal canal connects with urogenital sinus, structures fuse

Step 2 of vagina formation

Two sinovaginal bulbs surround the uterovaginal canal and fuse

Step 3 of vagina formation

The center core of cells hollows

out to form a lumen in vagina.

External genitalia is the same up until the _ week

9th

male and female genitals differentiate at about the ___ week

12th

Maternal estrogen causes ________

female external genitalia development

Genital tubercle elongates, which leads to the primordial phallus, which ultimately becomes the _____

clitoris

Labioscrotal folds develop into the _____

labia minor and majora

4 categories of internal genitalia anomalies

1. Failure of formation

2. Failure of fusion

3. Failure of dissolution

4. Failure of structures to disappear

Less than ____ (percent) of all women have congenital deformities

5%

Hysterosalpingography (HSG) –

radiographic imaging of the uterus and fallopian tubes after injection of radiopaque material

Sonohysterography (SHG) –

sonographic imaging of the uterus after injecting saline fluid to distend the cavity and separate endometrial walls

Sonohysterography (SHG) is AKA as

Saline Infused Sonogram (SIS)

Cornis -

uterine horns

collis -

cervix

Failure to form is AKA as

arrested development

Complete agenesis:

Complete absence of vagina, cervix, uterus, and fallopian tubes.

Partial agenesis

Range of anomalies, including absence of the upper vagina and cervix with persistence of the uterus and fallopian tubes or unicornate uterus with a single fallopian tube

Unicornate uterus Happens when there is complete or partial failure of one _____

mullerian duct to elongate, resulting in a hemi-uterus

Unicornate uterus is __% of all mullerian duct anomalies

2-13

Unicornate uteruses have a very poor __________

reoriductive outcome

If a pt has Complete absence of vagina and uterus, the sonographic findings would be

Absence of uterus and middle and upper third of the vagina

If a pt has Hypoplasia of the vagina and uterus, the expected sonographic findings would be

Underdeveloped uterus and vagina, or normal uterus but small vagina, or normal vagina and small uterus

If a pt has a Unicornuate uterus, the expected sonographic findings would be

Normal to slightly asymmetric uterus, loss of pear shape, lateral displacement

The cause for Complete absence of vagina and uterus

Both mullerian ducts failed to develop

Clinical findings for Complete absence of vagina and uterus

Primary amenorrhea, infertility

Origin of Hypoplasia of the vagina and uterus

Neither mullerian duct develops fully

Clinical findings for Hypoplasia of the vagina and uterus

Primary amenorrhea, infertility, or poor pregnancy outcome

Cause of unicornate uterus

One mullerian duct not developed fully

Clinical findings for unicornate uterus

Poorest reproductive outcomes

2 failure of fusion anomalies

Uterus didelphys and Bicornuate uterus

Uterus didelphys is a Complete failure of fusion, meaning theres a Separate ___

uterus, cervix, and vagina

_____ makes up 5% of uterine anomalies

Uterus didelphys

uterus didelphys is Associated with ___ ___ more than any other anomaly

renal agenesis

Uterus didelphys is Associated with _________, usually unilaterally

transverse vaginal septum

Bicornuate uterus has a

Single vagina, one or two cervices, and variable lack of fusion of the upper uterine cavity

Bicornus unicollis

1 cervix

Bicornis bicollis

2 cervixes

____ makes up 10% of uterine anomalies

Bicornuate uterus

Surgery for didelphys

only recommended in case of a vaginal obstruction

bicornuate uterus Cervical incompetence is__% (both variances total)

38

Bicornis unicollis has higher ___ rates than bicornus bicollis

SAB and preterm delivery

Septated uterus -

The median septum fails to dissolve after fusion of the two separate Mullerian ducts.

Septated uterus is the most common uterine anomaly, with __%

55

Septated uterus typically results in

ONE vagina, cervix, and uterus and TWO endometria separated by an intrauterine septum

TWO endometria separated by an intrauterine septum is a characteristic of

septated uterus

Partially septate is called

subseptate

The least severe presentation of septate uterus is called an ____

arcuate uterus

Arcuate: indentation is

< 10mm

Septate: Indentation is

> 10mm

Arcuate angle is

90 degrees

septate uterus reproductive outcomes:

Poorest reproductive outcomes among all uterine anomalies

Septates poor repro outcomes does NOT include ____

arcuate

DES (DIETHYLSTILBESTROL) SYNDROME is a

synthetic form of estrogen

DES was prescribed to pregnant women between 1948-1971 to prevent ____ _____, and related complications of pregnancy

miscarriage, premature labor

Offspring of women exposed to DES during pregnancy were associated with…

 Vaginal clear cell carcinoma

 Poor pregnancy outcome

 Increased risk of cervical and breast carcinoma

 T- Shaped Endometrium

T shaped uterus pregnancy outcomes

• Twofold increased risk of SAB

• Ninefold increased risk of ectopic pregnancy

• Increased risk of premature labor and perinatal mortality

• Cervical incompetence risk increases

In the presence of uterine anomalies, ovaries may be located more ___ than expected

superiorly

Most common failure of disappearance is the ___

Gartner’s duct cyst

Gartner’s duct cyst is a remnant of the

mesonephric (Wolffian) duct

failure of disappearance is sometimes known as

vestigial remnants

The most common cystic legion of the vagina:

Gartner’s duct cyst

A Gartner’s duct cyst is;

Benign vaginal cystic lesion that arises from a remnant of the distal mesonephric duct (aka Wolffian duct)

Gartner’s duct cyst: clinical symptoms

renal and ureteral abnormalities if large enough

Garter’s duct cyst sonographic findings

anechoic mass found in the anterolateral or lateral wall of the vagina

Hemato=

blood

Pyo=

Pus

Hydro=

water/serous fluid

Metro=

Uterus

Colpos=

vagina

Hematocolpos =

blood in vagina

Hydrometrocolpos =

fluid in uterus and vagina

Imperforate Hymen is:

Congenital disorder caused by failure of the hymen to perforate during fetal development

Imperforate hymen is the

Most common congenital abnormality of female genital tract

Imperforate hymen is NOT a

mullerian anomaly

Imperforate hymen clinical symptoms in newborns:

acute urinary retention