What is the difference between 3D and 4D images?
3D = static image, 4D = live or real time image
What are the uses of 3D/4D imaging in gynaecology?
- Congenital uterine anomalies
- IUD location
- Endometrial lesions
- Determining fibroid number and location
- Origin of adnexal masses
- Saline-infused sonohysterography
- Infertility evaluation
- Evaluation of the pelvic floor
What are the uses of 3D/4D imaging in obstetrics?
- Facial anomalies and ears
- Nasal bone
- CNS anomalies
- Cranial sutures
- Spine
- Extremities
- Fetal heart
- Chromosomal abnormalities and syndromes
- Fetal movement and behavior
At what week do germ cells migrate from the yolk sac and form the genital ridges?
5 weeks gestation
At what week do both male and female embryos have 2 sets of paired genital ducts?
6 weeks gestation
What are the names of the female and male ducts?
Female: Paramesonephric (Müllerian)
Male: Mesonephric (Wolffian)
At what week do the paramesonephric (Müllerian) ducts fuse caudally to form the uterus, cervix, and upper part of the vagina?
10 weeks gestation
At what week do the unfused cranial ends form the paired fallopian tubes?
10 weeks gestation
At what week does the median septum formed by the medial walls of the Müllerian ducts resorb, leaving a single uterine cavity?
10 weeks gestation
What happens if the Wolffian ducts don’t fully degenerate?
Causes Gartner Duct Cyst mainly along the vagina
What is the incidence rate for uterine congenital abnormalities?
1%
What might uterine malformations be caused by?
1) Arrested development of the Müllerian ducts
2) Failure of fusion of the Müllerian ducts
3) Failure of resorption of the median septum
What are the two types of arrested development?
1) Bilateral - extremely rare & results in Congenital absence of the uterus (uterine Aplasia)
2) Unilateral - Development results in: Uterus Unicornis Unicollis = 1 Uterine horn, 1 cervix, Hyroplasia of one mullerian duct - Rudimentary Uterine horn
Generally, what is arrested development?
Failure of one of the müllerian ducts to form - results in the development of a unicornuate uterus. Smaller than normal uterus.
A rudimentary horn may accompany this malformation.
What is complete failure to fuse of the Müllerian ducts?
Results in uterus didelphys - 2 uteri, 2 cervices, 2 vaginas.
What is partial/incomplete failure to fuse of the Müllerian ducts?
1) Uterus bicornis bicollis - 2 uterine horns, 2 cervices, 1 vagina
2) Uterus bicornis unicollis - 2 uterine horns, 1 cervix, 1 vagina.
What are the types of lack of resorption?
Complete = uterus septum (I Sentus), Incomplete = uterus subsentum (II Subsertus), Arcuate.
What is an arcuate uterus?
Mildest fusion anomaly, mild indentation of endometrium at uterine fundus, often considered a normal variant.
What does lack of resorption (complete or incomplete) result in?
A complete or partial duplication of the uterine cavity without duplication of the uterine horns.
What is the diagnosis and treatment for uterus variants?
1) Abdominal surgery to repair bicornuate uterus
2) Outpatient hysteroscopic resection of septum for septate uterus
3) Diagnosis: hysterosalpingogram, MRI, and ultrasound.
Why is it easier to scan in the secretory phase?
Thick and echogenic endometrium.
Why scan kidneys for agenesis or ectopia?
Urogenital ridge developed at the same point in the embryo.
What is congenital diethylstilbestrol?
Was given in the 1st trimester to prevent miscarriage in the old days; daughters may have smaller uteri and T-shaped cavity, related to infertility & cancer, need hysterosalpingogram to confirm.
What is the treatment for congenital diethylstilbestrol and do kidneys need to be scanned?
Tx = give estrogen supplements and no, estrogen doesn’t affect kidneys.
