Uterine Anomalies and Pathologies (Lecture 1)

Salpinges

fallopian tubes

Cornua

horns of uterus where fallopian tubes enter

Collis

neck of cervix

Colpos

vagina

Metra

endometrial cavity

Corpus

uterine body

What is the HOXA10 gene?

Uterine development regulated by this gene; anomaly with this gene = abnormal uterine development

What are the 3 causes of Mullerian duct anomalies?

- Arrested development of Mullerian ducts

- Failure of fusion of Mullerian ducts

- Failure of resorption of median septum

What is bilateral uterine aplasia/agenesis? What are its sonofeatures?

- incomplete or absent uterus

- SF: absent/incomplete uterus and fallopian tubes

TRUE or FALSE: In bilateral agenesis, there is the absence of the uterus, fallopian tubes, and ovaries.

FALSE: Bilateral agenesis of has NO effect on the ovaries, as the ovaries are developed from the gonadal ridge, not the Mullerian ducts

What is Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome?

most common manifestation of complete agenesis of uterus

What is unicornis unicollis?

one horn/one cervix; failure of one Mullerian duct to form properly

What is a communicating unicornuate uterus?

rudimentary horn joins cervix (normal periods)

What is a non-communicating unicornuate uterus?

- rudimentary horn does NOT join cervix

- Abnormal period (blood gets stuck in rudimentary horn)

TRUE or FALSE: Uterine agenesis is incompatible with pregnancy.

TRUE

What are the pregnancy outcomes of a unicornuate uterus?

- Poorest overall reproductive outcomes of all uterine anomalies

- Since ovaries are unaffected, oocytes can be harvested for surrogacy

What are the 2 outcomes of failure of fusion of the Mullerian ducts?

- Uterus didelphys (complete)

- Bicornuate uterus (partial)

What is uterus didelphys? What are its pregnancy outcomes?

- complete failure of the Mullerian ducts to fuse, resulting in 2 hemi-uteri, 2 cervices, 2 vaginas, 1 vaginal opening

- can have normal, simultaneous dizygotic pregnancies

Whta is a bicornuate uterus? What are the 2 types?

Partial failure of fusion

Types:

- Bicornis bicollis: 2 horns, 2 cervices, 1 vagina

- Bicornis unicollis: 2 horns, 1 cervix, 1 vagina

What does the endometrium in bicornuate uterus look like?

Divided and there's only one horn on each side.

What is bicornis bicollis?

type of bicornuate uterus (failure of fusion), resulting in 2 horns, 2 cervices, 1 vagina.

What is bicornis unicollis?

type of bicornuate uterus (failure of fusion), resulting in 2 horns, 1 cervix, 1 vagina.

What are the pregnancy outcomes in bicornuate uterus?

- No difficulty conceiving (assuming no extrauterine fertility issues)

- Poorer outcomes than women with normally formed uterus

- Cervical incompetence

What is the failure of resorption of the median septum

Most common MDA (approx 55%) where the septum in the uterus is not resorbed, resulting in a uterine septum composed of poorly vascularized fibromuscular tissue

What are the 3 clinical presentations of median septum failure?

- Dyspareunia (painful intercourse)

- Dysmenorrhea (painful period)

- Infertility

What is a septate uterus?

Complete septum

Which MDA gives the poorest reproductive outcomes?

Septate uterus

What is a subseptate uterus?

incomplete/partial septum

How can you differentiate between a septated and bicornuate uterus?

- Septated = normal fundus shape, thin wall separating endo cavities

- Bicornuate = indented fundus shape

What is an arcuate uterus?

Mild indentation of endometrium at fundus.

How does a T-Shaped uterus occur?

Associated with DES exposure, which was prescribed to women experiencing pregnancy complication from 1948-71

What is DES (diethylstilbestrol)?

Prescribed to women experiencing pregnancy complications from 1948-71.

Name 3 effects of DES exposure

- Increased risk of breast cancer

- Hypoplastic uterus

- Widened lower uterine segment

- Twofold increased risk of spontaneous abortions

- Ninefold increased risk of ectopic pregnancy

- Incompetent cervix

- Septate uterus

(not as relevant b/c discontinues in 1971, so patients are past their reproductive years)

What are some imaging techniques for congenital uterine anomalies?

- 2D U/S: see separate endo cavities

- 3D U/S: coronal plane, fundus shape

- Hysterosalpingogram (X-ray)

- MRI: soft tissue, expensive, long wait times