TEALE FENNING

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973

AFS Classification of Anomalies of the Mullerian Duct

I Segmental or complete agenesis or hypoplasia

Agenesis and hypoplasia may involve the vagina, cervix, fundus, tubes, or any combination of these structures. Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is the most common example in this category.

II Unicornuate uterus with or without a rudimentary horn

When an associated horn is present, this class is subdivided into communicating and noncommunicating . The noncommunicating type is further subdivided on the basis of whether an endometrial cavity is present in the rudimentary horn. These malformations have previously been classified under asymmetric lateral fusion defects. The clinical significance of this classification is that they are invariably accompanied by ipsilateral renal and ureter agenesis.

III Didelphys uterus

Complete or partial duplication of the vagina, cervix, and uterus characterizes this anomaly.

IV Complete or partial bicornuate uterus

Complete bicornuate uterus is characterized by a uterine septum that extends from the fundus to the cervical os. The partial bicornuate uterus demonstrates a septum, which is located at the fundus. In both variants, the vagina and cervix each have a single chamber.

V Complete or partial septate uterus

A complete or partial midline septum is present within a single uterus.

VI Arcuate uterus

A small septate indentation is present at the fundus.

VII DES-related abnormalities A T-shaped uterine cavity with or without dilated horns is evident.

Source–AFS, 1988.
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Tue Nov 21, 2006 6:08 pm Post subject:

Nice - very important classification.

Few questions for you:

Question 1
OK who knows how to test for these abnormalities?

Question 2
What other tests should you also consider?

Question 3
What are the implications of each abnormality?

Question 4
What treatment options, if any, are available?

This sort of question could come up. It would involve the counselling of someone found to have a uterine abnormality. A bicornuate uterus did come up in the first set of essays back in 1997 if I remember correctly.
_________________
"Teale Fenning Medical Education" delivering evidence-based, exam-orientated learning since 1997

rpwalavalkar · Teale Fenning Administrator Joined: 20 Jul 2006 Posts: 973

History of pregnancy losses or prenatal exposure to DES

Breast examination

Pelvic examination

Ultrasound

Magnetic resonance imaging (MRI)

Hysterosalpingogram

Hysteroscopy

Laparoscopy

Karyotyping
_________________
Dr Miss. Raj Walavalkar MBBS MRCOG
TealeFenning Administrator
SR O&G Wessex Region

Nick Raine-Fenning · Posted: Thu Nov 23, 2006 1:40 pm Post subject:

You need to justify these tests though Raj - why is each one necessary and better than alternatives (where there are alternatives).

Also remember that when discussing tests it is important to consider their sensitivity and specificity, the prevalence of the condition, risks and risk factors (more for invasive tests), and cost implications where relevant. Furthermore you must relate the test to a treatment option - if there is no treatment option is the test worthwhile?

N