Müllerian duct anomalies

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.

Clinical presentation

Despite these anomalies being common ¹, the majority are asymptomatic. 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.

Obstruction of the Müllerian duct may occur : patients present with an abdominal mass and dysmenorrhea. Delayed treatment may result in severe consequences and potentially infertility.

Pathology

Associations

Renal anomalies are frequently associated

Sub types

• uterine agenesis : ~ 10 %
• arcuate uterus : often considered as part of normal anatomical variation : ~ 7 %
• unicornuate uterus : ~ 5 - 25 %
• uterine duplicational anomalies
  • uterus didelphys : ~ 5 - 11 %
  • bicornuate uterus : ~ 10 - 39 %
  • septate uterus : ~ 34 - 55 %

Radiographic assessment 

Ultrasound

• should be performed initially
• confirms any structural abnormalities of the genital tract
• sometimes cannot help to identify the type of MDA

MRI

• valuable non invasive 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

• Müllerian duct
• Müllerian duct anomaly classification
• uterus