Reproduction Lecture - Female Applied Anatomy

Question 1

What are the 2 parts the uterus can be divided into?

Answer 1

• Body of uterus superior (2/3)
  
  • Fundus
  • Isthmus
  • Uterine horns
• Cervix lower (1/3)

Question 2

What are the 3 parts of the body of uterus?

Answer 2

• Fundus
• Isthmus
• Uterine horns

Question 3

What can the cervix be divided into, and by what?

Answer 3

• Divided by the vaginal attachment into
  
  • Supra-vaginal part
  • Vaginal part

Question 4

Where is the supra-vaginal part of cervix between?

Answer 4

• Between isthmus and vagina

Question 5

What is the supra-vaginal part of uterus seperate from bladder and rectum by?

Answer 5

• Only separated from bladder anteriorly by loose connective tissue and from rectum posterior by recto-uterine pouch (pouch of Douglas)

Question 6

What is the recto-uterine pouch also called?

Answer 6

Pouch of Douglas

Question 7

What are the following relationships to the supra-vaginal part of cervix:

• anterior
• posterior
• lateral

Answer 7

• Anteriorly – urinary bladder
• Posteriorly – forms anterior wall of Douglas pouch
• Laterally – uterine artery (ureter below the uterine artery)

Question 8

What part of the cervix is visible during speculum examination?

Answer 8

Vaginal part of cervix

Question 9

What are the following arteries branches of:

• uterine artery
• vaginal artery

Answer 9

Both from anterior division of internal iliac artery

Question 10

For the ovarian artery:

• origin
• enlosed within

Answer 10

• Origin
  
  • Aorta
• Enclosed in
  
  • The infundibulo-pelvis ligament

Question 11

What does the ovarian vein anastomose with?

Answer 11

• Left
  
  • Left renal vein
• Right
  
  • IVC

Question 12

What is the lymphatic drainage of:

• uterus
• ovaries

Answer 12

• Uterus
  
  • Along uterine vessels within transverse cervical ligament to internal and external iliac lymph nodes and along uterosacral to sacral lymph nodes
• Ovaries
  
  • Along ovarian vessels to the para-aortic lymph nodes

Question 13

What are the 3 important nerves for the innervation of the female reproductive tract?

Answer 13

• Superior hypogastric plexus
• Inferior hypogastric plexus
• Pelvic splanchnic nerves

Question 14

For superior hypogastric plexus:

• course
• contains
• division

Answer 14

• Course – in front of sacral promontory
• Contains – sympathetic nerve fibres
• Division – divides into right and left hypogastric nerves

Question 15

For inferior hypogastric plexus:

• formed from
• course
• contains

Answer 15

• Formed from right and left hypogastric nerves and preganglionic parasympathetic fibres from pelvic splanchnic nerves
• Course – each side of rectum and base of bladder
• Contains – sympathetic and parasympathetic fibres

Question 16

For pelvic splanchnic nerves:

• origin
• course
• contains

Answer 16

• Origin – S2/3/4
• Course – join hypogastric nerves to form inferior hypogastric plexuses
• Contains – pre-ganglionic para-sympathetic fibres

Question 17

What are the functions of sympathetic and parasympathetic nerves in the pelvis?

Answer 17

• Sympathetic
  
  • Inhibits peristalsis
  • Stimulates contraction of genital organs during orgasm
• Parasympathetic
  
  • Increases peristalsis
  • Contraction of the bladder and rectum for urination and defecation

Question 18

What are the 3 true ligaments of the female pelvis?

Answer 18

• Transverse cervical ligament
  
  • From cervix and lateral part of vagina to lateral wall of pelvis
• Uterosacral ligament
  
  • Superior and posteriorly from the side of cervix to middle of sacrum
• Pubocervical ligament/fascia

Question 19

What does transverse cervical ligament extend from?

Answer 19

• From cervix and lateral part of vagina to lateral wall of pelvis

Question 20

What does uterosacral ligament extend from and to?

Answer 20

• Superior and posteriorly from the side of cervix to middle of sacrum

Question 21

What is A?

Answer 21

Superficial transverse perineal

Question 22

What is B?

Answer 22

Deep transverse perineal

Question 23

What is C?

Answer 23

Ischiocavernosus

Question 24

What is D?

Answer 24

External urethral sphincter

Question 25

What is E?

Answer 25

Bulbospongiosus

Question 26

What is F?

Answer 26

Vaginal opening

Question 27

What is G?

Answer 27

Perineal body

Question 28

What is H?

Answer 28

External anal sphincter

Question 29

What is I?

Answer 29

Coccygeus

Question 30

What is J?

Answer 30

Levator ani: iliococcygeus

Question 31

What is K?

Answer 31

Levator ani: pubococcygeus

Question 32

What is removal of the uterus called?

Answer 32

Hyperectomy

Question 33

What are the different kinds of hyperectomy?

Answer 33

• Subtotal
  
  • Only uterus removed, cervix left behind
• Total
  
  • Uterus and cervix removed
• Radical
  
  • Uterus, cervix, upper vagina and left and right parametrium
  • Indication – cervical cancer

Question 34

What is the procedure of incision of perineum and posterior vaginal wall for labour?

Answer 34

Episiotomy

Question 35

What are the different kinds of episiotomy?

Answer 35

• Midline incision
• Mediolateral incision

Question 36

What determines the type of delivery?

Answer 36

Whether foetal head is above or below ischial spine determines type of delivery:

• Level – called a 0 foetal position
• Below – called 1 foetal position
• Above – called -1 foetal position

Question 37

When the foetal head is at the following relative to the ischial spine it is called:

• level
• below
• above

Answer 37

• Level
  
  • 0 foetal position
• Above
  
  • 1 foetal position
• Below
  
  • -1 foetal position

Question 38

For pudendal nerve:

• origin
• innervation

Answer 38

• Origin
  
  • S2-S4 somatic distribution
• Innervation
  
  • Clirotis up to external anal sphincter

Question 39

What is used to locate the nerve for pudendal block?

Answer 39

• Use ischial spine to locate nerve

Question 40

What is the effect of pudendal block?

Answer 40

Analgesia