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Similar to congenitalmalformationsoffemalegenitaltract-151113094717-lva1-app6891 (1).pptx
congenitalmalformationsoffemalegenitaltract-151113094717-lva1-app6891 (1).pptx
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- 2. • These aregenetic in origin… • Major anatomic defect of the FGT is usually assoc with normal gonadal function and urinary tract abnormality.
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- 4. PERINEAL OR VESTIBULARANUS • Detected at the time of birth • Usual anal opening site is evidenced by anal pit • Either anus will be situated close to the posterior end of the vestibule or in the vestibule. • In vagina (rarely) (congenital rectovaginal fistula) • Opening is usually sufficiently big • Future reproduction not a problem • Ceaserian section adviced in the future
- 5. ECTOPIC URETER • Additionalureteric opening is usually in the vestibule close to the urethra or in the vagina. • Symptom:- • Uncontrollable wetness • Partial nephrectomy and ureterectomy may be indicated or implantation of the ectopic ureter into the bladder may be done.
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- 7. NARROW INTROITUS • Revealedafter marriage.. • DYSPAREUNIA MAY BE THE FIRST COMPLAINT or it may be detected during investigation of infertility • Treatment is effective by manual stretching under general anaesthesia or by surgical enlargment.
- 8. HYMEN ABNORMALITY • Imperforatehymen of significance abnormality. • Always unnoticed until 14 – 16 yrs. • Uterine functioning is normal menstrual blow is pent up inside vagina behind the hymen (CRYPTOMENORRHOEA) • Depending upon the amount of blood so accumulated, it first distends the vagina (HAEMATOCOLPOS) • The uterus is next involved and cavity dilated (HAEMATOMETRA) • If late and neglected, tubes may also be distended after the fimbrial ends becoming closed by adhesions (HAEMATOSALPHINX)
- 9. C/F: • Age –14 -16 • Periodic lower abdominal pain which may be continuous. • Primary amenorrhoea • Urinary symptoms
- 10. On examination • Abdominalexamination • Suprapubic swelling • Vulval inspection: • Tense bulging membrane of bluish colouration • Rectal examination: • Bulged vagina
- 11. Treatment • Cruciate incisionis made in the hymen. • Quadrants of the hymen are partially excised not too close to the vaginal mucosa • Spontaneous escape of dark tarry coloured blood is allowed. • Patient should be made to lie down with the head end raised.
- 12. TRANSVERSE SEPTUM ABOVETHE LOWER ONE – THIRD… • Usually comes earlier than the previous one with the septum placed higher and higher • Same presenting features, but urinary symptom absent. • Same surgical treatment
- 14. SEPTATE VAGINA • Completeor incomplete longitudinal septum • May be assoc with double uterus and double cervix • May be asymptomatic or may produce dyspareunia o may obstruct delivery • Treatment: septum to be excised.
- 16. PARTIAL ATRESIA OFTHE VAGINA • A segment of the vagina may be atretic in the upper third. May be assoc with cervical atresia • Functioning uterus (usually) • Primary amenorrhoea, periodic pain in lower abdomen with a mass felt per abdomen or rectal examination point to the diagnosis. • Excision of the atretic portion from below and suturing the upper and lower margins of the vaginal walls are usually effective.
- 17. COMPLETE ATRESIA • Assocwith absence of uterus • Healthy gonads and fallopian tubes • Pt is phenotypically female with normal karyotype pattern • Entity is often assoc with urinary tract abnormality called Rokitansky – Kuster – Hauser syndrome
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- 19. FAILURE OF FUSIONOF MULLERIAN DUCTS • In majority, the presence of deformity escapes attention. • Detection is made accidently during the investigation of infertility or repeated pregnancy wastage. • In other cases, diagnosis is made during D + E operation , manual removal of placenta or during Caesarean section.
- 21. TYPES: • Arcuate • Funduslooks concave with heart shaped cavity outline • This looks more like a normal uterus, except it has a dip, or slight indentation at the top. • It is a common abnormality, affecting about one in 25 women in the general population. • It doesn't usually make conceiving difficult.
- 22. • Uterus didelphys •Complete lack of fusion of the Mullerian ducts with a double uterus and a double vagina. • This is when the uterus has two inner cavities. • Each cavity may lead to its own cervix and vagina, so there are two cervixes and two vaginas. • It is uncommon, affecting about one in 350 women. • It is possible to conceive if you have this type of abnormality, and have a straight forward pregnancy.
- 23. • Uterus bicornis •There are varying degree of fusion of the muscle walls of the two ducts. • Uterus bicornis bicollis : 2 uterine cavity with double cervix with or without vaginal septum.
- 24. • Uterus bicornisunicollis • 2 uterine cavity with one cervix • Horns may be equal or one horn may be rudimentary and have no communication with the developed horn.
- 25. • Septate uterus •2 mullerian ducts fused together but there is persistence of septum in between the two either partially or completely
- 26. Clinical Features • Maynot produce any clinical manifestation. • Gynaecological: • Infertility and dyspareunia often related – vaginal septum • Menorrhagia – due to increased surface area in bicornuate uterus
- 27. • Obstetrical • Midtrimesterabortion – may be recurrent • Increased incidence of malpresentation – transverse lie in arcuate or septate, breech in bicornuate, unicornuate or complete or septate uterus • Preterm labour • Prolonged labour – due to incordinate uterine action • Obstructed labour • Retained placenta and postpartum haemorrhage where the placenta is implanted over the uterine septum.
- 28. Treatment • Rudimentary horncan be excised to prevent any obstetrical complications • Uterine septum can be effectively resected hysteroscopically either by scissors or laser
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- 30. • Tubes maybe unduly elongated • Rarely tube may be absent on one side • These may lower the fertility or favour ectopic pregnancy
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- 32. • There maybe streak of gonads or gonadal dysgenesis which are usually associated with errors of sex chromosomal pattern. • No treatment will help this condition • Accessory ovary may be present • Supranumerary ovaries may be present in the broad ligament or elsewhere (rare)