Normal And Abnormal Development Of Female Genital Tract

1
Normal And Abnormal Development Of Female Genital
Tract

• Dr Khalid Sait
• FRCSC
• A. Prof Gynecologist Oncologist

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Embryology

• Baby sex established at the time of fertilization
  ( sperm meet ovum )
• sperm 46 xy ovum 46 xx
  (23x 23 y) (23 x 23
  x)
  

Boy
Girl
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Genetic sex XX / XY
Gonadal sex Testes / Ovaries
Hormones
External genitalia
Internal genitalia
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Embryology

• Gonads appear as genital ridges by proliferation
  of coalemic epithelium(mesoderm)
• Primordal germ cell appear in the endodermal cell
  in the wall of yolk sac , migrate along the
  mesentery of hindgut and invade the genital
  ridges
• At 7 weeks the gonads of embryo indistinguishab
  le male and female ( indifferent gonad)
• At 8 weeks if xx ----- Ovary xy------
  - Testis

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EmbryologyOvary

• Gonadal ovary medullary cord degenerate and
  cortical cord develop
• Germ cells ----oogonia
• 11-12 w onset of oogenesis
• 20 w 7 million germ cells in each ovary
• Birth 2 millions
• Puberty 40,000 primary oocytes remaining in the
  ovaries. Only 400 ------------- secondary
  oocytes and extended at ovulation once every
  month during menst. Cycle.
• Descend of ovary is not an active migration, but
  result of rapid growth of body and failure of
  gubernaculum to elongatee ( that why its
  maintain blood supply from the aorta

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Congenital Uterine Anomaly

• Precise incidence is unknown (range from 1-2 ) 
• Clinical presentation
  
  1 Usually asymptomatic
  
  2 Menstrual disorder
  3  Dysmenorrhea
  4  Recurrent abortion ( decrease intrauterine
  volume and vascularity, increase uterine
  irritability and cervical incompetance )
  
  5 Premature labor
  
  6 Abnormal presentation
  7
  Primary infertility 

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Congenital Uterine Anomaly

• Diagnosis  History
  Pelvic exam Hysterosalpingography
  U/S MRI
  Laproscopy Hysteroscopy
  IVP or U/S (Exclude Renal anomaly )

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Congenital Uterine Anomaly

• Treatment  1-   Double uterus
  (didelphic uterus) no need to treat.
  2-   Bicornate ut. ---------
  Strassmann procedure ( if
  indicated ) 3-  
  Ut. Septum --------- (BCP for dysmenorrhea
  ), Tompkins metroplasty or Hysteroscopic
  resection of septum )
  4-   Unicornate ut. --------
  Surgery indicated if there is blind horn which
  cause symptom----- surgical resection of blind
  horn.

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Mullerian Agenesis

• Mayer Custer Hauser Rokitansky Syndrome
•  1 4000
•  Abscent upper vagina, cervix and uterus and
  tubes
• Normal ovaries and vulva
•  Associated with spine and renal anomaly
•  Treatment
  McIndoe procedure
  Self dilatation of vagina 

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Vaginal Agenesis

• 1 5000
• Normal Vulva
• Ass. With spine, renal and middle ear anomaly 
• Treatment  Karyotype,
  U/S - MRI ( only 5 will have normal
  functioning uterus) Once
  patient sexually active 1-  
  Gradual vaginal dilatation against vaginal dimple
  (daily for 20-30 mint for few month with gradual
  dilators size.
  2-   William procedure
  3-   Wharton and Macindo procedure  

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 Transverse Vaginal Septum

• Mid vagina usually 
• May be partial or complete 
• Presentation  Primary amenorrhea Dysparoni
  a 
• Treatment  Surgical resection  

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Adult Equivalents of Embryonic Structures
Female Embryonic Structure
ovary Indifferent gonad
ovarian follicles Cortex
rete ovarii Medulla
ovarian and round ligament of uterus Gubernaculum
epoophoron, paroophoron Mesonephric tubules
appendix vesiculosa, duct of epoophoron, duct of Gartner, ureter, pelvis, calices and collecting tubules Mesonephric Duct
hydatid of Morgagni, uterine tube, uterus Paramesonephric Duct
urinary bladder, urethra, vagina, urethral, paraurethral and greater vestibular glands Urogenital Sinus
hymen Sinus tubercle
clitoris Phallus
labia minora Urogenital folds
labia majora Labioscrotal swellings

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Imperforated Hymen 

• Presentation  Primary
  Amenorrhea  Pelvic mass 
• Treatment  Cuciate incision at hymen 
• Follow up  Endometrosis  Vaginal
  adenosis