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2.  Invagination of coelomic mesothelium occurs close to
the primitive gonad.
Two on either sides
Grow caudally
Cross Wolffian duct
meet in the midline

3.  Mullerian tubercle
 Sinovaginal bulbs
 Intervening septum
 Uterovaginal canal

4.  Aplasia : Failure of development
 Hypoplasia : Organs are rudimentary
 Atresia : Partial or complete failure of canalisation
 Mullerian Duct Anomalies : Assymetric development,
failure of fusion, failure of disappearance of
intervening septum
 Hermaphroditism and Pseudohermaphroditism :
Abnormal development of gonads
 Developmental Defects : Defective development of
urinogenital sinus

5. May involve the whole part of the Genital Tract in the
female.
1. Ovary
 Ovarian agenesis appearing as a streak gonad.
2. Fallopian Tube
 rudimentary tubes with abnormal ostia and fimbriae
3. Uterus
 Complete agenesis only with concurrent non
development of the urinary system
 A unilateral development of the Mullerian duct is
known to occur.

6. 4. Vagina
 Incidence is reported to be 1:400 to 1: 5000 women.
 Familial tendancy, multy factorial in origin.
 Failure of the vagina to canalize may be partial or complete
 Functioning uterus present occasionaly in 7 to 8 %
 Testicular Feminising Syndrome, RKH syndrome
(Rokitanski-Kuster-Hauser syn.)
 Development of secondary sexual characters is normal
 Menarche fails to occur
 Sexual intercourse is not possible

7.  Frank’s Technique / Construction of and artificial
vagina
 McIndoe Operation : space created between the urinary
bladder and the rectum by incising the dimple vagina
transversely. Later lined with a split skin graft (from
thigh) or fresh amnion
 William’s vaginoplasty : creating a pouch out of Labia
majora. Leaves grossly distorted external genitalia
 Frank’s dilatation

8. 1. More common than aplasia
2. C/F:
 Rudimentary horn
 Pubescent or infantile uterus
 Infantile cervix with a pin point os
 Uterocervical length less than
 Endometrial lining is scanty
 The fallopian tubes appear thin, long and wavy with poorly
developed Plicae.
 Underdeveloped external genitalia

9.  Resection of the rudimentary horn to prevent
development or spread of endometriosis and
occurrence of ectopic pregnancy.
 Uterine unification can be done in patients with
communicating horn.

10. 3. Presenting features:
 Infertility
 Hypomenorrhoea or Oligomenorrhoea
 Dysmenorrhoea and Dyspareunia
4. A non canalizing rudimentary horn may not cause
any problem. but can be mistaken for a fibroid.
5. A functioning horn may cause symptoms like
 Haematometra (communicating horn)
 Endometriosis and ectopic pregnancy (non
communicating)

11. 1. May involve a part or whole of the tract
2. Fallopian tube atresia : Partial/ Complete
 Partial atresia : Hematometra
 Atresia at the junction of Mullerian Tubercle :
Imperforate Hymen or Vaginal septum
Mucocolpos or Hematocolpos

12. 1. Imperforate Hymen may be the cause
2. C/F :
 Colicky abdominal pain which is often cyclic
 Menarche has not yet achieved.
 Vagina gets progressively filled with blood
Pressure symptoms
 Difficulty in micturition Urinary retention

13. 3. O/E :
 A suprapubic bulge producing discomfort on
palpation
 On separation of the labia, a bluish bulging membrane
is recognized
4. Complications:
 Progress beyond hematocolpos to hematometra and
hematosalpinx
 Development of pelvic endometriosis
 Constitutional symptoms : Low grade fever,
tachycardia, malaise, pallor etc
 USS establishes any associated renal abnormality

14. 1. These result from defective fusion, canalization or
absorption of the medial septum of the female
reproductive septum during embryonic development
2. Usually asymptomatic. Symptoms include
reproductive failures (Abortions, Preterm birth,
LBW), malpresentations (transverse lie/oblique
lie/breech)

15.  Two Mullerian Ducts fails to
fuse along the whole of their
lengths
 Develop normally and remain
separate
 Two vaginas open at the vulva
 A vaginal Septum can be seen
 Two cervices seen

16.  Two Mullerian ducts fuses at
the body of the uterus
 Uterus bicornis bicollis:
Vagina is single but the two
cornua remain separated
and two cervices project
into the vagina.
 Uterus bicornis unicollis:
Vagina is single with a single
cervix

17.  Although the two Mullerian
ducts have fused, a median
septum passes from the
fundus of the uterus to the
cervix and may extend into
the vagina
 In Uterus subseptus, the
septum is retricted to the
body of the uterus

18.  There is no actual septum
in the region of the
fundus
 Instead of the usual
dome-shaped convexity
of the fundus, there is a
shallow concave
depression

19.  Seen in 1% cases and is
associated with renal
abnormality on the same
side.
 Recognized by the absence
of round lig. And fallopian
tube on the opposite side
 Can cause abortion,
preterm labor and IUGR

20. Class I Segmental Mullerian a) Vaginal
agenesis or hypoplasia b) Cervical
c) Fundal
d) Tubal
e) Combined
Class II Unicornuate uterus a) With Rudimentary
horn
• With a
communicating
endometrial cavity
• With a non
communicating cavity
• With no cavity
a) Without any
rudimentary horn

21. Class III Uterus didelphys
Class IV Bicornuate uterus a) Complete upto the
internal os
b) Partial
c) Arcuate
Class V Septate uterus a) With a complete
septum
b) With an incomplete
septum or Uterus
subseptus
Class VI Uterus with internal
luminal changes

22.  Dyspareunia due to a coexisting vaginal septum
 Pap smear must be taken separately from each cervix
for gynaec. Examination
 Use of separate IUDs for each horn
 Bicornuate uterus cause the following gynaec.
Problems.
 Habitual abortions due to myometrial weakness or septal
implantation
 Preterm labour
 Persistent malpresentations
 Retained adherent placenta

23.  Ultrasound of the pelvis as well as the renal region
 Hysterogram
 Hysteroscope : the gold standard in the diagnosis as
well as management
 Laparoscopy

24. 1. Strassman utriculoplasty with a transverse fundal
incision; in women with bicornuate uterus
2. Jones’ operation of wedge resection of a part of
fundus with the septum followed by uniting the two
horns vertically; in women with septate uterus
3. Hysteroscopic resection using a resectoscope, has a
higher pregnancy rate that other invasive procedures
4. Excision of the rudimentary horn to avoid
heamatometra and ectopic pregnancy

25.  True hermaphroditism : Glands of both sexes must be
present in the same individual.
 In most cases the accessory sex gland is atrophic and
shows no evidence of functional activity
 In other cases the functional glands are partly of
ovarian and partly of testicular tissue
 Along with Ovarian follicles and corpus luteum
spermatogonia and spermatocytes are seen

26.  In this case, the sex glands are of one sex while the
external genitalia will be of opposite sex
 Ovaries may descend within the inguinal canal to lie n
the labia majora, with a hypertrophied clitoris and
fused labiosacral folds rescemble a rudimentary
scrotum (female pseudohermaphroditism)
 Testis fails to descend, the penis is ill developed and
the external genitalia rescembles that of a female
(Male hermaphroditism)

27.  Epispadias: Rare anomaly presenting with genital
prolapse and urinary incondinence
 Ectopia vesicae: Due to the defective development of
the lower abdominal wall and the anterior wall of the
urinary bladder. The red mucous membrane of the
interior of the bladder remain exposed and two
ureteric orifices are visible.
 Hypospadias

28.  Imperforate anus:
Results from the failure of the claocal membrane to
divide below the terminal intestine
 Atresia recti:
Lower part of the rectum fails to develop. Much more
serious than imperforate anus.
 Congenital rectovaginal Fistula:
Imperfect separation between rectum and the
urogenital sinus. It can result in a perineal anus or
vaginal anus

29.  The upper part of the Wolffian duct may at times dilate
to form a Para ovarian cyst and the lower portion
forms a Gartner Cyst
 Usually diagnosed by a laparotomy, when the ovary is
normal and the cyst lies in the broad ligament
 A small gartner’s cyst can be left alone, but if it causes
dyspareunia, excision is required.

30.  A double ureter is rarely encountered. Its recognition
by laparotomy is necessary to avoid any injury
 An ectopic ureter sometimes communicates with
vagina
 Diagnosis confirmed by a pyridine test and an
intravenous pyelogram (IVP)