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Submitted by Amer Hussien, M.D & Hesham Al-Inany M.D

Congenital anomalies of the uterus
 

Approximately 10% of infants are born with some abnormality of the genitourinary system.

 
 

 
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  Related
 
 

Embryology of female genital system
Gametogenesis: a basic review

 
   
 
     

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 . 

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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