Müllerian duct anomalies
Updates to Article Attributes
Müllerian duct anomalies (MDAs) are congenital abnormalities that occur when the Müllerian ducts (paramesonephric ducts) do not develop correctly. This may be as a result of complete agenesis, defective vertical or lateral fusion, or resorption failure.
Epidemiology
MDAs are estimated to occur in 1-5% of all women. There is a higher rate of women with repeated miscarriages (3-15%) 2,5.
Clinical presentation
Despite these anomalies being common 1, the majority are asymptomatic. Obstruction of the Müllerian duct may occur, and patients present with an abdominal mass and dysmenorrhea. Delayed treatment may result in severe consequences and potentially infertility. Patients may also present with recurrent miscarriages and infertility 2,5.
Pathology
Subtypes
The Müllerian duct anomaly classification system divides them according to clinical manifestations, prognosis, and treatment. Accurate diagnosis is essential, since management varies according to the type of malformation.
- uterine agenesis: ~10%
- arcuate uterus: often considered as part of normal anatomical variation, ~7%
- unicornuate uterus: ~15% (range 5-25%)
-
uterine duplicational anomalies
- uterus didelphys: ~7.5 % (range 5-11%)
- bicornuate uterus: ~25% (range 10-39%)
- septate uterus: ~45% (range 34-55%)
Associations
Renal anomalies are frequently associated, most commonly renal agenesis but also crossed fused renal ectopia, and duplex kidney 2.
Radiographic assessment
Ultrasound
- should be performed initially
- confirms any structural abnormalities of the genital tract
- sometimes cannot help to identify the type of MDA (especially on 2D imaging alone)
- 3D coronal transvaginal imaging has a high degree of diagnostic accuracy
. This, and ideally should be performed in the secretory phase of the menstrual cycleideally.
MRI
- valuable noninvasive technique
- evaluation of the female pelvic anatomy
- accurate MDA classification
Treatment and prognosis
Many patients are asymptomatic and require no treatment. However, where obstruction occurs, surgical intervention is usually required and may result in permanent infertility: counseling is required.
See also
-<li>3D coronal transvaginal imaging has a high degree of diagnostic accuracy. This should be performed in the secretory phase of the cycle ideally.</li>- +<li>3D coronal transvaginal imaging has a high degree of diagnostic accuracy, and ideally should be performed in the secretory phase of the menstrual cycle</li>
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