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MRI Pays Off in Obstructive Mullerian Anomalies.
HOT SPRINGS, VA. -- Magnetic resonance imaging is expensive, but it's worth it in the evaluation of obstructive mullerian anomalies such as cervical atresia and transverse and longitudinal vaginal septa, Dr. Judith Burgis said at the annual meeting of the South Atlantic Association of Obstetricians and Gynecologists.
Physicians need a high index of suspicion to diagnose mullerian anomalies, the incidence of which is thought to be between 0.1% and 3.8%.
In normal development, the mullerian ducts elongate and reach the urogenital sinus by 9 weeks' gestation. The uterovaginal canal forms and inserts into the urogenital sinus at Muller's tubercle, the ducts fuse, and internal canalization and septum resorption occur by 20 weeks' gestation. By the time the child is born, the hymen should have formed and become perforate, explained Dr. Burgis, who is in private group practice in Columbia, S.C.
With mullerian anomalies these stages of development are incomplete.
In the case of longitudinal vaginal septum, for example, there's an arrest in fetal development of the mullerian and metanephric ducts at around 8 weeks' gestation. Patients can present with or without symptoms of cyclic pain and abnormal bleeding. If the septum is incomplete, the physical exam may not show anything, making MRI highly useful for delineating the anatomy.
The goal of surgery is to excise the septum; a Foley catheter in the bladder during the procedure can help keep the anatomy defined. The vaginal mucosa behind the obstruction is mucosa-lined epithelium with glandular crypts of the cervical type. This layer has been known to eventually transform into mature squamous epithelium in 1-3 years; patients should be warned that they're likely to experience heavy discharge during this transformation period.
Dr. Burgis discussed the diagnosis and treatment of the following other mullerian anomalies:
- Imperforate hymen may have familial origins.
- Newspaper article from: Medical Devices & Surgical Technology Week January 18, 2004 700+ words
...amp; NewsRx.net) -- Imperforate hymen may have familial origins...research from Malaysia, "imperforate hymen is an uncommon obstructive...familial occurrence of imperforate hymen have been reported so...
- Consider mullerian agenesis in cases of imperforate hymen.(Adolescent Health)
- Magazine article from: Internal Medicine News Finn, Robert July 1, 2005 700+ words
PORTLAND, ORE. -- Some cases of apparent imperforate hymen are actually mullerian agenesis, and that possibility...defense of the first physician, it does look like an imperforate hymen," said Dr. Lee of Oregon Health & Science...
- Research from G. Yildirim and co-researchers in the area of obstetrics and...
- Magazine article from: Women's Health Weekly October 30, 2008 700+ words
...study from Istanbul, Turkey, "Imperforate hymen is one of the most simple and most...sonography may prenatally detect imperforate hymen due to presentation of hydrocolpos...report a prenatally diagnosed of imperforate hymen with hydrometrocolpos." Yildirim...
- Data on urinary retention reported by A. Gyimadu and co-researchers.
- Magazine article from: Women's Health Weekly September 10, 2009 700+ words
...examination revealed a pale blue imperforate hymen bulging from the vaginal introitus...clinicians should keep in mind that imperforate hymen may be a causative factor and this...retention in an adolescent girl with imperforate hymen: an uncommon presentation. Archives...
- New findings reported from University of California, Medical Department...
- Magazine article from: Women's Health Weekly April 23, 2009 700+ words
...were performed in seven women with Mullerian anomalies." "Tubal ET was performed via...ongoing pregnancy rates in women with Mullerian anomalies, suggesting that 1) endometrial...Diethylstilbestrol-associated and other Mullerian anomalies: Evidence from tubal embryo transfer...
- Genital abnormalities require precise diagnosis: those not trained to recognize...
- Magazine article from: Family Practice News MacNeil, Jane Salodof April 1, 2005 700+ words
...obstructions, for example, they may just think it is an imperforate hymen and are not even aware that there is even an entity called...therapy. Among developmental abnormalities of the vagina, imperforate hymen is usually asymptomatic until a child reaches menarche...
- Slim-Fit Tampons.(Brief Article)
- Magazine article from: Family Practice News May 1, 2001 700+ words
...year-old girl who did not know she had a partially imperforate hymen, which apparently led her to insert the tampon into the...episodes of hematuria after her first use. "A partially imperforate hymen, as in this case, may not be diagnosed until a young...
- Slim-Fit Tampon Mistakenly Inserted Into Urethra.
- Magazine article from: OB GYN News MOON, MARY ANN May 1, 2001 700+ words
...year-old girl who did not know she had a partially imperforate hymen, a condition which apparently led her to insert the tampon...episodes of hematuria after her first use. "A partially imperforate hymen, as in this case, may not be diagnosed until a young...
Source: HighBeam Research, MRI Pays Off in Obstructive Mullerian Anomalies.