Müllerian duct anomalies

Dr Jeremy Jones et al.

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.

MDAs are estimated to occur in 1-5% of all women. There is a higher rate of women with repeated miscarriages (3-15%) 2,5

Despite these anomalies being common 1, the majority are asymptomatic. Obstruction of the Müllerian duct may occur, and patients present with an abdominal mass and dysmenorrhea. Delayed treatment may result in severe consequences and potentially infertility. Patients may also present with recurrent miscarriages and infertility 2,5

Subtypes

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.

Associations

Renal anomalies are frequently associated, most commonly renal agenesis but also crossed fused renal ectopia, and duplex kidney 2

Ultrasound
  • should be performed initially
  • confirms any structural abnormalities of the genital tract
  • sometimes cannot help to identify the type of MDA (especially on 2D imaging alone)
  • 3D coronal transvaginal imaging has a high degree of diagnostic accuracy and ideally should be performed in the secretory phase of the menstrual cycle
MRI
  • valuable noninvasive technique
  • evaluation of the female pelvic anatomy
  • accurate MDA classification

Many patients are asymptomatic and require no treatment. However, where obstruction occurs, surgical intervention is usually required and may result in permanent infertility: counselling is required.


Abdominal and pelvic anatomy
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Article Information

rID: 6988
Section: Anatomy
Synonyms or Alternate Spellings:
  • Uterine anomalies
  • Müllerian duct anomaly (MDA)
  • Mullerian duct anomaly
  • Anomalies of uterine development
  • Congenital uterine anomalies
  • Uterine anomaly
  • Mulleran duct anomalies

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    Figure 1: diagram: Müllerian duct development
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    Bicornuate Uterus
    Case 1: bicornuate Uterus
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    Axial T2 pelvis

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    Case 2: bicornuate uterus
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    Case 3: septate uterus
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    Cor T2 00
    Case 4: arcuate uterus
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     Case 5: uterus didelphys
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