Congenital malformations are not infrequent and are the result of imperfect development of the Miillerian ducts. These ducts are two parallel tubes that normally unite in their long axis, forming in this way the uterus. There may be marked hypoplasia of the uterus and vagina, with very imperfect development of the tubes and ovaries. By failure of fusion of the ducts the uterus may contain two cavities, and if it extends downward divide the vagina into two canals.

Atresia or stenosis of the os uteri may be either congenital or the result of inflammatory conditions. On account of the obstruction the uterine cavity may become dilated by the retention of fluids. If by menstrual discharges, is known as hematometra; by seromucous secretion, hydrometra; if decomposition occurs and gas is formed it is then a physometra; when pus is present, is a pyometra.

Rupture of the uterus may result from the retention of fluid with gradual thinning and degeneration of its walls. It generally happens as an accident during pregnancy or labor. There may be some diseased condition, particularly malignant, of the muscle, or the wall may give on account of too great contraction of its fibers. If the tear does not extend all the way through the wall, it is an incomplete rupture; is complete whenever the serous covering is involved. The condition is associated with shock, and generally very severe and frequently fatal hemorrhage. If death does not result from the loss of blood, it usually follows from peritonitis. Sometimes the wound will cicatrize, the fetus degenerate and be discharged through fistulae, and the patient recover.

In rupture the tear begins, as a rule, just above the cervix on the inside and extends in the direction of the fundus. If the uterus has been perforated by an instrument, the larger opening of the wound is on the outer surface, the opposite to what occurs in rupture.

Malpositions Of The Uterus

Normally the uterus is in a position of slight anteflexion and anteversion. The common displacements are either forward or backward, as the broad ligaments prevent lateral changes. In pathologic anteflexion the uterus is greatly flexed or bent, allowing the fundus to fall forward and downward. As a result the uterine cavity is obstructed and the menstrual fluid retained, giving rise to dysmenorrhea. In anteversion the fundus of the uterus falls forward and the cervix is displaced backward without a change in shape. In retroflexion the uterus is bent backward at an angle, the fundus falling downward and backward toward Douglas's pouch. Retroversion refers to a bending backward of the uterus without any change in the shape of the organ. Although they may occur separately, retroflexion and retroversion are generally associated. These deformities may be due to pressure from above, from the presence of new growths, from tight clothes, or to the presence and contraction of inflammatory adhesions. They may also be brought about by disease of the uterus itself.

The uterus may be elevated as a result of the presence of tumors within the pelvis or of the contraction of adhesions dragging the organ upward. The opposite condition, prolapse of the uterus, or procidentia, is comparatively frequent. It is apparently due to a loss of tone in the structures supporting the organ, as in a torn perineum, or to an enlargement of the uterus. As it descends the vagina is slowly invaginated. According to the extent of the prolapse three degrees of severity may be considered. If the descent is slight and the uterus does not leave the pelvis, it is a simple prolapse; if the organ is not entirely out of the pelvis, it is a partial prolapse; if the uterus has descended to the vulva and discloses the vaginal walls, it is a complete prolapse or procidentia. In this latter the rectal and vesical walls are also dragged down, causing a rectocele and a cystocele. Inversion is a condition in which the uterus is more or less completely turned inside out. It occurs during labor, from large polyps or from localized pressure on the fundus. This condition is often accompanied by prolapse.

Stenosis of the cavity of the uterus may result from various inflammations or may be congenital. As a result of the blocking of the outlet dilatation of the uterus not infrequently occurs.