Mullerian anomalies are congenital disorders i.e. present since birth which is developed during embryonic morphogenesis of female foetus. These are caused by some errors in mullerian ducts during morphogenesis.
Classification of Mullerian Anomalies :
Class 1 – Mullerian Agenesis
Class 2- Unicornuate Uterus
Class 3 – Didelphys Uterus
Class 4 – Bicornuate Uterus
Class 5 – Septate Uterus
Class 6 – Arcuate Uterus
Class 7 – DES related changes
Class 2 to Class 6 are lateral fusion defects.
1. Mullerian Agenesis :
Mullerian Agenesis is caused due to absence of uterus, fallopian tubes and upper one – third of vagina. In mullerian agenesis blind vaginal pouch is found. Females having mullerian agensis have normal and healthy ovaries and normal karyotype ( XX ). There is normal estrogen synthesis by ovaries but due to absence of uterus she doesn’t bleed. Due to normal estrogen synthesis Breast development and presence of pubic hair is normal.
Clinical presentation of woman with this anomaly :
Primary amenorrhea, Infertility, Difficulty in coitus
Clinical management :
Primary amenorrhea can’t be treated but if woman wants to have her own child surrogacy and IVF can be planned accordingly.
2. Unicornuate Uterus :
Unicornuate uterus is formed due to only one sided development of uterus and fallopian tube. But sometimes the other underdeveloped side is present as a rudimentary horn and if the rudimentary horn has functional uterus then endometrium develops and blood also collects in it because the endometrium is not connected to the rest of the uterine cavity ( causing significant dysmenorrhea ). If ectopic pregnancy occurs in this rudimentary horn it is known as Cornual Pregnancy.
3. Didelphys Uterus :
Didelphys Uterus is characterised by duplication of uterus and cervix. It is associated with vertical vaginal septum and duplication of genital tract. It has double uterus and double cervix.
4. Bicornuate Uterus :
Bicornuate Uterus is due to incomplete fusion of mullerian ducts. There is dip at the fundus of uterus. There are 2 uterine cavities with a single cervix.
5. Septate Uterus :
Septate Uterus is formed due to failure of dissolution of septum. In this anomaly fundus of uterus is intact. There are 2 uterine cavity with a single cervix. It leads to recurrent abortions usually in 2nd trimester due to improper development of placenta ( constricted space ).
6. Arcuate Uterus :
Arcuate Uterus is also known as flat topped uterus. It has slight dip at the fundus but the uterine cavity is normal. It is a radiological abnormality because it is usually identified on radiological investigations ( USG, MRI ).
7. DES ( Diethyl Stillbesterol ) related changes :
DES drug was given to woman back in 1940s to prevent abortions in pregnant ladies. This drug is now eradicated because it caused many anomalies like vaginal adenoids (most common), hypoplastic uterus, clear cell cancer of vagina, T- shaped uterus, etc.
Investigations needed for diagnosis of anomalies :
• 3-D USG – it is cheaper than other methods
• MRI (magnetic resonance imaging) – it is better way for diagnosis
• Hysteroscopy
• Laparoscopy
Treatment :
Surgical correction of any anomaly is done only if woman is symptomatic i.e. she is undergoing with recurrent abortions, infertility (after ruling out other potential causes of infertility). If on any routine investigations accidental diagnosis of any anomaly is made then it’s surgical treatment is not done because she is not symptomatic.
Contributor- Medico Eshika Keshari
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