OB Broad Perspective and Anatomy of Female Repro Flashcards Preview

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1

Leading cause of women's death worldwide as of 2013

Cardiovascular disease

2

Leading cause of maternal death in the Philippines

Pregnancy related complications

3

An average of _ among <20 y/o population has already been pregnant at least once

22%

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No. of times pregnant, regardless of the duration or outcome (how many times have you been pregnant?)

Gravida

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Delivered before 37 weeks

Preterm birth

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Number of abortion that took place in the Philippines (2008)

500,000

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Number of women who sought treatment for complications after abortion

90,000

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Maternal causes of death in the Philippines

Complications related to pregnancy thru labor, delivery, & puerperium (38.4%)

Hypertension (35.2%)

Postpartum hemorrhage/uterine atony (17.3%)

Abortive outcome (9.1%)

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Deals with child birth and treatment of the mother before and after childbirth

Deals with pregnancy, labor, & puerperium (6 weeks after childbirth, mother recovers to non pregnant state)

Obstetrics

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Maternal mortality rate in the Philippines

162 deaths per 100,000 live births

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Infant mortality rate in the Philippines

19.34 deaths per 1,000 live births

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External generative tract

Mons pubis
Labia majora and minora
Clitoris
Hymen
Vestibule
Vagina
Perineum
Bartholin's
Para urethral glands
Uretha

13

Internal generative tract

Uterus
Cervix
Oviducts/Fallopian tubes
Ovaries

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Also known as mons veneris
A fat filled cushion
Forming the escutcheon
Contains many nerve endings

Mons pubis

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Mons pubis

Function: padding during coitus

Embryo: from fusion of labioscrotal swellings

Histo: stratified squamous keratinized epithelium

Blood supply: inferior epigastric artery & deep external pudendal artery

Lymphatics: superficial inguinal lymph nodes

Innervation: ilioinguinal & genitofemoral nerves

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Innervation of mons pubis

Ilioinguinal and genitofemoral nerves

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Has rich venous plexus that may develop varicosities during pregnancy due to increased venous pressure by the enlarged uterus

Labia majora

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Continuos with the mons pubis superiorly

Posteriorly, merge over the perineal body to form the posterior commisure

Round ligaments terminate at its upper border

Labia majora

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Highly sensitive (coitus)

Homologous with male scrotum

From labioscrotal swellings

Labia majora

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Blood supply of Labia majora

Internal pudendal artery
Venous plexus

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Innervation of Labia majora

Ilioinguinal & genitofemoral nerves

Posterior labial nerves

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Histology of labia majora

Keratinized stratified squamous

Apocrine, eccrine, & sebaceous glands

Dense CT with elastic fibers and adipose

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Length: 7-8cm
Depth: 2-3cm
Thickness: 1-1.5cm

Labia majora

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Paired, thin, hairless tissue fold medial to the labia majora

Length: 2-10cm
Width: 1-5cm

Labia minora

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2 lamellae of the Labia minora

Upper: fuse to form prepuce (hood) of clitoris

Lower: frenulum of the clitoris

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Fuse in midline as low ridges of tissue called FOURCHETTE

Highly sensitive (coitus)

Labia minora

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Derived from urethral (urogenital) folds

Homologous to ventral shaft of penis

Labia minora

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Histology of labia minora

Outer: thinly keratinized stratified squamous

Inner: lateral portion same as outer.
Medial to Hart line: non keratinized

Dermis: CT with elastic fibers, sm, and sebaceous glands

Lacks hair follicles, eccrine, and apocrine glands

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Blood supply of labia minora

Internal pudendal artery and dorsal artery of the clitoris

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Lymphatics and Innervation of Labia minora

Lymphatics: deep inguinal nodes

Innervation: dorsal nerve of clitoris and post. labial nerve (perineal nerve)

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Beneath prepuce & above the frenulum and urethra

Projects downward and inward towards vaginal opening

Length: 2cm

Clitoris

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Clitoris is composed of

Glans (stratified squamous), corpus, and 2 crura

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Principal female erogenous organ

Clitoris

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Derived from genital tubercle

Erectile homologue of the penis

Clitoris

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Histology of Clitoris

Keratinized stratified squamous without dermal appendages

Abundant in erectile tissues

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Blood supply of clitoris

Deep artery of clitoris (branch of internal pudendal artery) -body of clitoris

Dorsal artery of clitoris - glans and prepuce

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Lymphatics of clitoris

Deep inguinal nodes

Internal iliac nodes

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Innervation of clitoris

Inferior hypogastric plexus

Dorsal nerve of the clitoris (from pudendal nerve)

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An almond shaped area. Functionally mature female structure

Vestibule

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Vestibule

Laterally: Hart line

Medially: external hymen

Anteriorly: frenulum of clitoris

Posteriorly: fourchette

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Posterior portion of vestibule is called

Fossa navicularis

-posterior portion between fourchette and vaginal opening
-seen only in nulliparas

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Six opening of vestibule

Urethra
Vagina
2 bartholins
2 skenes

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Vestibule is derived from

Urogenital membrane

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Histology of vestibule

Non keratinized stratified squamous

Minor vestibular glands (acini) -mucinous columnar epi

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Also known as greater vestibular glands

Major glands measure 0.5-1cm

Bartholin glands

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Measure 1.5-2cm and open distal to the hymenal ring (at 5 & 7 o'clock position on the vestibule)

Bartholin glands

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May swell & obstruct to form cyst or abscess (following trauma or infection)

Bartholin glands

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Lie inferior to vestibular bulbs & deep to inferior end of the bulbocavernousus muscle

Bartholin glands

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Also known as skene's glands

Obstruction & inflammation may lead to urethral diverticulum

Paraurethral glands

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Lower 2/3 lie immediately above vaginal canal

Urethra

Length: 2-3cm
Too short that makes female more prone to UTI

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Upper portion of vagina is separated from the rectum by

Cul-de-sac or pouch of Douglas

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Vagina is anteriorly separated from the bladder and rectum by

Vesicovaginal septum

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Vagina is posteriorly separated from the rectum by

Rectovaginal septum

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Anterior wall: 6-8cm
Posterior wall: 7-10cm

Vagina

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Transport of sperm, serves as birth canal, physiologic changes during arousal (vasocongestion & lubrication)

Vagina

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Embryology of vagina

Upper 1/3: Müllerian duct (paramesonephric)

Lower 2/3: urogenital sinus

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Histology of vagina

Epithelial layer: non keratinized stratified squamous
(Premenopausal, lining becomes thin with folds - rugae)

Muscular layer: sm, collagen, & elastin

Adventitial layer: collagen & elastin

No glands

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Blood supply of Vagina

Proximal: cervical branch of uterine artery & vaginal artery

Posterior: middle rectal artery

Distal: internal pudendal artery

Venous plexus

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Lymphatics of vagina

Upper 3rd: external, internal, and common iliac nodes

Middle 3rd: internal iliac nodes

Lower 3rd: inguinal lymph nodes

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Innervation of upper vagina

Uterovaginal plexus

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Innervation of lower vagina

Pudendal nerve

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Surrounds vaginal orifice

Hymen

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Diamond shaped area with boundaries that mirror those of the bony pelvic outlet

Perineum

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Boundaries of the perineum

Anterior: pubic symphysis

Anterolateral: ischiopubis rami & ischial tuberosities

Posterolateral: sacrotuberous ligaments

Posterior: coccyx

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Fibromuscular mass found in the midline at the the junction between the anterior and posterior triangle of the perineum

Perineal body or central tendon of the perineum

Provides perineal support

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Homologous with male's corpora spongiosa

Vestibular bulbs

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Contents of superficial space of anterior triangle

Bartholin glands
Vestibular bulbs
Clitoral body and crura
Pudendal vessels and nerves
Ischiocavernosus
Bulbocavernosus
Superficial transverse perineal muscles
Superficial space bounded by Colles fascia and perineal membrane

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Helps maintain clitoral erection by compressing the crus of clitoris by obstructing venous drainage

Ischiocavernosus muscles

69

Constrict vaginal lumen and aid release of secretion from bartholin glands

Contributes to clitoral erection by compressing the deep dorsal vein of the clitoris

Bulbocavernosus muscles

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Contents of deep space of anterior triangle

Urethra and vagina
Internal pudendal artery
Urethrae and urethrovaginal sphincter muscles

Deep space is continuous with the pelvic cavity

71

Happens when veins in vestibular bulbs lacerate or even rupture due to child birth

Vulvar hematoma

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Size of uterus in multiparous women

9-10 cm

6-8cm in nulliparous

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Functions of the uterus

Implantation
Pregnancy support
Labor and delivery
Menstruation

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Uterus is derived from

Paramesonephric (Mullerian) ducts

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Histological parts of the uterus

Myometrium: sm bundles with elastic fibers and blood vessels

Endomentrium: basalis and functionalis

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Blood supply of uterus

Uterine artery (from int Iliac artery)

Ovarian artery (from aorta)

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Venous drainage of Uterus

Arcuate veins
Uterine vein
Int Iliac vein
Common iliac
Veins in pampiniform plexus
Ovarian vein
Rt ovarian vein
Inf vena cava
Left ovarian vein
Left renal vein

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Lymphatics of uterus

Internal iliac nodes and para aortic nodes

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Innervation of uteus

Autonomic - pelvic viscera

Sympa - presacral nerve/ superior hypogastric plexus (T10-12)

Para- anterior rami of S2-4 / pelvic splachnic nerves

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Components of Inferior Hypogastric Plexus (Pelvic Plexus)

2 hypogastric nerves (sympa) + 2 pelvic splachnic nerves (para)

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3 divisions of inferior hypogastric plexus

Vesical - bladder

Middle rectal - rectum

Uterovaginal - uterus, proximal fallopian tubes, and upper vagina

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Upper cervical segment that lies above the vagina's attachment to the cervix

Portio supravaginalis

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Cervical segment that protrudes into the vagina

Portia vaginalis

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Fusiform in shape

Cervix

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Serves as opening of the uterus (sperm transport/ barrier & chilbirth)

Attaches the uterus to vagina

Cervix

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Epithelium of endocervix

Columnar mucin-secreting epithelium

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Epithelium of ectocervix

Non-keratinized stratified squamous

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Where squamous and columnar epithelium of the cervix meets

Squamo-columnar junction

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Blood supply of cervix

Cervicovaginal artery (from uterine artery)

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Lymphatics of cervix

Internal iliac nodes

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Innervations of cervix

Uterovaginal plexus

Sensory afferent: pelvic splanchnic n. (S2-S4)

92

Oval organs located in the upper pelvic cavity

Rests on ovarian fossa of Waldeyer

Ovary

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The female gonad

Supported by uteroovarian ligament

Ovary

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Produces mature germ cells (ova)
Source of female hormones

Ovary

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Develops from mesothelial layer of the epithelium (coelomic epithelium)

Ovary

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Epithelium of Ovary

Epithelium: simple cuboidal (germinal layer of Waldeyer)

Cortex: oocytes & developing follicles

Medulla: loose CT, arteries and veins, & smooth muscle fibers

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Blood supply of ovary

Ovarian artery (from abdominal aorta)

Ovarian branch of uterine artery

Ovarian vein

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Lymphatics of ovary

Lateral aortic nodes

99

Innervation of ovary

Ovarian plexus (sympa)
Hypogastric and aortic plexus
Vagus nerve (parasympa)
Sensory afferents (T10)

100

Also called oviducts

Fallopian tubes

101

Tubular structures arising from the uterine cornua

Length: 8-14cm

Fallopian tubes

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Where fertilization and ectopic pregnancy usually occurs

Ampulla

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Covered by mesosalpinx at the superior margin of the broad ligament

Isthmus, ampulla, & infundibulum

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Conduit of sperm and site of fertilization

Fallopian tubes / oviducts

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Important in ovum transport

Tubal peristalsis created by the cilia and muscular layer contractions (endosalpinx of fallopian tubes)

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Provides support to the uterus and other pelvic structures

Ligaments

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4 major ligaments

Round ligament
Broad ligament
Cardinal ligament
Uterosacral ligament

RBCU

108

Corresponds embryologically to the male gubernuculum testes

Round ligament

109

Passes thru inguinal canal and terminates at upper portion of labia majora

Round ligament

110

Branch of uterine artery that runs within the round ligament

Sampson artery

111

Two winglike structures from lateral uterine margins to the pelvic sidewalls

Broad ligament

112

Divides the pelvic cavity into anterior and posterior compartments

Broad ligament

113

Also known as transverse cervical ligament or Mackenrodt ligament

Cardinal ligament

114

Originates at the supravaginal portion of the cervix and inserts into the fascia over sacrum

Uterosacral ligament

115

Aids in fallopian tube identification during puerperal sterilization

Round ligament

116

Male homologous for scrotum

Labia majora

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Male ventral shaft

Labia minora

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Glans penis

Clitoris

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For protection

Mon pubis

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For sperm transport

Vagina

121

Episiotomy: surgical repair

Midline: easy

Mediolateral: more difficult

122

Episiotomy: blood loss

Midline - less

Mediolateral - more

123

Leading cause of maternal death worldwide as of 2014

Pre-existing maternal conditions (cardiovascular disease, renal disease, etc)