Malformation of the uterus and vagina

As mentioned earlier, the Queen vagina develop from mullerova moves, what happens at the end of the second month of intrauterine fetal life. From the part where mullerova moves merged to form the uterus and vagina, and from the top, not merged parts are formed fallopian tube.
If in the process of merging mullerova moves in fetal life happens for any deviations from normal development, then we will have some kind of birth defects that can occur as a result of: 1) the lack or insufficient development of mullerova moves; 2) development of only one mullerova progress; 3) independent development of both mullerova moves preserving between partitions.
The absence of the uterus in viable fetuses is not observed, because even in those cases, when it seemed that the uterus is missing, with careful study found minor accumulation of smooth muscle fibers (precursors of the uterus).
In such cases the vagina usually also appears to be underdeveloped or absent (aplasia of the vagina).
In case of incomplete development and the absence of the merger mullerova of moves, resulting in two rudimentary uterus.
If during fetal life develops only one Muller course, we will have monocorn the womb (uterus unicornis) (Fig. 43). The body of the monocorn's uterus is commonly side arched curvature, gradually narrowing upwards and quietly turning into a pipe. The vagina at this Vice - development there is usually narrow, as it evolves from one half of the pair body. The ovary and pipe usually develop normally.
Quite developed monocorn uterus usually does not cause any pain, because its normal function. Pregnancy can occur the same way as during normal uterus and pregnancy and childbirth can proceed without any deviations from the norm.
If one of mullerova moves developed correctly and the other behind in its development, then the latter is called rudimentary, or underdeveloped. Sometimes rudimentary horn is only a strip of muscle tissue adjacent to a fully developed other half of the uterus; cavity in such cases completely absent (Fig. 44).
Less pronounced underdevelopment rudimentary horns muscle layer it developed stronger, and it has more or less expressed cavity, covered with mucous membrane and soamsawali barely noticeable progress with the cavity of the uterus, and sometimes even without any message with the uterus (Fig. 45). Sometimes this extension horn can function normally, and then when a message with the body of the uterus menstrual blood is released through the uterus into the vagina; if such a move is not, in the extension horn form clusters of blood, which can lead to rupture of the walls of vestigial horns and cause internal bleeding.
A serious complication of pregnancy is at a rudimentary horn; it may come as if there is communication between the uterus and the extension horn, and failing that, with a pregnancy in this situation develops as a consequence of the external (abdominal) movement of a fertilized egg. This complication in its course and outcome reminds ectopic pregnancy, and therefore requires surgical intervention.
In those cases, when in the process of development will be incomplete merge mullerova moves or absent, the horns of the uterus can be developed normally, or will represent a deviation in development.
When the highest degree of underdevelopment both halves of the uterus are completely separated from each other. Such double uterus is called the uterus didelphus (Fig. 46). With this cancer usually have other defects in the structure of urogenital system, making the fetus is not viable. In adults a defect occurs as a rare exception.
If there are two of the womb and both cervix closely adjoined to each other, then the uterus is called the two-horned, two (uterus bicornis bicollis) (Fig. 47).
If two separate body of the uterus have one common cervix, this uterus is called the uterus bicornis unicollis (Fig. 48), and in this case the division of the body of the uterus can be full or partial. In case of incomplete merge only the top departments mullerova moves uterus has sometimes only a saddle-node impression in the bottom - uterus arcuatus (Fig. 49).
In more rare cases, there are two outdoor throat when one of the uterine cavity, the cervical canal whole or in part is divided by a partition is the so - called two uterus - the uterus septus duplex (Fig. 50).
In more rare cases, there are two outdoor throat when one of the uterus, but the cervical canal whole or in part is divided by a partition is the so - called uterus biforis (Fig. 51).
In all these cases the vagina may submit the changes, ranging from double vagina to barely visible partitions, walking on the front wall of the vagina (rice, 52).
Malformations of the uterus usually don't show any symptoms and complaints, if they do not reach a large extent.
With equal development of both females pregnancy can occur in any of them. When pregnancy is one of the mares other softened, increased slightly in scope and encompasses the falling shell, which is expelled during delivery or in the postpartum period. Delivery usually occur normally.
When two uterus there are complications in the postpartum period, if part of the placenta is attached to the wall. Partition in the cervix and vagina may prevent the expulsion of the fetus. Breaks partitions during delivery can lead to severe bleeding that require surgical intervention to stop them.
In order to determine with any malformation we are dealing with, it is necessary to carefully examine the patient as bimanual and using tools (introduction mirrors, sensing).
To the treatment of double uterus and vagina resort in those cases, when they are a violation of the normal function of the sexual apparatus. Sometimes you have to dissect the partition, if it interferes with sexual relations or violates the course of pregnancy and childbirth. In some cases, the presence of bicornuate uterus resort to surgery of double transformation of the uterus in solitary.