devlopment of uterus and abnormalites

1. DEVLOPMENT OF UTERUS &
ABNORMALITIES & CLINICAL
PROBLEMS ASSOCIATED WITH
ABNORMALITIES OF
DEVLOPMENT OF UTERUS
-Ravali.K

2. DEVLOPMENT OF UTERUS

3. MULLERIAN DUCTS
• Till end of 6th week, the genitail system is
in an undifferentiated state, when both
pairs of genital ducts {Mullerian & wollfian
ducts} are present
• In 7th week of IUL of the embryo, an
invagination of coelomic mesothelium
occurs close to the primitive gonad, in the
upper lateral portion of the intermediate
cell mass; this is called the Müllerian duct
(paramesonephric duct).
• Devlopment into female genital system,
Depends on absence of male
determining factor present on Y-

4. • As the two Müllerian ducts, one on either
side, develop and grow caudally, they
approach each other in the midline after
crossing the Wolffian duct (mesonephric
duct) and fuse .
• The caudal tip of the fused Müllerian
ducts called the Müllerian tubercle.
• It projects into the urogenital sinus; the
intervening portion is filled up by a
proliferation of cells called the
sinovaginal bulbs. These bulbs later
canalize to form the lower part of the
vagina
• The hymen represents the junction
between the sinovaginal bulbs and the
urogenital sinus.

5. • The cranial free parts of the Müllerian ducts
develop into the fallopian tubes.
• The middle fused portion forms the uterus and
cervix.
• the caudal fused portion forms the upper three-
quarter of the vagina.
• Initially, when the two Müllerian ducts fuse, the
intervening septum is present, but later it
disappears so that the uterovaginal canal
appears as a single continuous passage.
• Myometrium and endometrial stroma are
derived from adjacent mesenchyme, but the
glandular epithelium of the uterus and cervix
develops from the Müllerian duct

6. MULLERIAN DUCT ANOMALIES

7. • Mullerian and wolffian ducts are so closely related embryologically that
Mullerian anamolies are commomly associated with anomalies of kidney
and ureter
• Devlopment of gonads is separate from ducts so normal ovaries are
present in Mullerian anomalies
DEVLOPMENT OF DUCTS AS FOLLOWS-
1. ORGANOGENISIS
2. FUSION {lateral & vertical}
3. SEPTAL RESORPTION

8. • ORGANOGENISIS
.one or both Mullerian duct may not develop, resulting in - fully uterine
agenesis or hypoplasia, unicornuate uterus
• FUSION
1.lateral fusion-process during which lower segment of paired Mullerian
ducts fuse. Failure of fusion results in- uterine didelphys or bicornuate uterus
2. vertical fusion- fusion of the sinovaginal bulb with Mullerian system
forms a normal patent vagina, incomplete vertical fusion results in an
imperforate hymen
• SEPTAL RESORPTION
a cental septum is present after the lower Mullerian ducts fuse. The septum
must be resorbed to form a single uterine cavity and cervix, failure of
resorption- cause septate uterus,arcuate uterus.

9. CLASSIFICATION
• According to American Society of Reproductive Medicine 1988 –
classified into 7 classes.
• Class I—Müllerian agenesis or hypoplasia.
• Class II—Unicornuate uterus, with absent or defective development
of one Müllerian duct.
• Class III—uterus didelphys.
• Class IV—bicornuate uterus.
• Class V—septate uterus.
• Class VI—arcuate uterus.
• Class VII- des/ t-shaped uterus

10. CLASS 1- AGENISIS
• The most common form is MRKH [mayer-Rokitansky-kuster-
hauser] syndrome: combined agenesis of uterus, cervix, and upper
portion of vagina

11. CLASS II-UNICORNUATE
• Developmental arrest of one Müllerian duct results in the formation of
the uterus and fallopian tube entirely from the other Müllerian duct.
• Often a solid nonfunctioning horn is present but remains undiagnosed,
and renal anomalies frequently coexist on the side of the absent horn.
• It accounts for 1–2% of all uterovaginal anomalies and is often
associated with a poor reproductive performance.
• Spontaneous abortion rates are high, as also the incidence of
prematurity.
• A third of these patients have breech presentations,
• a high incidence of severe intrauterine growth restriction (IUGR) has
been recorded.
• The incidence of caesarean sections is high in this sub-group of
women.

12. • 1.With rudimentay horn-
- With endometrial cavity {communicating, non
communicating}
- however, if the endometrium is functional, retention
ofmenstrual blood causes cyclic abdominal pain
,spillage of blood into the coelomic cavity via the tubal
ostium may lead to endometriosis.
- Sometimes a narrow communicating channel exists
between the rudimentary horn and the opposite uterine
cavity. Under these circumstances, pregnancy is
possible, most of these patients present with symptoms
suggestive of an ectopic pregnancy including uterine
rupture causing catastrophic bleeding and circulatory
collapse.
- -without endometrial cavity
• 2.Without rudimentary horn

13. CLASS III-UTERUS DIDELPHYS
• A symmetric lateral fusion defect results in
each Müllerian duct developing independently
side by side without communication leading to
theformation of double uterus.
• Each duct forms one cervix, one uterus and
one fallopian tube on either side.
• The duplication may go right down the vagina
(part derived from Müllerian ducts) as well.

14. CLASS-IV BICORNUATE UTERUS
• The external configuration of the uterus is normal, and the
malfusion is represented only by the presence of a septum.
• These women often suffer from miscarriages, preterm births,
IUGR, abnormal fetal presentations like breech and oblique
presentations. Incidence of dystocia during labour is high,
• 3rd stage complications like adherent placenta, postpartum
haemorrhage is more frequent.
• Unification surgical procedures undertaken at laparotomy
(Strassman operation, Tompkins operation or Jones’ wedge
metroplasty operation) or hysteroscopic resection of uterine
septum help to improve obstetric performance in 60–85%cases.

15. CLASS V-SEPTATE
UTERUS
• This may be partial, complete, thick or
thin.
• It is associated with higher incidence
of pregnancy wastage.
• Septate uterus is a variant of vertical
Müllerian fusion defects which has an
important bearing on reproductive
performance.

16. CLASS VI-ARCUATE
UTERUS
• Near complete resorption of uterovaginal
septum
• A samml intrauterine indentation <1cm in
fundal region is seen
imild thickening of midline fundal myometrium
resulting in fundal cavity indentation but normal
outer fundal contor is seen
• It is considered as mild form of bicornuate
uterus

17. CLASS VII-DES[DIETHYLSTILBESTROL
RELATED]– T SHAPED UTERUS
• The uterine anomaly is seen in female offspring of women exposed
to DES during pregnancy
• Uterus-hypoplasia and a t shaped uterine cavity is seen
• Cervix- abnormal transverse ridges, hoods,stenoses seen
• Vagina- adenosis is seen

18. MORBIDITY
ASSOCIATED
WITH
ABNORMALITE
S
• OBSTETRICS
1. repeated abortions {First and second
trimester pregnancy losses (between 8–16 weeks
gestation) spontaneous abortions—25%,preterm delivery—
14.5% and live births—62%.}
2. cervical incompetence
3.preterm labour
4.IUGR
5.abnormal fetal lie
6.retained placenta
• GYNECOLOGY
1. infertility
2.dysmenorreha

19. MORBIDITY
ASSOCIATED
WITH
ABNORMALITE
S
3.obstructed or partially
obstructed Mullerian sytems present
with- hematosalpinx ,hematocolpos
• RENAL-
high association between Mullerian
duct anomalies and renal anomalies
such as unilateral agenisis