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MFD.

MFD. Mounir M. Fawzy El-Hao Prof. in Ob/Gyn Ain Shams University Cairo - Egypt. Incidence of Mullerian Abnormalities. General population Unknown 0.1 1.5% (Rudigozand Dorgent, 1985) HSG in infertility 1-3% (Ludmir et al., 1990) Women with reproductive difficulties1-12%

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MFD.

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  1. MFD. Mounir M. Fawzy El-Hao Prof. in Ob/Gyn Ain Shams University Cairo - Egypt

  2. Incidence of Mullerian Abnormalities • General population Unknown0.1 1.5% (Rudigozand Dorgent, 1985) • HSG in infertility 1-3% (Ludmir et al., 1990) • Women with reproductive difficulties1-12% (Rock and Schlaff, 1985)

  3. Incidence: 15 – 25% of spontaneous abortions are caused by Mullerian fusion defects(Portuonodo et al., 1986)

  4. Simple classification of Mullerian anomalies: • Agenesis (R-K.H-Syndrome) • Problems of vertical fusion Obstructive Non-obstructive • Problems of lateral fusion  Obstructive Non-obstructive

  5. Agenesis (RKH syndrome) Surgically corrected for sexual function Mc indoe’s William’s  Modified vicchietti

  6. Remember … Problems with vertical fusion represent a fault in the function between the down-growing Mullerian ducts (tubercle) and the up-growing derivative from the urogenital sinus

  7. Remember … Problems of lateral fusion of the two Mullerian ducts are especially note worthy in that obstructive lesions seem to have been observed clinically only when the obstruction was unilateral (absent kidney) i.e. (if bilateral = nonviable)

  8. Remember … Attention to obstructive lesions is often urgently necessary to prevent deterioration of reproductive capacity from retained mucous or menstrual blood

  9. Classification of LFD.

  10. Septum Resction

  11. Pregnancy rate • Topkins laparotomy procedure is 71.4% • Hysteroscopic resection of septum is 84% (Fayez, 1986)

  12. Vaginal delivery • Topkins laparotomy 80% • Hysteroscopic metroplasty 76% (Fayez, 1986)

  13. Hysteroscopic resection of the uterine septum was first described by Edstrom in 1974

  14. DIAGNOSIS. • HSG. • LAPAROSCOPY. • HYSTEROSCOPY. • MRI. • 3DIMENSION US.

  15. Diagnosis: Difference between the data obtained by HSG and those by hysteroscopy as regards the length of the septum, was due to dispersion of the dye around the septum on both sides, which faded the septum that disappears especially in the lower part (Kesler and Lancet, 1986)

  16. LAPAROSCOPY. • VISUALISES THE OUTSIDE OF THE UTERUS.

  17. HYSTEROSCOPY • VISUALISES THE INSIDE OF THE UTERUS.

  18. THREE DIMENSION US VISUALISES THE INSIDE OF THE UTERUS,THE CAVITY AND THE OUUTSIDE..

  19. Septate uterus.

  20. MRI septate uterus ?

  21. Laparoscopy broad fundus.

  22. SEPTATE BY 3D.

  23. LARGE BASE SEPTUM

  24. DISTORTED SEPTATE ? TB.

  25. Septate with two cervicies.

  26. Told unicornuate.

  27. Told unicornuate.

  28. WRONG DIAGNOSIS BY HSG(end on x ray) (Portuonod(Portuonodo et al., 1986) o et al., 1986)

  29. Unicornuate uterus by HSG.

  30. Laparoscopy unicornuate uterus.

  31. Unicornuate uterus.

  32. URINARY BLADDER. HAEMATOMETREIA

  33. Abnormal uterus by three D US. • Endometrium of each uterus shows triangular cavity.

  34. Unequal double uterus.

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