Evaluation and management of Mullerian duct anomalies
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20251034Keywords:
Congenital anomalies, Mullerian duct anomalies, Hysterosalpingography, Ultrasonography, Magnetic resonance imagingAbstract
Background: Development of the female genital tract is a complex embryogenesis including cell differentiation, migration, fusion, and canalization. Mullerian duct anomalies (MDA) are structural anomalies which occur due to defective embryogenesis of the Mullerian ducts, resulting in abnormalities of internal reproductive organs and ambiguity of the external genitalia. Other causes include deficiencies in steroidogenesis, signalling defects of WNT4 gene and TP63, receptor defects and genetic abnormalities.
Methods: A prospective observational study was performed at our institute to observe the congenital anomalies of the female genital tract in our population and their clinical implication.
Results: Most common anomaly observed was septate uterus followed by bicornuate uterus. Gynaecological complication: most common presenting symptom was primary amenorrhea followed by cyclical abdominal pain. Obstetric complication: women with Mullerian duct anomalies have a higher incidence of preterm labour, repeated first trimester spontaneous abortions, foetal malpresentations, and intrauterine foetal growth restriction. Hysterosalpingography (HSG) and ultrasonography (USG) are the primary tools to detect genital tract anomalies, Magnetic resonance imaging (MRI) being gold standard for detecting Mullerian duct anomalies.
Conclusions: Mullerian duct anomalies can present with various obstetric and gynaecological complications. MRI is superior to other diagnostic modalities (HSG or USG) in establishing an accurate diagnosis and deciding further management options. Surgical approach used for correction of these anomalies is specific to the type of malformation and may vary in a specific group.
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References
Amesse LS, Pfaff-Amesse T. Mullerian Duct Anomalies. Medscape. 2023. Available at: https://emedicine.medscape.com/article/273534-overview?form=fpf. Accessed on 12 January 2025.
Mullen RD, Behringer RR. Molecular genetics of Müllerian duct formation, regression and differentiation. Sex Dev. 2014;8(5):281-96. DOI: https://doi.org/10.1159/000364935
Moore KL, Persaud TV, Torchia MG. Before we are born: essentials of embryology and birth defects. Saunders; 9th edition-Elsevier Health Sciiences. 2016.
Connell M, Owen C, Segars J. Genetic Syndromes and Genes Involved in the Development of the Female Reproductive Tract: A Possible Role for Gene Therapy. J Genet Syndr Gene Ther. 2013;4:127. DOI: https://doi.org/10.4172/2157-7412.1000127
Hua M, Odibo AO, Longman RE, Macones GA, Roehl KA, Kahill AG, et al. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynaecol. 2021;205(6):558.
Raj N, Chavan NN. An observational study of effect of Mullerian anomalies on pregnancy. Int J Reprod Contracept Obstet Gynecol. 2019;8(3):1155-61. DOI: https://doi.org/10.18203/2320-1770.ijrcog20190897
Minto CL, Hollings N, Hall-Craggs M, Creighton S. Magnetic resonance imaging in the assessment of complex Müllerian anomalies. Br J Obstet Gynecol. 2001;108(8):791-7. DOI: https://doi.org/10.1111/j.1471-0528.2001.00200.x
Zhang Y, Zhao YY,Jie Q.Obstetric outcome with uterine anomalies in China. Chinese Med J. 2010,123(4):418-22.
Hua M, Odibo AO, Longman RE. Congenital uterine anomalies and adverse pregnancy outcomes. Am J Obstet Gynecol. 2011;205:558. DOI: https://doi.org/10.1016/j.ajog.2011.07.022
Nishida M, Otsubo Y, Arai Y, Ichikawa R, Sakanaka M. Difference in reproductive performance between two subtypes of bicornuate uterus. Arch Gynecol Obstet. 2016;293(6):1335-8. DOI: https://doi.org/10.1007/s00404-016-4047-4
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