Monday, 8 September 2014

The Uterine abnormality - case of mullerian agenesis

The Uterine abnormality - case of Mullerian Agenesis

 Mullerian  agenesis is a congenital malformation of genital tract which  occurs in 1 out of every 4,000 to 10,000 females. This condition is characterized by congenital absence of the vagina, uterus, or both. Diagnosis can be made after ultrasound/MRI or endoscopy.

In the given picture , fallopian tube is the  pink and long structure  lying on the bluish looking colon.  The small bulging seen at the proximal end is the uterine horn and there is no uterus other than that. The patient had a diagnostic laparoscopy to view the internal structures. We can see that fallopian tubes are looking   normal, but only a small peanut sized uterine horn is present  in the place of uterus .

The patient never menstruated in her life , as by birth she was devoid of uterus . Her ovaries were normal , hence we were able to do  egg collection and  successful child birth could be achieved  after embryo transfer was done to a surrogate mother . Although  this  is a  rare condition , we have done 2 cases this month , when the patients came for surrogacy .

Before commencing the treatment, the patient and her family  should be thoroughly counseled  to prevent anxiety and low self esteem.  She should be prepared psychologically   to face  the implications on reproduction.

Satisfactory vaginal creation  can be usually managed non surgically  and the most common method used  is vaginal dilation; however, there are a variety of surgical options for creation of a neovagina.  Evaluation for associated congenital renal anomalies or other anomalies is also very crucial. 

Dr Anita mani.

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