Name the bones which make up the pelvis:
2 x Innominate bones
What is the innominate bone?
Bone formed from the fusion of the ilium, ischium and pubis = ‘Hip bone’
What is the linea terminalis?
Line which separates the true pelvis from the false pelvis
- Made up of arcuate line, pectineal line and pubic crest
What is a gynecoid pelvis?
The most common type of female pelvis, which is ideal for childbirth:
- Round inlet
- Straight side walls
- Ischial spines are not too prominent
- Well-rounded greater sciatic notch
- Well-curved sacrum
- Pubic angle > 90’
Name the 2 clinically useful pelvic conjugates:
1) Obstetric conjugate
2) Diagonal conjugate
What is the obstetric conjugate? How is it measured?
AP diameter from the midpoint of the pubis, to sacral promontory. Usually ~ 10 cm.
- Only measured via imaging. Instead use diagonal conjugate.
What is the diagonal conjugate? How is it measured?
AP diameter from inferior border of pubis to sacral promontory.
- Measured via inserting 2 fingers into vagina and palpating sacral promontory, and noting on hand the lower border of the pubis
What is the minimum size of the diagonal conjugate to allow childbirth?
~ 11.5 cm
Which pelvic conjugate is easily measured?
Name the layer of connective tissue which lies under the epithelium of the ovaries:
What is the mesovarium?
Portion of the broad ligament of the uterus, which suspends the ovaries
What is the arterial supply to the ovaries?
Ovarian arteries (from abdominal aorta, below renal arteries)
What is the venous drainage of the ovaries?
- Left drains into left renal vein
- Right drains into IVC
To which nodes do the lymphatics of the ovaries drain into?
What are ovarian cysts usually developed from?
The majority of ovarian tumours are derived from which tissue?
Epithelium = Ovarian adenocarcinomas
Are ovarian teratomas usually benign or malignant?
Name the pouch located anterior to the uterus:
Name the pouch located posterior to the uterus:
If need to drain the uterovesical or rectouterine pouches, how are they accessed?
Via anterior or posterior fornices of the vagina
What is the ideal position of the uterus?
1) AnteVerted in relation to the Vagina
2) AntefleXed in relation to the cerviX
Name the ligaments which support the position of the uterus:
- Transverse cervical ligament = thickening of base of broad ligament to support cervix
- Uterosacral ligament = Maintains anteversion
What is the arterial supply to the fallopian tubes and the fundus of the uterus?
Ovarian arteries (from abdominal artery)
What is the arterial supply to the uterus?
- Ovarian arteries
- Uterine arteries
- Branches of vaginal arteries
- Branches of internal pudendal arteries
What is the venous drainage of the uterus?
Uterine venous plexus
- into uterine veins
- into internal iliac veins
To which nodes do the lymphatics of the uterus drain to?
- Internal iliac
- External iliac
What is salpingitis, and what are some complications of this?
Infection of the fallopian tubes
= Can cause adhesions, leading to ectopic pregnancies or infertility
What is an ectopic pregnancy? Where does this usually occur?
Implantation at site other than the uterus
- 95% in ampulla or isthmus of fallopian tube
Why can pain sometimes be felt in the left shoulder if patient has an ectopic pregnancy?
Can cause haemorrhage
- when lying down, blood may irritate diaphragm, sensed by phrenic nerve (C3-5)
- C5 dermatome = shoulder
Why is a patient at high risk of prolapse if they have a retroverted uterus?
Uterus is positioned directly over the vagina