Development of uterus
♣Origin:
Middle part of Mullerian duct.
♣Mullerian duct:
◊ 2 ducts develop as invagination of
coelomic epithelium.
◊ They are lateral to genital ridge &
Wolffian system.
◊ It extends on each side & caudally
as following
* 1st part (Cranial long. part)
lateral to Wolffian duct,
* 2nd part (Middle transverse
part) crossing infront of Wolffian duct,
* 3rd part (Caudal long. part) medial to Wolffian duct.
◊ It reach the dorsal wall of urogenital sinus at the 9th week.
◊ They are solid rods then undergo canalization.
◊ The upper ends are separate & form fallopian tube & later on fimbriae develop
around the distal opening.
◊ The lower parts of Mullerian duct fuse together to form the uterus, cervix &
median septum between them disappear forming vagina (Upper 3/4).
♣Congenital anomalies:
A. Imperfect development
1) Aplasia:
◊ Def.: complete absence of the uterus.
◊ Anomaly: Both ducts didn’t develop.
◊ C/p: lry amenorrhea as part of Mullerian agenesis
(i.e. associated with no tubes & no upper 3/4 of the vagina).
◊ Complications: sterility (incurable cause of infertility).
◊ Treatment: has no treatment.
2) Hypoplasia:
◊ Def.: total length of the uterus & cervix<6.25 cm.(N. 7.5 cm)
◊ Anomaly: poor development of both ducts.
◊ C/p: according to the degree:
a.Rudimentary solid uterus:
* Small solid organ having no cavity.
* Primary amenorrhea.
b.Infantile uterus:
* Retains infantile dimensions (Body / Cervix = 1/2)
* lry amenorrhea.
c. Prepubertal uterus:
* Retains prepubertal dimensions (Body / Cervix = 1/1)
* Delayed menarche or hypomenorrhea or habitual abortion of increasing duration.
◊ Complications: * infertility * spasmodic dysmenorrhea
* Habitual abortion & preterm labour.
◊ Treatment: Cyclic estrogen & progesterone therapy if the uterus has a cavity.
3) Uterus unicornis (unicornuate uterus):
◊ One Mullerian duct didn’t develop (one tube only).
4) Uterus with rudimentary horn:
◊ Def.: Defective development of one Mullerian duct.
◊ Anomaly: One duct developed correctly,
While the other one developed poorly.
◊ Types: *Communicating. *Non-communicating.
◊ Complications: * Spasmodic dysmenorrhea
* Ectopic pregnancy.
* Obstructed labour.
◊ Treatment: Excision of the rudimentary horn.
B. Imperfect fusion of Mullerian ducts:
♣ Types:
1) Uterus didelphys: uterus bicornis bicollis with
double vagina:2 bodies + 2 cervices with 2 vaginae
2) Uterus pseudodidelphys: uterus bicornis bicollis
with single vagina:
2 bodies + 2 cervices + 1 vagina.
2 bodies & 2 cervices are attached together.
3) Bicornuate uterus(uterus bicornis unicollis):
2 bodies + 1 cervix + 1 vagina.
4) Arcuate uterus: broad depressed fundus.
5) Septate uterus: complete longitudinal median septum.
6) Subsptate uterus: incomplete longitudinal median septum.
♣C/P of uterine anomalies due to imperfect fusion:
1) Amenorrhea & Infertility: In uterine hypoplasia.
2) Menorrhagia: due to ↑ surface area of endometrium in 1st 3 types.
3) Spasmodic dysmenorrhea: due to abnormal configuration of muscle fibres.
4) Habitual abortion: *Cervix is incompetent,
*Uterus is hypoplastic,
*Poor implantation in uterine septum.
5) Ectopic pregnancy: If zygot implanted in a rudimentary horn.
6) Placenta acreta: If zygot implanted over a uterine septum.
7) Malpresentations: as transverse lie in bicornuate uterus.
8) Obstructed labour: As in case of long. vag. septum.
C. Imperfect canalization:
◊ Cervical atresia or stenosis.
◊ Complications:
*spasmodic dysmenorrhea. * Hematometra & hematosalpinx.
*pyometra. * Infertility.
*Cervical dystocia during labour (If pregnancy occurs).
D. Other anomalies:
1) Congenital pseudoprolapse:
Congenital elongation of portio-vaginalis of the cervix,
C/P: dyspareunia & infertility.
D.D.: congenital prolapse.
Treatment: excision.
2)Cochleate uterus (C-shaped uterus):
Cause: marked growth of the posterior wall
of the uterus > anterior wall so,
fundus & external os look forward.
C/p: spasmodic dysmenorrhea & infertility.
3)R.V.F. uterus (retroverted retroflexed uterus).
4)Patulous internal os (isthmic incompetence):
Passage of Hegar No. 8 through the internal os without pain or resistance.
Complications: *habitual abortion. *habitual preterm labour.
Development of Fallopian tube
♣Origin:
u1/3 (Cranial longitudinal part) of Mullerian tube.
♣Congenital anomalies
1. Aplasia: complete absence of tubes (usually part of Mullerian agenesis).
2. Hypoplasia:
* thin long tortuous tube.
* may lead to ectopic
pregnancy & infertility.
3. Accessory ostium : leads to
infertility or ectopic pregnancy.
4. Narrow ostium: (fimbrial
phimosis) :leads to infertility.
5. Congenital diverticulum:
predisposes to ectopic pregnancy.
Uterus and fallopian tube development videos:
Development of Uterus (Detailed Demonstration) video
Paramesonephric duct – uterus development video
Congenital Uterine Abnormalities – CRASH! Medical Review Series video
(Disclaimer: The medical information contained herein is intended for physician medical licensing exam review purposes only, and are not intended for diagnosis of any illness. If you think you may be suffering from any medical condition, you should consult your physician or seek immediate medical attention).
