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Submitted by Amer Hussien, M.D & Hesham Al-Inany M.D
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Approximately 10% of infants are born with some abnormality of the
genitourinary system.
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Diagnosis
Vaginal septa
are usually discovered during routine pelvic examinations or by the
woman who notices that vaginal tampons are not always effective in absorbing
menstrual blood . Difficulty with coitus in longitudinal vaginal septum
.
Uterine malformations
· A high index of suspicion is important
for detection
- Simple inspection or bimanual examination in a patient with recurent
abortions . An abnormality in the uterus will be found in about 10% of
cases .
- An anomalous uterus may be suspected when the patient becomes pregnant
despite presence of an IUD
- A palpable mass mat be found to be uterine anomaly when confirmed
by ultasound
- Frequently they discovered during CS, D and C or during manual exporation
of the uterine cavity after vaginal delivery . Fundal notching , palpated
abdominally , is most often indicative of malformed uterus .
· The clinical impression can be confirmed
by
- Ultrasonic screening for screening of uterine anomalies , although
98% specific , has only a 43% sensitivity
- Hysteroscopic examination and hysterography are of value in ascertaining
the configuration of the uterine cavity . Hysterogram should be taken
at right angle to the axis of the uterus so that a true assessment of
the deformity can be made . The study is best performed under fluoroscopy
. The distinction between uterine septum and bicornuate uterus can nt
be made by hysterescopy or hysterography alone .
- Laprascopy combined with hysteroscopy or hysterography to confirm
absence or presence of an external division of the uterus and presence
or absence of a uterine horn , can virtually describe and classify all
uterine abnormalities accurately .
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Urological evaluation
- When asymmetrical development of the reproductive tract is found,
urological evaluation is indicated because of frequent association of
urinary tract anomalies
- When there is uterine atresia on one side or when one side of a double
vagina terminates blindly, an epsilateral urological anomaly is common
Auditory evaluation
- Up to third of women with Mullerian defects were reported to have
auditory defects
- These are characterized by sensorineural hearing defects in the high-frequency
range
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