GYNECOLOGY

LECTURE: 1.03 Congenital Abnormalities of Female Reproductive Tract

LECTURER: Dr. Junio
DATE: January 12, 2017
TRANSCRIBER: Trans Team 12 (Ollero), Noble – Ong J.
EDITOR: Carl Monzon

OUTLINE  Didelphys (category III) and bicornuate (category IV)

I. INTRODUCTION: AFS CLASSIFICATION OF MULLERIAN describe anomalies involving a varying degree of
ANOMALIES failure of midline fusion;
II. EMBRYOGENESIS  Septate (category V) and arcuate (category VI)
A. Embryonic Precursors identify anomalies with some degree of failure of
B. Stages of Embryogenesis resorption of the midline septum.
III. UTERINE ANOMALIES OF AFS  With this classification system, associated anomalies
A. Class I: Hypoplasia/Agenesis of the vagina, cervix, fallopian tubes, and urinary
B. Class II: Unicornuate Uterus system must be documented separately. It should
C. Class III: Uterine Didelphys also be recognized that numerous anomalies exist
D. Class IV: Bicornuate Uterus that are exceptions to the standard theory of
E. Class V: Septate Uterus müllerian duct development.
F. Class VI: Arcuate Uterus
G. Class VII: DES- Related Anomalies
IV. ASSOCIATED ANOMALIES
A. Vaginal Atresia
B. Transverse Vaginal Septum
C. Imperforate Hymen
D. Endometriosis
V. DIAGNOSTIC
VI. REPRODUCTIVE CONSEQUENCES
VII. SURGICAL CORRECTION

GUIDE QUESTIONS:
At the end of the lecture, the student should be able to answer
the following questions:
1. What are the anomalies of the female reproductive tract?
2. How are they formed?
3. How are they diagnosed?
4. What are the usual complaints at the time of consult
5. Are these anomalies correctable?
References (APA Bibliography format):
Lecturer’s powerpoint, Comprehensive Gynecology 7th edition
Legend: Italicized – quoted from the lecturer; bold – emphasis,
or from references
I. AFS CLASSIFICATION OF MULLERIAN ANOMALIES
 There are several classification system for müllerian
anomalies; in 1988 the American Fertility Society provided a
straightforward classification system of uterine anomalies
based on embryologic origin.
 Based on the degree of uterine anomalies that are grouped
according to similarities of clinical manifestations, treatment
and reproductive prognosis.
 Concerned with lateral fusion anomalies of the uterus and
excludes associated anomalies of the vagina, fallopian tubes
and renal system.
o Why the renal system? If you go back to embryology,
the development of the reproductive tract happens
side by side with the development of the urinary tract.
Thus, if there is a problem in the reproductive tract, it
is very important that the clinician should check if
there is an associated problem in the urinary tract, or
vice versa.
 There are 7 AFS groups of uterine anomalies.
 Hypoplasia/agenesis (category I) and unicornuate
(category II) denote anomalies with developmental
failure of one or both müllerian ducts;
Figure 1. AFS Classification. 1) Hypoplasia/Agenesis: very
small, maldeveloped/underdeveloped, or completely absent; 2)
Unicornuate: only 1 horn, but there are instances wherein
remnants of the other horn is still present and it is called the
rudimentary horn; 3) Didelphys: complete duplication of the
uterus so it seems like there are 2 uteri, both of which are
functioning; 4) Bicornuate: looks much like the didelphys uterus
except that there is incomplete division of the uterine cavity and
there is only one cervix; 5) Septate: looks very much like the
bicornuate uterus except that the septum is thinner and the
fundus is still rounded (without any indentation); 6) Arcuate:
considered by some to be a variant of the normal uterus because
there is just mild indentation at the fundal part of the uterine
cavity; 7) DES drug-related: T-shaped uterine cavity; already
uncommon because DES is now banned. Picture from
Comprehensive Gynecology (7th edition)
II. EMBRYOGENESIS
A. Embryonic Precursors
1. Paired Müllerian Ducts
 Müllerian ducts are the embryologic origin of the
fallopian tubes, uterus, cervix, and a portion of the
vagina.
 Other term for mullerian ducts: paramesonephric ducts
 Counterpart in males: wolffian or mesonephric ducts
 There is fusion of the müllerian ducts in the middle,
forming the uterine cavity.
 The cephalad end will remain separated and this will
give rise to the fallopian tubes.

TRANSCRIBER: Trans Group 12 (Ollero 09397665874) EDITOR: Carl Monzon Page 1 of 9

GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)

 The caudal end will fuse, giving rise to the cervix and the septum. If the septum reaches the cervix, it is
the upper 2/3 of the vaginal canal. complete; if it ends above the cervix, it is an incomplete
or partial septum.
2. Urogenital Sinus
 One of the elongated cavities, formed by the division of III. UTERINE ANOMALIES OF AFS
the cloaca in early embryonic development, into which
open the ureter, mesonephric and paramesonephric A. Class I: Hypoplasia/Agenesis
ducts, and bladder. It also gives rise to the vestibule,
urethra, and part of the vagina in the female and part of
the urethra in male (From Mosby’s Medical Dictionary, 9th ed.).
 The urogenital sinus meets up with the most caudal
portion of the müllerian ducts and it will form the
lower 1/3 of the vaginal canal.

Figure 3. Class I: Hypoplasia/ agenesis

 Uterus and vagina are BOTH absent = Mayer-Rokitansky-

Kuster-Hauser Syndrome (46XX)
o They look like normal, phenotypically female; their
chromosome make up is 46XX; the only problems is
Figure 2. Embryonic Precursors. that they do not have a uterus AND vagina.
o Clinical manifestation: Primary amenorrhea due to
B. Stages of Embryogenesis obstruction and/or cyclic hypogastric pain associated
1. ORGANOGENESIS with a pelvic mass
 Most critical part of development
 Happens as early as 8th week AOG Take note. Primary amenorrhea is considered if you are still
 Müllerian ducts fuse to form a confluence. not menstruating at the age of 16. You should consult a
 If one of the tubes fails to develop, it results to gynecologist for investigation. It doesn’t mean that they have
unicornuate uterus. If both fail, this causes uterine Mayer Rokitansky-Kuster-Hauser syndrome but it is abnormal
agenesis or hypoplasia. because at age 16, they should already be menstruating.

2. FUSION  If the uterus is developed, but the cervix and the vagina are
a. Lateral absent at the time of puberty
o Happens during the 7th-9th week AOG o Clinical manifestations: Primary amenorrhea due to
o Fusion of the paired mullerian ducts in the middle. obstruction, and cyclic hypogastric pain
o Forms the uterus, tubes and cervix; and failure of (dysmenorrhea) because with the pooling of blood into
this process causes bicornuate or didelphys the uterus with no way out, the uterus will increase in
uterus – forming an indentation as if dividing the size and become distended, and she will start to
uterine cavity into two cavities. complain of pain each time she menstruates.
Eventually, you would feel a mass in the pelvis or
b. Vertical suprapubic area.
o Formation of the vagina thru the fusion of the  Ultrasound findings: there will be absent uterus in
lower parts of müllerian duct that forms the upper complete agenesis and hematometra (uterus distended with
2/3 of the vaginal canal, and the ascending blood) in partial
sinovaginal bulb that forms the lower 1/3. o Hematocolpus – if vagina is distended with blood
o Incomplete vertical fusion leads to imperforate
hymen (8th week).
o There is a vaginal canal but because of failure to
recanalize, there is a septum that covers the
canal.

3. SEPTAL RESORPTION
 Happens around the 20th week AOG
 Fused müllerian ducts form a septum after lateral fusion
that subsequently undergoes resorption to form a single
uterine cavity.
 Failure of this process leads to septate uterus, which
can be complete or partial depending on the length of Figure 4. Hemametra and Hematocolpos

TRANSCRIBER: Trans Group 12 (OLLERO 09397665874) EDITOR: Carl Monzon Page 2 of 9

GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)
B. Class II: Unicornuate Uterus
Figure 5. Class II: Unicornuate Uterus. A) Communicating –
if there is communication between the main uterine cavity and
the rudimentary horn, essentially, there will be no problem; b.
Non-communicating – Blood is trapped within the rudimentary
horn, so patient will also have cyclic pain. If pregnancy happens
in the non-communicating horn, via transmigration, it will
eventually rupture like an ectopic pregnancy since it only has a
small cavity and is not able to sustain a developing embryo.; c.
No cavity; d. No horn
Take note. Transmigration – the sperm enters through the
vagina and the cervix, it goes through the uterine cavity of
the more developed uterine horn, exits through the tube,
migrates to the other tube, fertilizes the egg waiting in the
rudimentary horn, and implants there.
 Only one Mullerian duct develops normally.
 They are still capable of getting pregnant but pregnancy
outcome is poor, with a high abortion rate (51%) and a
preterm birth rate (15%)
 Pregnancy in rudimentary horn presents like an ectopic
pregnancy hence should be removed.
 If patient has a functional rudimentary horn (i.e. with
endometrium and a cavity), patient must undergo hemi-
hysterectomy even before pregnancy occurs. However, if it
is non-functional, then there would be no problem. It would
just be a remnant dangling on the side of the well-developed
horn.
C. Class III: Uterine Didelphys
Figure 6. Uterine didelphys. Failure of lateral fusion. There are
2 uterine cavities, 2 cervices, and 1- 2 vaginal canal depending if
there is a septum present in the canal.
 Failure of midline (lateral) fusion resulting to two separate
functional uteri, divided by a septum.
 May be accompanied by partial or complete vaginal septum,
usually longitudinal but may be transverse
TRANSCRIBER: Trans Group 12 (OLLERO 09397665874) EDITOR: Carl Monzon
o If there is a transverse septum and it covers one or
two of the cervices, what do you expect to happen?
Build-up of menstrual blood in the uterus or upper
vaginal canal depending on the location of transverse
septum. The patient would present as having cyclic
pain and enlarging mass in the pelvis.
 Clinical manifestation: Asymptomatic unless with cervical
obstruction. If with cervical obstruction, it would manifest as
cyclic hypogastric pain associated with a pelvic mass.
o If both cervices are blocked, symptoms would present
immediately after menarche.
 They are capable of getting pregnant. Some of them are
undiagnosed even at the time of delivery.
D. Class IV: Bicornuate Uterus
Figure 7. Bicornuate Uterus. It looks like a didelphys uterus
except that there is an indentation in the fundus and only one
cervix. a. Complete: if the septum reaches at the level of the
cervix. b. Incomplete: Septum higher than the cervix
 Failure of Mullerian ducts to fuse before complete
unification.
 Splayed upper uterine cavity with indentation at the
fundus, that is usually >1cm If you measure this indentation
from the fundus down the angle.
 Complete if with septum extending to the cervix
 Clinical Manifestation: Usually asymptomatic
 They are capable of carrying a pregnancy to term
E. Class V: Septate Uterus
Figure 8. Septate uterus. a. Complete type - If it reaches down
to the cervix; b. Partial type – ends above the cervix
 Most frequent anomaly resulting from incomplete
resorption of the combined medial walls of mullerian ducts
after longitudinal fusion
 Septum is made up of poorly vascularized fibromuscular
tissue
 Gives the poorest reproductive outcome (abortion rate as
high as 75%) because when a zygote implants to the poorly
vascularized septum, then it would not be able to sustain the
pregnancy leading to abortion, intrauterine fetal restriction,
or even preterm birth.
 Can be repaired by doing a resection of the septum
using combined hysteroscopy and laparoscopy
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GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)
o Hysteroscopy – a scope is placed inside the uterus
then the septum is located and resected. Edges are
sutured to prevent adhesions; looks at the uterus
from the inside
o Laparoscopy – looks at the uterus from the outside to
make sure that no perforation is done
F. Class VI: Arcuate Uterus
Figure 9. Arcuate Uterus. It looks like a normal uterus from
outside but the uterine cavity is indented.
 Considered a mild septate uterus or even a normal variant
 <1cm fundal indentation of the uterine cavity with a rounded
fundus externally
 Clinical Manifestation: Patients are usually asymptomatic
and has the least adverse obstetrical outcomes
G. Class VII: DES-related Anomalies
Figure 10. DES-related uterus.
 T-shaped uterine cavity, widened lower uterine segment,
mid fundal constriction and hypoplastic uterus
 Not amenable to surgical correction
 We are not seeing this anymore
IV. ASSOCIATED ANOMALIES
The following are considered associated anomalies because
these were not included in the classification of the American
Fertility Society. These associated anomalies may occur singly
or in combination with other anomalies.
A. Vaginal Atresia
 Failure of the vaginal sinus to form the inferior portion of the
vagina and is replaced by fibrous tissue. Mullerian structures
are normal
 Clinical manifestations: Presents with primary
amenorrhea, cyclic pelvic pain and suprapubic mass.
 Treatment: Excision of fibrous tissue
Figure 11. Vaginal Atresia
TRANSCRIBER: Trans Group 12 (OLLERO 09397665874) EDITOR: Carl Monzon
B. Transverse Vaginal Septum
 Tissue formed by the fusion of vaginal plate and caudal
aspect of mullerian ducts fails to canalize.
 May be complete or incomplete.
o Complete type is more symptomatic presenting with
amenorrhea, cyclic pelvic pain and a hypogastric
mass.
o Which one is more symptomatic, complete or
incomplete? It is the incomplete because when there
is only partial obstruction, blood is still able to exit
through the vagina. And because the outflow of blood
is slow due to the obstruction, there will be residual
blood in the cavity which would drain out even after
the menstruation period and would present as a
prolonged menstruation.
 Rarest anomaly, commonly in the junction of 3rd and lower
2/3rd of vaginal canal.
 Treatment: Excision of septum
C. Imperforate hymen
Figure 12. Imperforate hymen.
 Believed to be a persistent portion of the urogenital
membrane.
 Clinical manifestation: amenorrhea, cyclical pain, and a
suprapubic mass
 Findings: Hematocolpos, Hematometra; everything looks
normal except that you see a bulge in the introitus, which
appears bluish because of the blood building up behind the
membrane.
 Treatment: Cruciate incision – X incision then suture the
edges to the vaginal wall to maintain patency
D. Endometriosis
Figure 8. Endometriosis. If for how many months, the patient
with imperforate hymen did not seek consult and eventually the
blood builds up, you could expect a retrograde flow of the blood
into areas with least resistance and eventually go into the pelvis,
exiting through the fimbriae, and pools on the pools within the
posterior cul de sac, which may induce formation of
endometriosis. Viable endometrial tissue may implant
somewhere else outside the uterus e.g. ovary (most common
site of endometriosis)
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GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)

 Because of outflow tract obstruction, retrograde flow of uterine anomalies and a history of poor reproductive
menstrual blood to pelvic structures ensues with pooling in outcomes.
the posterior cul-de-sac.  Hysteroscopic metroplasty to correct a partial or complete
septate uterus can improve reproductive outcomes and is
V. DIAGNOSTICS indicated in women with recurrent pregnancy loss or second
1. 3- Dimensional Transvaginal Ultrasound trimester pregnancy loss (Homer, 2000).
o Able to take a picture of the uterus in a coronal view
o More accessible so it is often used Goals of surgery:
o Non-invasive, only need to empty bladder o restoration of pelvic anatomy
o Sensitivity of 86%, Specificity of 96%, PPV of 99% o preservation of fertility
2. Hysterosalpingogram o treatment of pelvic pain and endometriosis
o Invasive procedure – inserts a catheter into the
uterine cavity and inject a contrast medium/dye, to REVIEW QUESTIONS
which the patient may react to.
3. Magnetic Resonance Imaging Part 1. Identify the anomaly
o Not widely available
o Very costly
 Able to assess more complex müllerian anomalies
that may involve the uterus, cervix, and vagina, and
simultaneous assessment of the urinary tract is
possible (Comprehensive Gynecology, 7th Ed.)
Note: Check if with concurrent anomalies of the urinary tract. 1 3
2
VI. REPRODUCTIVE CONSEQUENCES
 Infertility
 Abortion
 Preterm delivery
 Intrauterine growth restriction 5 6
4
 Increased Cesarean section rate
o Because these types of uterus have smaller uterine
cavity compared to that of a normal uterus, so there
is less room for the baby to move and most of the
type these babies will be malpresented (more
commonly in breech position). So this is done not
because of the anomaly but because of obstetric 7 8 9
indications.
Answer to part 1:
VII. SURGICAL CORRECTIONS 1. Unicornuate
 Depends whether patient is symptomatic or desires 2. DES-related – t-shaped
pregnancy. 3. Septate – Complete – Do not expect septum to be as low as
 Obstructive anomalies are corrected to establish normal the cervical canal. At least at the level of the internal os.
menstrual flow and sexual function. For imperforated hymen 4. Bicornuate – note fundal indentation
and transverse vaginal septum, you have to do something 5. Arcuate
once it has been diagnosed. 6. Didelphys
 Metroplasty (repair of the uterus) is indicated if it increases 7. Septate- partial – septum ends above the cervix
pregnancy rate and improves pregnancy outcome. For 8. DES-related. Viewed by hysterosalpingogram, a
bicornuate uterus, metroplasty would be taking out the radiographic examination wherein a contrast medium is
middle of the uterus and you suture back what is remaining injected and images are taken. Left fallopian tube is seen
to create a single uterine cavity. If metroplasty would not while the right side is not patent. There is also spillage of the
result to a better pregnancy outcome, you might as well not dye from the fimbria.
do anything about it since you would simply increase risk for 9. Septate – Viewed using MRI. Uterine cavity is indented and
adhesions and uterine rupture if the patient gets pregnant. is >1cm.
Weigh the risk and benefits.
 Of the uterine anomalies, the septate uterus is amenable to
surgical correction
 In contrast, the unicornuate uterus is never considered
operable, but excision of a functional rudimentary uterine
horn and the attached fallopian tube is recommended to
prevent a horn or tubal gestation and to treat hematometra
and pelvic pain
 Abdominal metroplasty can be performed to unify a
bicornuate or didelphys uterus - performed in certain
patients with poor obstetric outcomes.
 When indicated, a cervical cerclage can be utilized to
attempt to improve pregnancy outcomes in women with

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GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)
Part 2. Identify the anomaly
1. What is the imaging technique used above?
2. Identify the anomaly.
Answer to part 2:
1. 3 dimensional transvaginal ultrasound (coronal view)
2. Identify the anomaly.
a. Normal uterus- triangular shape uterine cavity, no
indentation in the fundus also outside the uterus, and
only one cervix
b. Unicornuate- uterine cavity leaning only to one side
c. Didelphys- if you measure the distance from one
endometrial cavity to the other, it is more than 4 cm.
The indentation in between is more than 1 cm.
d. Bicornuate- indentation of the fundus externally. If you
measure the fundus down to the angle, it looks like an
acute angle less than 90 deg.
e. Bicornuate
f. Septate, partial
g. Septate, complete
h. Arcuate, angle is obtuse, more than 90 degrees,
widened angle. Indentation is not more than 1 cm.
i. DES-related- T shaped and a ballooning lower uterine
cavity.
END OF TRANS
TRANSCRIBER: Trans Group 12 (OLLERO 09397665874) EDITOR: Carl Monzon
Review questions from last year:
1. A 24 year-old was recently diagnosed with uterine didelphys.
What common concomitant congenital defect may be associated
with this condition?
a. Cardiac
b. Gastrointestinal
c. Genitourinary
d. Pulmonary
2. What type of anomaly is formed when both Mullerian ducts
develop but fail to fuse?
a. Bicornuate uterus
b. Septate uterus
c. Unicornuate uterus
d. Uterus didelphys
3. A 29-year old G3P2 (0020) consulted for recurrent
miscarriage. On work-up, hysterosalpingogram demonstrated a
deep central symmetrical wedge-shaped filling defect within the
uterine cavity extending from the fundus toward the cervix and
bilateral tubal patency. What will be your primary consideration?
a. Arcuate uterus
b. Normal uterus
c. Septate uterus
d. Uterine didelphys
4. A 25-year old G0, sexually active presents with decreased
amount of menses, pain on sexual contact, dysmenorrhea and
foul-smelling vaginal discharge. Pelvic examination shows a
seemingly blind vaginal pouch. What is your primary
consideration?
a. Complete imperforate hymen
b. Complete transverse vaginal septum
c. Incomplete perforation of hymen
d. Incomplete transverse vaginal septum
5. A 14-year old with primary amenorrhea presented with a
suprapubic cystic mass associated with cyclic pelvic pain. On
physical examination, secondary sexual characteristics were
present. A bulging mass was seen behind the well delineated
hymen. What is your primary consideration?
a. Complete transverse vaginal septum
b. Incomplete transverse vaginal septum
c. Microperforate hymen
d. Septate hymen
Answers: C, D, C, D, A
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GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)

CLASS I – HYPOPLASIA/AGENESIS CLASS II – UNICORNUATE CLASS III – DIDELPHYS CLASS IV – BICORNUATE

 Presents with only one horn; but  A complete duplication of the uterus,  Similar to the didelphys type but there is
remnants of the other horn (rudimentary which presents as two functioning an incomplete duplication of the uterine
horn) may still be present uterus divided by a septum with two cavity and there is only one cervix; and
 Types: cervices. unlike the septate type, there is an
1. Communicating  Capable of carrying a pregnancy; indentation in the fundus of the uterus
2. Non-communicating some of them are undiagnosed even at that is usually >1cm If you measure this
3. No Cavity, and the time of delivery. indentation from the fundus down the
4. No Horn angle.
 Affects the vagina, cervix, fundus,  Capable of carrying a pregnancy
fallopian tube or a combination of these
parts.

Stage of embryogenesis: Organogenesis Stage of embryogenesis: Organogenesis Stage of embryogenesis: Lateral Fusion Stage of embryogenesis: Lateral Fusion

 Clinical manifestation: Primary Clinical Manifestation: If communicating, Clinical Manifestation: if septum is Clinical manifestation:
amenorrhea and/or cyclic hypogastric pain asymptomatic – since blood is still able to longitudinal – asymptomatic; if septum is  usually asymptomatic
associated with a pelvic mass (e.g. Uterus exit through the vaginal canal; if non- transverse and cervical obstruction –
and vagina are BOTH absent = Mayer- communicating – presents with cycling cyclic hypogastric pain associated with a
Rokitansky-Kuster-Hauser Syndrome plain; if no cavity/no horn – asymptomatic; pelvic mass. If both cervices are blocked,
46XX) if pregnancy occurs in the functional symptoms would present immediately
 Ultrasound findings: there will be rudimentary horn – presents similarly to an after menarche.
absent uterus in complete agenesis and ectopic pregnancy.
hematometra (uterus distended with
blood) in partial; may also present with
hematocolpus.
Treatment: Hemi-hysterectomy should be
done in a patient with a functional
rudimentary horn, even before pregnancy
occurs.
GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)

CLASS V – SEPTATE CLASS VI – ARCUATE CLASS VII – DES-DRUG-RELATED DIAGNOSTIC TESTS

1) 3-Dimensional Transvaginal UTZ
o Able to take a picture of the
uterus in a coronal view
o More accessible so it is often
used
o Non-invasive, only need to
empty bladder
o Sensitivity of 86%, Specificity
of 96%, PPV of 99%
 Considered as a variant of the normal
uterus; it appears with fundal indentation 2) Hysterosalpingogram
of the uterine cavity that is <1cm with a o Invasive procedure – inserts a
rounded fundus externally. catheter into the uterine cavity
and inject a contrast
medium/dye, to which the
patient may react to.
 May be complete (up to the cervix) or
partial (above the cervix) 3) Magnetic Resonance Imaging
 Presents with T-shaped uterine cavity,
 Similar to the bicornuate, except the o Not widely available
widened lower uterine segment, mid
septum is thinner and the fundus remains o Very costly
fundal constriction and hypoplastic
rounded. Septum is made up of poorly uterus
vascularized fibromuscular tissue Note: Check if with concurrent anomalies
 Rare
 Gives the poorest reproductive outcome of the urinary tract.
(abortion rate as high as 75%)

Stage of embryogenesis: Septal

Resorption

Clinical Manifestation: Poor Reproductive Clinical Manifestation: Patients are REPRODUCTIVE CONSEQUENCES
Outcome - when a zygote implants to the usually asymptomatic and has the least  Infertility
poorly vascularized septum, pregnancy adverse obstetrical outcomes  Abortion
cannot be sustained leading to abortion,  Preterm delivery
intrauterine fetal restriction, or even preterm  Intrauterine growth restriction
birth.  Increased Cesarean section rate

Treatment: resection of the septum through Not amenable to surgical correction Surgical Correction depends whether
combined hysterectomy (looking at it from patient is symptomatic or desires
the inside) and laparoscopy (looking at it pregnancy.
from the outside; makes sure that no
perforation is done.)
GYNECOLOGY: CONGENITAL ABNORMALITIES OF FEMALE REPRODUCTIVE TRACT (2018B)

VAGINAL ATRESIA TRANSVERSE VAGINAL SEPTUM IMPERFORATE HYMEN ENDOMETRIOSIS

 Tissue formed by the fusion of vaginal
plate and caudal aspect of mullerian
ducts fails to canalize. May be complete
or incomplete.
 It is the incomplete because the
obstruction is only partial but somehow
there is still drainage of blood although
the menstruation looks prolonged
 BUT, according to the PPT, the complete  Believed to be a persistent portion of
type is more symptomatic presenting with the urogenital membrane.
amenorrhea, cyclic pelvic pain and a  Clinical manifestation: amenorrhea,
 Failure of the vaginal sinus to form the
hypogastric mass. cyclical pain, and a suprapubic mass
inferior portion of the vagina and is
 Rarest anomaly, commonly in the  Findings: Hematocolpos,
replaced by fibrous tissue. Mullerian
junction of 3rd and lower 2/3rd of vaginal Hematometra; everything looks normal
structures (Uterus, Cervix, Fallopian Tube)
canal. except that you see a bulge in the
are normal
 Clinical Manifestation: hypogastric pain introitus, which appears bluish because
 Clinical manifestation: Presents initially
associated with a pelvic mass. If both of the blood building up behind the
with primary amenorrhea, followed by
cervices are blocked, symptoms would membrane.
cyclic pelvic pain and suprapubic mass.
present immediately after menarche.  Treatment: Cruciate incision – X-  Because of outflow tract obstruction,
 Treatment: Excision of fibrous tissue
 Treatment: Excision of septum incision then suture the edges to the retrograde flow of menstrual blood to
vaginal wall to maintain patency pelvic structures ensues with pooling in
the posterior cul-de-sac