Congenital malformations of the female reproductive organs

　　The occurrence of female reproductive organs takes place during the 4th to 8th weeks of embryonic development. The embryo has two sets of reproductive ducts, namely the mesonephric duct and the mesonephric ductal recess. If the germ cells differentiate into ovaries, due to the lack of androgen action, the bilateral mesonephric ducts regress, while the mesonephric ductal recess develops. The cephalic segment of the bilateral mesonephric ducts evolves into fallopian tubes, and the caudal segments fuse to form the uterus. The ovaries on both sides are formed from the surface epithelium of the germ cell ridge, and the ovaries on both sides descend to the pelvic cavity in the later stage of embryonic development. The vaginal plate evolves into a hollow vagina, which is internally connected to the uterus and externally separated from the vestibule of the vagina by the hymen. The hymen pierces before and after birth.

　　Congenital malformations of the female müllerian ducts account for approximately 0.1% to 1.5%, of which about 90% are uterine malformations. There are many classification methods for congenital malformations of female reproductive organs, and there is no unified classification method at present. Some are classified according to the mechanism of malformation formation during organ development, some are classified according to whether the malformed organs are symmetrical or not, and some are classified according to the organ parts where malformations occur.

　　During the development process of female reproductive organs in the embryonic period, if disturbed by certain intrinsic or extrinsic factors, they can lead to developmental abnormalities. Common developmental abnormalities of reproductive organs include: abnormalities caused by the obstruction of normal canal formation, including imperforate hymen, vaginal septum, vaginal septum, absence of vagina, vaginal atresia, and cervical atresia. Abnormalities caused by the underdevelopment of mesonephric duct derivatives include absence of uterus and absence of vagina.

　　Congenital malformations of the female reproductive system include external genitalia malformations and internal genitalia malformations. Uterine malformation includes imperforate hymen, hymen without a hole, vaginal atresia, where the anterior vestibule of the vulva is not connected to the development of the internal genitalia, menstrual blood cannot flow out after menarche and accumulates in the vagina, and then accumulates in the uterine tubes and flows back. Treatment causes gradual exacerbation of dysmenorrheal lower abdominal pain, lower abdominal mass gradually increases, often accompanied by urinary retention. Examination during inspection shows the hymen is prominent and purple-red.

　　The vaginal septum or transverse septum is mostly located in the upper part of the vagina. A complete transverse septum is rare, and most have small holes in the center or on one side of the septum, through which menstrual blood can be discharged. The high position of the septum will not affect sexual intercourse, while the low position will. If pregnant, the descent of the fetus at the time of delivery will be blocked, such as if the septum is thick, cesarean section is required; if the septum is thin, a mid-septum incision can be made during the delivery process, which also has complete and incomplete types. Both have no effect on the discharge of menstrual blood, sexual intercourse, and pregnancy. The complete septum often has double cervix and double uterus, and generally does not need to be treated repeatedly.

　　1. Computed Tomography (CT):Because CT can only do cross-sectional imaging, its role in showing the shape of the uterine cavity is very limited, and the display of the uterine base shape is also not ideal. In addition, CT is difficult to differentiate between the uterus and the cervix, so its diagnostic value for congenital uterine abnormalities is equivalent to that of abdominal ultrasonography but not as good as vaginal ultrasonography. In addition, CT has a certain degree of radiation, and should be used with caution in women of childbearing age.

　　2. Magnetic Resonance Imaging (MRI):MRI, with its advantages of high soft tissue resolution and multi-directional slicing, can accurately measure the various diameters, endometrial, and muscular layer thicknesses of the uterus, differentiate the corpus and cervix, and perform unique qualitative analysis of the septal tissue or other components within the uterine cavity. It is the best imaging method for showing congenital uterine abnormalities, providing reliable information for selecting treatment plans, and is an important supplementary examination method after ultrasonic examination. MRI examination has replaced traumatic pneumoperitoneography and can reduce unnecessary laparotomy. However, the cost of the examination is relatively high. In terms of MRI examination methods, sagittal T2WI is essential for observing the female reproductive tract structure. Literature reports that thin-section (slice thickness less than 5mm) transverse T2WI is the best for showing the vagina, oblique coronal view along the long axis of the uterus is helpful to show the uterine cavity and cervix, and axial T1WI is helpful to show the ovaries and hemorrhagic lesions. Comprehensive observation of these sequences and planes helps to judge the type of vaginal malformation and whether there are other reproductive tract malformations.

　　3. Hysterosalpingography (HSG):HSG is a relatively traditional examination method that can show most uterine and fallopian tube malformations and determine their types. However, it has obvious defects, as it can only show the shape of the uterine cavity and cannot observe the overall shape of the uterus, making it difficult to differentiate between uterine septum and bicornuate uterus. It requires uterine cavity injection of contrast medium and has radioactive damage. Currently, the use of HSG is relatively less frequent.

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　　Congenital malformations of female reproductive organs should be treated as early as possible to reduce mental trauma. Postoperative diet is very important.

　　Dietary adjustment should pay attention to the following points:

　　1. Protein is an important component of antibodies. If the intake is insufficient, the body's resistance will decrease. Therefore, it is recommended to eat more chicken, lean pork, eggs, milk, soybeans, and soy products.

　　2. Due to the relatively weak body, it is easy to sweat. Therefore, water should be supplemented in small amounts and in multiple times to reduce the amount of water evaporation; a large amount of water-soluble vitamins are excreted in sweat, especially vitamin C, vitamin B1, and vitamin B2, so it is recommended to eat more fresh vegetables and fruits. In this way, it is also conducive to preventing constipation.

　　4. It is necessary to ensure the supply of high-quality protein, sufficient vitamins and inorganic salts, especially to supplement sufficient iron to prevent the occurrence of anemia. Food selection should not only pay attention to nutrition but also be easy to digest and absorb. Fresh fish, tender chicken, eggs, animal liver, animal blood, lean meat, soy products, milk, jujube, lotus seeds, fresh fruits and vegetables can be provided. It is not recommended to eat or eat less greasy, cold food, such as radish, hawthorn, bitter melon, tangerines, etc., which have properties of promoting Qi, activating blood, and coldness. It is recommended to eat more easily digestible food. The time for replenishment should be half a month, and for those with weak bodies, poor constitution, and excessive bleeding, the time for replenishment can be appropriately extended.

　　The vaginal septum or transverse septum is mostly located in the upper part of the vagina. A complete transverse septum is rare, and most have small holes in the center or on one side of the septum, through which menstrual blood can be discharged. The high position of the septum will not affect sexual intercourse, while the low position will. If pregnant, the descent of the fetus at the time of delivery will be blocked, such as if the septum is thick, cesarean section is required; if the septum is thin, a mid-septum incision can be made during the delivery process, which also has complete and incomplete types. Both have no effect on the discharge of menstrual blood, sexual intercourse, and pregnancy. The complete septum often has double cervix and double uterus, and generally does not need to be treated repeatedly.