0:01

So as we wrap up Müllerian duct

0:03

anomalies, I have a few teaching points

0:05

when you're approaching these cases.

0:08

Number one, always look at the fundal

0:09

contour, whether it's 3D imaging with

0:11

ultrasound or MRI, getting that uterus in

0:14

the right plane to see that fundal contour.

0:16

That's going to help you narrow it down to a

0:18

resorption issue, which is a septate or even

0:21

an arcuate uterus, versus a fusion issue,

0:23

which is going to be your bicornuate, which

0:25

is your didelphys, and your unicornuate.

0:29

You also need to look at the number of uterine

0:31

horns and the number of cervices that are there.

0:35

And that's going to help you decide whether

0:36

it's unicornuate versus bicornuate or

0:38

didelphys, depending on the number of horns.

0:41

And of course, if you have a unicornuate,

0:42

always look for that rudimentary horn

0:44

and look to see if it has endometrium.

0:47

Number of cervices, that's going to tell

0:49

you didelphys versus bicornuate, especially

0:51

if the horns are widely spaced, like

0:53

in that last case that we showed you.

0:57

Don't forget the vaginal evaluation.

0:59

That's going to be tricky with a transvaginal

1:01

ultrasound, but if you see a fluid collection or

1:03

your tech feels like there's a blockage right

1:05

there, that might be a septation problem there.

1:09

If you have an MRI, look for that

1:10

septum, look for obstruction.

1:13

Septums have a high association with

1:15

didelphys, so keep that in mind.

1:17

And there's also, of course, an

1:18

association with a complete septate

1:20

uterus, not just a partial, but a complete.

1:23

There is a low, but there is a real

1:25

association with bicornuate as well,

1:27

so keep that in the back of your mind.

1:29

If you do have a septate uterus, make

1:31

sure you measure the length of the septum.

1:33

That's what your surgeon absolutely needs

1:35

to perform the correct operation for them.

1:38

And then lastly, if you have agenesis, make sure

1:40

you look for hypoplasia of the vagina because

1:42

it's vitally important for operative planning.