Vulval Inspection and Diagnosis

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Questions and Answers

What is the primary clinical feature of haematocolpos?

Urinary obstruction

Abdominal pain (correct)

Interference with micturition

Primary amenorrhoea

What is the treatment for a septate uterus?

Hysteroscopic metroplasty (correct)

Strassman's metroplasty

Laparoscopic surgery

Vaginoscopy

What is the age range of patients typically presenting with haematocolpos?

20-25 years old

14-15 years old (correct)

10-12 years old

16-18 years old

What is the term for an imperforate membrane at the lower end of the vagina?

Imperforate hymen Signup and view all the answers

What is the treatment for a non-obstructed uterus didelphys?

Strassman's metroplasty Signup and view all the answers

What is the term for retention of menstrual flow in the vagina?

Haematocolpos Signup and view all the answers

What is the treatment for an obstructed duplicate uterus?

All of the above Signup and view all the answers

What is the success rate of Strassman's metroplasty for a bicornuate uterus?

90% Signup and view all the answers

What is the characteristic of an imperforate hymen that may be observed during vulval inspection?

Its colour may vary depending on its thickness Signup and view all the answers

What is the purpose of examination a few weeks after treatment of an imperforate hymen?

To ensure that no pelvic mass remains Signup and view all the answers

What is the treatment for an imperforate hymen when the obstruction is more extensive?

Resection of the absent segment and reconstruction of the vagina Signup and view all the answers

What is the orientation of a longitudinal vaginal septum in the vagina?

It lies in the sagittal plane Signup and view all the answers

What is a possible complication of a vaginal septum during vaginal delivery?

Serious tears may occur Signup and view all the answers

What is the treatment for a longitudinal vaginal septum?

Surgical excision of the septum Signup and view all the answers

What is a possible condition associated with a longitudinal vaginal septum?

Double uterus and cervix Signup and view all the answers

What is a possible outcome of a double vagina where one side is not patent?

Haematocolpos Signup and view all the answers

What is the purpose of a split-thickness skin graft inoperative vaginoplasty?

To line the newly created cavity Signup and view all the answers

What is a possible reproductive option for individuals with genital tract abnormalities?

Assisted Reproductive Technology (ART)/IVF/surrogacy Signup and view all the answers

What type of uterine abnormality is characterized by a heart-shaped appearance?

Bicornuate uterus Signup and view all the answers

What is a common clinical presentation of a septate uterus?

Recurrent spontaneous miscarriage Signup and view all the answers

What is the clinical significance of a rudimentary horn?

Rupture during pregnancy with profound bleeding Signup and view all the answers

What is the gold standard for investigating genital tract abnormalities?

Pelvic magnetic resonance imaging (MRI) Signup and view all the answers

What is a possible complication of a rudimentary horn?

Obstruction to communication between the horn and the main uterine cavity or vagina Signup and view all the answers

What is the treatment for a rudimentary horn?

Surgical removal of the horn Signup and view all the answers

Study Notes

Hysteroscopy and Other Diagnostic Techniques

Hysteroscopy is a diagnostic technique used to visualize the uterus and diagnose abnormalities.
Vaginoscopy is another diagnostic technique used to examine the vagina.
Laparoscopy is a surgical diagnostic technique used to visualize the uterus and surrounding organs.
Laboratory investigations, including hormonal assays, testosterone levels, and chromosomal studies, are also used to diagnose abnormalities.

Treatment of Structural Abnormalities

Treatment depends on the type and extent of the structural abnormalities.
Bicornuate uterus: Strassman's metroplasty can be recommended, either open surgery or laparoscopically, with a 90% rate of full pregnancy.
Septate uterus: Hysteroscopic metroplasty is the chosen treatment.
Uterus didelphys: Strassman metroplasty procedure unifies the two uterine cavities and leaves the cervix intact.
Obstructed duplicate uterus: Full excision of the vaginal septum and hemi-hysterectomy are required.
Transverse vaginal septum/imperforate hymen: Operative vaginoplasty procedure creates a cavity and lines it with a split-thickness skin graft.

Reproductive Outcomes

Patients with structural abnormalities may experience reproductive difficulties, including infertility and recurrent miscarriage.
Reproductive techniques such as ART/IVF/surrogacy may be possible.

Fusion Anomalies

Bicornuate uterus: A heart-shaped appearance with separate cornual parts, but no clinical signs or symptoms.
Septate or Subseptate uterus: Presence of a septum extending down the uterine cavity, leading to clinical problems such as recurrent miscarriage and malpresentation.
Uterus didelphys: Complete duplication of the uterus and cervix, often associated with a septate vagina.
Rudimentary horn: Rupture can occur with profound bleeding, dysmenorrhoea, and pelvic pain; surgical removal is indicated.

Investigations and Diagnosis

Pelvic ultrasound, pelvic magnetic resonance imaging (MRI), and hysterosalpingography are used to diagnose structural abnormalities.
Vulval inspection may reveal imperforate membrane or vaginal septum.
Imaging: ultrasound or MRI.

Treatment of Vaginal Abnormalities

Transverse vaginal septum/imperforate hymen: Simple excision of the membrane and release of retained blood, or resection of the absent segment and reconstruction of the vagina.
Longitudinal vaginal septum: Surgical excision of the septum.

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Description

Diagnosing imperforate membrane and vagina obstruction with ultrasound and MRI, and possible treatment options.