REPRODUCTIVE TRACT

ANOMALIES

Bitew .A
02/20/24 1
 Introduction
Developmental anomalies of the reproductive system represent
some of the most fascinating disorders that obstetricians and
gynaecologists encounter.
The Mullerian ducts are the primordial anlage of the female
reproductive tract.
They differentiate to form the fallopian tubes, uterus, the
uterine cervix, and the superior aspect of the vagina
A wide variety of malformations can occur when this system is
disrupted.
They range from uterine and vaginal agenesis to duplication of
the uterus and vagina to minor uterine cavity abnormalities.
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 TERMINOLOGY
 Hematometria -The distension of the uterus with blood or
menstrual fluid.
 Hematometrocolpos - The distension of the uterus and vagina
with blood or menstrual fluid; because the vaginal wall is more
distensible, the vagina will preferentially fill before the uterus.
 Hydrocolpos - The distension of the vagina with fluid; often seen
in infants with complex reproductive anomalies.
 Metroplasty -Uterine reconstructive procedure.
 Uterine anlagen -An underdeveloped uterine structure that is a
remnant of a single embryologic Mullerian duct.
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 Embryology and Development
Indifferent Embryo
 Genotype of embryo 46XX or 46XY is established at
fertilization.
 At 1-6 wks it is sexually indifferent or
undifferentiated stage; that is genetically female and
male embryos are phenotypically indistinguishable.
 AT Week 7 begins phenotypic sexual differentiation.
 Week 12 female or male characteristics of external
genitalia can be recognized.
 Week 20 phenotypic differentiation is complete. 4
 UROGENITA
L SYSTEM

INTERMEDIATE PRIMITIVE UROGENITAL SINUS

MESODERM

VESICO DEFINITIVE
URETHRAL UROGENITAL SINUS
CANAL
has

CRANIAL CAUDAL PELVIC PHALLIC

PART PART PART PART

PRIMITIVE VAGINAL
URINARY PLATE
URETHRA
BLADDER
FEMALE URETHRA
02/20/24 5
 Indifferent Embryo

 Components which form the adult female and male

reproductive systems are:

1.Gonads ovaries or testes

2. Genital Duct Systems are
Paramesonephric and Mesonephric Ducts
3. External Genitalia

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 Female Genital Duct Systems

• After the folding of the embryonic disc and the

formation of the peritoneal cavity, the intermediate
mesoderm forms a bulging on the posterior
abdominal wall, lateral to the attachment of the
dorsal mesentery of the gut
• This bulging is now called the NEPHROGENIC
CORD.
• Its surface is covered by the epithelium lining the
peritoneal cavity-COELOMIC EPITHELIUM 02/20/24 7
Genital Duct Development
 After about 37 days of fertilization, two pairs
of genital ducts appear
 Mesonephric Duct extending from the
mesonephric to the cloaca (urogenital sinus)
referred to as the Wolffian system
 Second duct arises as a longitudinal
invagination of coelomic epithelium on the
anterolateral surface of the urogenital ridge,
known as Paramesonephric or Mullerian
Duct. 02/20/24 8
 Paramesonephric Duct

• Cranial uterine tubes

• Caudal portions fuse and form the uterovaginal
primordium and bring together two peritoneal
folds, the broad ligament.
• Initially they remain separated by a septum but
later they fuse to form the uterus.

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 Paramesonephric Duct
• Paramesonephric ducts do not make
contact with the urogenital sinus.
• Paramesonephric ducts fuse with the
medial wall of the mesonephric ducts
• Below the caudal tip of the uterine
primordium and above the dorsal wall of
the urogenital sinus, with the
mesonephric ducts lying laterally, a
collection of paramesonephric cells forms
constituting the Mullerian tubercle.
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02/20/24 11
02/20/24 12
02/20/24 13
 Female Genital Duct Formation

 In ovary the absence of testosterone

inhibits the development of the
mesonephric ducts.
 The atretic remains form the
epoophoron, paraoophoron and
Gartner’s ducts.
 In absence of AMH,
paramesonephric ducts form the
female internal genital tract.
02/20/24 14
 A-Genital ducts in the female at the end of the second month.
B. Genital ducts after descent of the ovary. The only parts remaining
from the mesonephric system are the epoophoron, paroophoron, and
Gartner's cyst

02/20/24 15
 Embryology of Vagina
Derived paramesonephric ducts vs. mesonephric ducts vs.
urogenital sinus, or a combination.
Most accepted, superior part derived from
paramesonephric , while inferior part arises
from urogenital sinus.
The lower part of the utero-vaginal canal comes in close
contact with the dorsal wall of the phallic part of the
urogenital sinus
The utero-vaginal canal and the urogenital sinus are soon
separated from each other by the formation of a solid plate
of cells called the VAGINAL PLATE 02/20/24 16
 Ctd
• The endodermal cells of the urogenital sinus proliferate to form 2
swellings called sino -vaginal bulbs
• These bulbs soon fuse to form 1 mass
• Most of the vaginal plate is formed from these sino -vaginal bulbs
• The part of the vaginal plate near the future cervix is derived from
mesodermal cells of the utero-vaginal canal.
• The vagina is formed by the development of a lumen within the
vaginal plate
• The hymen is situated at the junction of the lower end of the
vaginal plate with the urge
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Inductor role of mesonephric duct on
vagina

Sinovaginal bulbs are caudal segments of mesonephric

ducts.
Between these bulbs and caudally to the
paramesonephric ducts, a solid epithelial structure is
located contacting the dorsal wall of the urogenital
sinus…the Mullerian tubercle.

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Theory of Mullerian Tubercle

• Mullerian tubercle -cellular condensation b/w inferior part

of fused paramesonephric ducts and urogenital sinus.
• Sinovaginal bulbs develop, constitute vaginal plate.
• Cavity formed is lined with paramesonephric epithelium,
opens into the urogenital sinus

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Formation of the uterus and vagina. A. 9 weeks. Note the disappearance of
the uterine septum. B. At the end of the third month. Note the tissue of the
sinovaginal bulbs. C. Newborn. The fornices and the upper portion of the
vagina are formed by vacuolization of the paramesonephric tissue, and the
lower portion of the vagina is formed by vacuolization of the sinovaginal
bulbs. 02/20/24 20
 Mesonephric duct induction
• Vagina derived from fused mesonephric ducts and Mullerian tubercle.
• Paramesonephric ducts form uterus to external cervical os and adequate
formation is induced by mesonephric ducts.
• Mesonephric ducts regress cranially but at cervical os, they enlarge and
form the sinovaginal bulbs.
• The paramesonephric cellular condensation (mullerian tubercle )
incorporates itself in the vaginal plate formed by fusion of the two bulbs.
• Cavitation allows the paramesonephric cells to line the primitive vaginal
cavity with paramesonephric epithelium.

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 Agenesis of mesonephric duct
 As ureteral bud sprouts from the opening of the
mesonephric ducts in the urogenital sinus, the absence or
distal agenesis of a mesonephric duct would result in an
absence of its opening to the sinus ( the origin of the
blind vagina) and in an absence of the ureteral bud on
that side.
• Thus, the definitive kidney would fail to develop
(ipsilateral renal agenesis)

02/20/24 22
Development of external genitalia

• Early, similar in both sexes

• 6th wk, three external protuberance surround cloacal
membrane, the left and right genital swellings meet
anteriorly to form the genital tubercle.
• 12th wk identify difference.
• Genital swelling labioscrotal folds
scrotum or labia major
• Genital tubercle phallus penis or clitoris
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 Development of External Genitalia
Anlage Male Female

Genital Tubercle Glans and shaft of Glans and shaft of

penis clitoris
Urogenital Sinus Penile urethra Vestibule of vagina

Urethral fold Penis Labia Minora

Labioscrotal fold Scrotum Labia Major

American Fertility Society Classification of
Mullerian Anomalies

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02/20/24 26
AMERICAN FERTILITY SOCIETY CLASSIFICATION
OF Uterovaginal ABNORMALITIES

 CLASS 1
 DYSGENESIS OF MULLERIAN DUCTS
 CLASS 2
 DISORDERS OF VERTICAL FUSION OF THE MULLERIAN
DUCTS
A) Asymmetric
1. Unicornuate uterus with a non communicating rudimentary anlage or
horn
2. Unilateral obstruction of a cavity of a double uterus
3. Unilateral vaginal obstruction associated with a double uterus
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 ctd

B) Symmetric unobstructed
1. Didelphis uterus
 Complete longitudinal vaginal septum
 Partial longitudinal vaginal septum
 No longitudinal vaginal septum

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 ctd
a)Complete
• Complete longitudinal vaginal septum
• Partial longitudinal vaginal septum
• No longitudinal vaginal septum
b) Partial
• Complete longitudinal vaginal septum
• Partial longitudinal vaginal septum
• No longitudinal vaginal septum
02/20/24 29
 ctd
2) BICORNUATE UTERUS
A) Complete
• Complete longitudinal vaginal septum
• Partial longitudinal vaginal septum
• No longitudinal vaginal septum
b) Partial
• Complete longitudinal vaginal septum
• Partial longitudinal vaginal septum
• No longitudinal vaginal septum
02/20/24 30
 …
4)T-SHAPED UTRINE CAVITY(DES RELATED)
5)UNICORNUATE UTERUS
a) with a rudimentary horn
1.With endometrial cavity
 Communicating
 Non-communicating
2. Without endometrial cavity
b)without a rudimentary horn
CLASS4
UNUSUAL CONFIGURATIONS OF VERTICAL LATERAL FUSION
DEFECTS 02/20/24 31
 Mullerian duct abnormalities
• Abnormalities in the formation or fusion of the mullerian
ducts results in a variety of anomalies of the uterus and
vagina:
• Single, multiple, combined, or separate.
• Failure of development of a mullerian duct is associated
with failure of development of a ureteric bud from the
caudal end of the wolffian duct.
• Thus, the entire kidney can be absent on the side ipsilateral
to the agenesis of a mullerian duct.
02/20/24 32
 ctd
• Depending on the timing of the teratogenic influence, renal units
can be absent, fused, or in unusual locations in the pelvis.
• Ureters can be duplicated or can open in unusual places, such as
the vagina or uterus
• Polygenic or multifactorial inheritance.
• Hox-9, 10, 11, 13 are expressed along the length of mullerian
ducts. Alteration of HOX genes may give rise to mullerian
anomalies
• Involvement of the Y chromosome in the pathogenesis of
müllerian anomalies has not been considered. 02/20/24 33
 Disorders of Ineffective Suppression
of Mullerian Ducts
 Ambiguous external genitalia frequently are accompanied
by a small rudimentary uterus or a partially developed
vagina.
 Additionally, when there is a genetic loss of cytoplasmic
receptor proteins within androgenic target cells, as it occurs
in the androgen insensitivity syndrome (formerly called
testicular feminization syndrome), the vagina is
incompletely developed because the existing male gonads
suppress the development of the mullerian ducts.
 Genetically male patients ,but seen clinically as phenotypic
XY females without a completely formed vagina02/20/24 34
 Ctd

• OTHER EXAMPLES
• Congenital rectovaginal fistula, imperforate (covered)
anus, hypospadias, and other anatomic variants of
cloacal dysgenesis
• These anomalies can be associated with
maldevelopment of the mullerian and mesonephric duct
derivatives.

02/20/24 35
 CONGENITAL ABSENCE OF
MULLERIAN DUCTS

Include congenital absence of the vagina and uterus.

referred as congenital absence of the vagina (vaginal
agenesis)
Accurately labeled aplasia (or dysplasia) of the mullerian
ducts because the lower vagina generally is normal, but
the middle and upper two thirds are missing.
Uterus absent
Rudimentary uterine primordia are present
Tubes and ovaries are generally are normal.
02/20/24 36
 CHARESTICS OF WOMEN WITH
MULLERIAN AGENESIS
• Congenital absence of the uterus and vagina (small rudimentary
uterine bulbs are usually present with rudimentary fallopian
tubes)
• Normal ovarian function, including ovulation
• Sex of rearing: female
• Phenotypic sex: female (normal development of breasts, body
proportions, hair distribution, and external genitalia)
• Genetic sex: female (46,XX karyotype)
• Frequent association of other congenital anomalies (skeletal,
urologic, and especially renal) 02/20/24 37
Mayer-Rokitansky-Kuster-Hauser
Syndrome (utero-vaginal agenesis)
 15% of primary
amenorrhea
 Normal secondary
development & external
female genitalia
 Normal female range
testosterone level
 Absent uterus and upper
vagina & normal ovaries
 Karyotype 46-XX
 15-30% renal, skeletal and
middle ear anomalies
02/20/24 38
 Ctd
• First seen by a gynaecologist at age 14 to 15 years, when the
absence of menses causes concern.
• Have a normal complement of chromosomes (46,XX)
• Usually have normal ovaries and secondary sex characteristics,
including external genitalia.
• Menstruation does not appear at the usual age because the uterus
is absent, but ovulation occurs regularly.
• There are some exceptions to the rule of normal ovaries.
• For example, polycystic ovaries and gonadal dysgenesis have
been reported in patients with congenital absence of the vagina.
• Additionally, nested polymerase chain reaction demonstrated the
presence of testis-specific protein 1-Y-linked (TSPY) gene 39in
02/20/24
two women
 Associated Urologic and Renal
Anomalies
• Incidence-47%
• Includes unilateral renal agenesis, unilateral or
bilateral pelvic kidney, horseshoe kidney,
hydronephrosis, hydroureter, and a variety of
patterns of ureteral duplication.

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Associated Skeletal and Other
Anomalies
• Spine (wedge vertebrae, fusions, rudimentary
vertebral bodies, and supernumerary vertebrae),
• The limbs and ribs also can be involved.
• Other anomalies include syndactyly, absence of a
digit, congenital heart disease, and inguinal
hernias,

02/20/24 41
Vertical Fusion Defects
obstructive and non-obstructive
• Incomplete cavitation of the vaginal plate formed by
the down-growing mullerian ducts and the up-
growing urogenital sinus.
• Can be considered in two categories:
1. Imperforate Hymen
2. Transverse Vaginal Septum

02/20/24 42
 VAGINAL ABNORMALITIES

Developmental abnormalities of the normal single vagina

include:
• Vaginal agenesis
• Vaginal atresia
• Double vagina
• Longitudinal vaginal septum
• Transverse vaginal septum
02/20/24 43
Vertical Fusion Defects

02/20/24 44
Transverse Vaginal Septum

02/20/24 45
 TRANSVERSE VAGINAL
SEPTUM
 Vertical fusion - complete cavitation of the vaginal plate between the
sinovaginal bulbs and uterovaginal canal.
 Transverse vaginal septum may be caused by a failure of this process
 The septum may be obstructive, with accumulation of mucus or menstrual
blood, or may be non-obstructive, allowing for flow of mucus and blood.
 Transverse vaginal septum can develop at any level within the vagina but
is more common in the upper portion, that is, at the junction between the
sinovaginal plate and the caudal end of the fused müllerian ducts
 46 percent of septa were located in the upper vagina, 35 percent in the
middle, and 19 percent in the lower portion of the vagina.
 The thickness of the septum may be variable, and thicker septa tend to be
located nearer the cervix.
 Typically, a septum is thin (average thickness of 1 cm
02/20/24 46
 ctd
In neonates and infants, obstructive transverse vaginal
septum causes fluid and mucus collection in the upper
vagina, resulting in a mass that may be large enough to
compress abdominal or pelvic organ limit diaphragmatic
movement, and neonatal deaths have been reported.
Pyomucocolopos, pyometria, and pyosalpinges may
develop
In contrast to other defects of the mullerian ducts,
transverse vaginal septum is fortunately associated with few
urologic abnormalities. 02/20/24 47
 Ctd
 Patients with obstructive transverse vaginal septum usually present
during adolescence with
 Cyclic lower abdominal pain
 Amenorrhea
 Gradual development of a central pelvic mass.
 Patients with nonobstructive transverse vaginal septum
 Typically complain of abnormal menstrual flow
 Pain with intercourse,
 Difficulty in placing or removing tampons
 Obstructed labor.
02/20/24 48
 Longitudinal vaginal septum

• Results from defective lateral fusion and incomplete

reabsorption of the paired müllerian ducts.
• These septa are generally seen with partial or complete
duplication of the cervix and uterus.
• Pt complain of difficulty with intercourse or with complaints of
vaginal bleeding
• In an obstructive variety of longitudinal vaginal septum -patient
presents in adolescence with normal menarche, but reports
worsening monthly unilateral vaginal and pelvic pain .
• On examination, a patent vagina and cervix is noted, but a
unilateral vaginal and pelvic mass can be seen.
• The mass represents obstruction of one of the hemivaginas
associated with uterine duplication. 02/20/24 49
02/20/24 50
 Vaginal Agenesis
• Females with vaginal atresia lack the lower portion of the
vagina, but otherwise have normal external genitalia.
• The embryonic origin of this condition is presumed to
involve failure of the urogenital sinus to contribute its
expected caudal portion of the vagina .
• As a result, the lower portion of the vagina, usually one fifth
to one third of the total length, is replaced by 2 to 3 cm of
fibrous tissue.
• In some individuals, vaginal atresia may extend to near the
cervix.
02/20/24 51
 Ctd
 Condition doesn’t become apparent until the time of
expected menarche.
 Cyclic pelvic pain due to hematocolpos or hematometra.
 On physical examination, normal breast and pubic hair
development is present.
 The perineum is usually normal, with normal secondary
sex characteristics with a hymeneal ring and beyond the
ring, a vaginal dimple or small pouch.
 A rectoabdominal examination confirms the presence of
midline structures
02/20/24 52
 ctd
• Sonographic or MR imaging will display upper
reproductive tract organs.
• MR imaging is a more accurate diagnostic tool, as the
length of the atresia, the amount of upper vaginal
dilatation, and the presence or absence of a cervix can be
identified.
• Laparoscopy, is necessary for diagnosis when the anatomy
cannot be fully evaluated with radiographic studies.
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 OBSTETRICAL SIGNIFICANCE OF
VAGINAL ABNORMALITIES

 Complete mullerian agenesis – pregnancy is impossible

because uterus and vagina is absent
 About one third of women with vaginal atresia have
associated urological abnormalities
 Complete vaginal atresia – precludes pregnancy by
vaginal intercourse unless corrected operatively
 In most cases of partial atresia, because of pregnancy-
induced tissue softening, obstruction during labor is
gradually overcome. 02/20/24 54
Imperforate Hymen

02/20/24 55
 Ctd
• By the 12th week, the paramesonephric ducts and/or upper
vagina joins with the vaginal plate, which canalizes beginning
caudally and creates the lower vagina.
• By the fifth month of gestation, the canalization of the vagina is
complete.
• The hymen is formed from the proliferation of the Sinovaginal
bulbs, becoming perforated before or shortly after birth.
• An imperforate hymen results when this "sheet" of tissue fails to
completely canalize.
• Varying degrees of perforation result in findings such as a
cribriform or septate hymen.
02/20/24 56
Imperforate Hymen: Diagnosis/
Treatment
• Classic appearance of bulging, blue-domed,
translucent membrane
• Cyclic pelvic pain due to hematocolpos
hematometria, or hematosalpinx
• Bulging hymeneal membrane or a blind-ending
pouch on exam.
• Pelvic/Rectal exam, U/S, MRI
• Rarely urologic anomalies.
• Tx: Cruciate incision 02/20/24 57
Lateral Fusion Defects:
obstructive and non-obstructive

02/20/24 58
 Lateral Fusion Defects
• Most common type of mullerian defects
• The resulting organs are either asymmetric or symmetric
and obstructed or nonobstructed.
• Result from failure of formation of one mullerian duct,
migration of a duct, fusion of the mullerian ducts, or
absorption of the intervening septum.
• Defective resorption of the septum between the fused
mullerian ducts results in a uterine septum, which may
extend either partially down the uterus or the full length
to the cervix.
• This is the most common uterine defect. 02/20/24 59
 Obstructed Lateral Fusion:
Presentation
• Dysmenorrhea, abd pain, vaginal masses, intermittent
foul odor, mucopurulent discharge, endometriosis
• IVP generally shows renal agenesis on obstructed side.
• Diagnosis is difficult: U/S, HSG, MRI
• Treatment: excision of septum or excise obstructed
uterine horn to prevent endometriosis or pregnancy in
rudimentary horn

02/20/24 60
Lateral Fusion defects without obstruction

02/20/24 61
UTERUS DIDELPHYS

02/20/24 62
 Uterine didelphys

 Two mullerian ducts fail to  Generally have good

fuse, thus duplication of reproductive outcomes.
system.  A septated vagina may occur
 Generally limited to uterus in 75% of cases and may
and cervix (uterine cause difficulty with
didelphys and bicollis (two intercourse or vaginal
cervices), although delivery.
duplication of vulva,
bladder, urethra, vagina and
anus may also occur 02/20/24 63
 ctd
• This anomaly is distinguished from bicornuate and septate uteri by the
presence of complete nonfusion of the cervix and hemiuterine cavity
• Except for ectopic and rudimentary horn pregnancies, problems
associated with uterine didelphys are similar but less frequent than
those seen with unicornuate uterus
• Complications may include
- preterm delivery (20%)
- fetal growth restriction (10%)
- breech presentation (43%)
- cesarean delivery rate (82%) 02/20/24 64
 Uterine didelphys with complete
vaginal septum
• Resection of septum:
metroplasty or hysteroscopic
resection of septum
• Obstructed hemivagina and
ipsilateral renal agenesis will
have regular menses, but
pain.

02/20/24 65
Uterus didelphys, bicollis, with complete upper vaginal
septum with bilateral obstruction
02/20/24 66
UNICORNUATE UTERUS

02/20/24 67
 Unicornuate Uterus
 Reproductive potential is essentially normal
 High risk for infertility, endometriosis,
 Risk for spontaneous abortions,Pre term labour, IUFD ,breech presentations
 No septum, no intervention.
 Asymmetric lateral fusion defect.
 One cavity normal with fallopian tube and cervix, while the failed mullerian duct
has various configurations.
 Affected mullerian duct may not develop or develop partially as horn or an anlager.
 It may or may not communicate.
 Most rudimentary horns are asymptomatic, others contain functional endometrium
that is shed cyclically. If the rudimentary horn is obstructed (without
communication to the other uterus or cervix), the women may develop cyclic pain
and may require surgical excision of the obstructed horn.
 DX: HSG, IVP, U/S, MRI, no treatment.
02/20/24 68
1. Unicornuate
2. Unicornuate with uterine horn (not containing an
endometrial cavity) not fused to unicornuate uterus

02/20/24 69
1. Unicornuate with uterine horn (no endometrial cavity)
fused to unicornuate uterus
2. Unicornuate uterus with noncommunicating horn
containing endometrial cavity not fused

02/20/24 70
Unicornuate with communicating uterine horn

02/20/24 71
BICORNUATE UTERUS

02/20/24 72
02/20/24 73
Septate Uterus: Partial and Complete

02/20/24 74
Septate Uteri

02/20/24 75
 Bicornuate and Septate Uteri

Bicornuate Septate
• Fundus indented • Normal external surface, need
• Partial fusion of mullerian laparoscopy to dx
ducts • Defect in canalization or
• Variable degree of separation resorption of midline septum
of uterine horns that can be between mullerian ducts.
complete, partial or minimal
• Septum can cause infertility,
• HSG won’t dx, need recurrent midtrimester loss
laparoscopy
• Minimal reproductive • Tx: resection of septum
problems, however can have hysteroscopically or
pregnancy loss, PTL, etc. hysteroscopic metroplasty
02/20/24 76
 BICORNUATE UTERUS

• Marked increase in miscarriages that is likely due

to the abundant muscle tissue in the septum
• Pregnancy losses in the first 20 weeks
• 70 percent for bicornuate
• 88 percent for septate uteri
• There also is an increased incidence of preterm
delivery, abnormal fetal lie, and cesarean delivery.

02/20/24 77
 DES RELATED ABNORMALITIES

• Development of rare vaginal clear cell adenocarcinoma.

• Increased risk of developing
• Cervical intraepithelial neoplasia
• Small-cell cervical carcinoma
• Vaginal adenosis,
• Non-neoplastic structural abnormalities

02/20/24 78
 ctd

Structural Abnormalities:
• Transverse septa,
• Circumferential ridges involving the vagina and cervix
• Cervical collars s
• Smaller uterine cavities
• Shortened upper uterine segments
• T-shaped and irregular
• Oviduct abnormalities 02/20/24 79
 Ctd

Reproductive Performance
• Women exposed to DES in utero in general have impaired
conception rates possibly associated with cervical hypoplasia and
atresia
• Their incidences of miscarriage, ectopic pregnancy, and preterm
delivery are also increased, especially in women with structural
abnormalities
Transgenerational Anomalies
• Genital tract anomalies have been described in the offspring of
women exposed to DES when they were a fetus 02/20/24 80
 OTHERS CERVICAL
ABNORMALITIES
Atresia.
 The entire cervix may fail to develop.
 This may be combined with incomplete development of the upper vagina or lower
uterus
Double cervix.
 Each distinct cervix results from separate müllerian duct maturation.
 Both septate and true double cervices are frequently associated with a longitudinal
vaginal septum.
 Many septate cervices are erroneously classified as double.
Single hemicervix.
 This arises from unilateral müllerian maturation.
Septate cervix.
 This consists of a single muscular ring partitioned by a septum.
 The septum may be confined to the cervix, or more often, it may be the downward
continuation of a uterine septum or the upward extension of a vaginal
02/20/24septum.
81
VULVAR ABNORMALITIES

Atresia
Complete atresia of the vulva includes atresia of the introitus
and lower third of the vagina.
In most cases, however, atresia is incomplete and results from
adhesions or scars following injury or infection
The defect may present a considerable obstacle to vaginal
delivery, deep perineal tears may result.
Labial Fusion
Most commonly due to congenital adrenal hyperplasia.

02/20/24 82
Thank you
02/20/24 83