Outflow Obstructions Workup
- Author: Latha Chandran, MBBS, MD, MPH; Chief Editor: Andrea L Zuckerman, MD more...
The history and physical examination usually suffice to establish the diagnosis.
In rare cases of transverse vaginal septum with microperforation, ascending infection may lead to pyohematometra. Fluid culture is helpful in determining appropriate antibiotic therapy.
If the patient has a blind vaginal pouch and no pubic or axillary hair, karyotyping or serum testosterone levels are helpful in establishing the diagnosis of androgen insensitivity syndrome.
If the patient has müllerian agenesis (absent uterus and tubes, normal female karyotype, Mayer-Rokitansky-Kuster-Hauser syndrome), consider screening for other skeletal and urinary anomalies. Thirty percent of these patients have associated renal anomalies, most commonly unilateral renal agenesis.
Three-dimensional (3D) ultrasonography of the pelvis can reveal additional associated congenital malformations of the uterus or cervix. Ultrasonography also reveals hematocolpos or hematometra.
Magnetic resonance imaging (MRI) can delineate other associated abnormalities, such as those of the urinary tract. For patients undergoing surgery, an accurate and full assessment of the underlying anatomy is important and is performed via MRI before the operation is performed.
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