Module 1 : Female Pelvis Flashcards Preview

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Flashcards in Module 1 : Female Pelvis Deck (41)
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1

Bones of the pelvis

Innominate
Sacrum
Coccyx

2

Innominate bones

Ilium
Ischium
Pubis
ALL MEET AT THE ACETABULUM

3

Boundaries of the pelvis

True pelvis and false pelvis divided by the ARCUATE LINE

Anteriorly
Superior margin of the symphysis pubis
Posteriorly
Sacral prominence

4

Arcuate Line

divides the true pelvis from false pelvis
LINEA TERMINALIS
PELVIC BRIM
ILIOPECTINEAL LINE

5

Structures in true pelvis and false pelvis

Inferior - uterus, ovaries, Fallopian tubes, vessels, muscles, some bowel, lymph nodes

Superior - bowel

6

Uterus segments

Fundus - right at the top
- Fallopian tubes enter here
Corpus (body)
Isthmus - between body and cervix PLACE WHERE UTERUS BENDS
Cervix - part of uterus; not its own thing

7

Uterine positions

Anteflexed - normal bend forward
Anteverted - normal tilt forward
Retroflexed - bend backward ( fundus lower than cervix)
Retroverted- tilt backwards ( unverted)

8

Uterus shape

Pear shaped in reproductive years and postmenopausal years

Bilobed in newborns and infants

Hollow structure

9

Uterus size

Infantile about 3cm long and 1cm thick
Neonatal is slightly larger than infant

REPRODUCTIVE : NULLIPAROUS 8x5x4 cm

* add one cm in all directions for multiparous

*coronal Plane is better for interrogation of endometrial canal

10

Uterine layers

Endometrium
-stratum functionalis (decidual)
+ layer that is shed
-stratum basalis
+ never shed; next layer of functionalis
Myometrium
-muscle layer
Perimetrium (Serosa)
-peritoneal coat
-

11

Endometrium

Proliferative Phase (3 stripe phase)
- 4 to 8mm (double layer)
Secretory Phase (after ovulation)
-7 to 14mm (double layer)

POSTMENOPAUSAL BLEEDING : <5mm (sign of cancer)
WITHOUT BLEEDING <9mm
POSTMENOPAUSAL BLEEDING MAY BE NORMAL IF WOMEN IS HRT (hormone replacement therapy)

12

Endometrial phases

Menstrual
- <1mm
Proliferative
- 5 to 8mm
Secretory
- 9 to 14mm

* women on BCPs will have thin endometrium

13

Vagina relationships

Encases the cervix and creates fornices
Fornices - potential space around the cervix
Vagina attaches at level of the internal os

14

Cervix

Between vagina and uterus
External os- opening into vagina
Internal os- opening into uterus

15

Adnexa/ Fallopian tubes

Contained in the mesosalpinx of broad ligament

16

Fallopian tube - segments

Interstitial - narrowest
Isthmus - directly adjacent
Ampulla - longest and widest
-where fertilization takes place
- most common place of ectopic pregnancy
Infundibulum - contains fimbriae

17

Ovaries - location

Location is variable
- fossa of waldeyer
*LANDMARK FOR OVARIES IS INTERNAL ILIAC ARTERIES

18

Ovaries - structure

Cortex
-outer
-where follicles live
Medulla
-inner

19

Ovaries - size and shape

Reproductive years
-ALMOND SHAPED
- 6cc VOLUME
- 3x2x2 CM
- CAN BE UP TO 20cc
Neonatal
-wide range up to 3.66cc
Infants
-sausage shaped
To menarche
- upper normal of 8cc
Post menopausal
-1 to 5.8 cc
- >8cc abnormal
Normal adult
-length 2.5 to 5 cm
-width 1.5cm to 3cm
- AP .6 to 2.2cm
- volume 6cc

20

Blood supply for uterus

Aorta - CIA - IIA (hypogastric) - Anterior branch of IIA- uterus

Uterine Artery - arcuate Artery - radial Artery- straight arterioles ( supply basal layer) - spiral arterioles (supply decidual layer)

21

Venous return from uterus

Venous plexus (veins around uterus) - uterine vein - IIV - CIV - IVC

22

Blood supply for ovaries

Abdominal aorta to ovarian arteries to hilum of ovary

Venous return
-RIGHT OVARIAN VEIN TO IVC
- LEFT OVARIAN TO KEFT RENAL VEIN

* OVARIAN ARTERIES WILL FORM ANASTOMOSES WITH THE UTERINE ARTERIES (of ovary twists collateral blood supply comes from uterus this doesn’t happen in males)

23

Ligaments

2 broad ligaments (double fold peritoneum)
2 round ligaments
2 uterosacral ligaments
2 ovarian ligaments
2 suspenseful ligaments ( infundibulopelvic)
2 mesosalpinx and 2 mesovarium

24

Broad Ligament

Double fold of peritoneum that drapes over uterus and Fallopian tubes
- mesosalpinx
+ drapes over Fallopian tubes
- mesovarium
+ posterior portion of the peritoneum that attaches to the ovary

* project from broad ligament

25

Round ligament

Help hold uterine fundus and body in a forward position
- retroflexed uterus = weak round ligaments

26

Uterosacral ligaments

Help to anchor cervix posteriorly

27

Ovarian ligaments

Attach ovary to uterus

28

Suspensory ligaments of infundibulopelvic

Attach ovary to lateral pelvic wall

29

Muscles in abdominopelvis

Rectum abdominus
- anterior wall of abdomen
-linea alba
+ aponeoroses that fuse 2 rectus muscles as well as oblique and transverse muscles at the midline
+ very dense and gets in the way
Psoas
- posterior abdominal wall
- part of iliopsoas muscle
- extreme lateral aspect of pelvis

30

Muscles in false pelvis

Iliopsoas
- anterior and lateral in pelvis
- lateral to external iliac vessels