Flashcards in Session 5 - Female and Pelvic Anatomy Deck (26):
Describe the relationship of the uterus with the peritoneum:
Anterior to the uterus is the uterovesicle patch
Posterior to the uterus is the 'pouch of Douglas' or rectouterine pouch
Describe the development of the uterus:
The paramesonephric duct open caudally to the abdomen and connect to the urogential sinus. In the absence of Mullerian Inhibiting Hormone the ducts persist. They then fuse in the midline forming the uterus, Fallopian tubes and the upper third of the vagina.
Name the ligaments associated with the uterus:
Describe the broad ligament:
Broad sheet made of peritoneum that covers the uterus and spans between the Fallopian tubes, ovaries and their blood supply.
It can be split into the
mesovarium which covers the hilum of the ovary
mesosalpinx - mesentry of the Fallopian tube
mesometrium - largest portion and coves the body of the uterus, also extends to cover the internal iliac artery?
Describe the suspensory ligament:
Contains the neurovascular supply to the ovary. E.g. the ovarian artey, vein and the ovarian nerve plexus. Travels from the ovary to the abdominal aorta.
Describe the ovarian ligament:
A ligament that joins the ovary to the uterus just below the fallopian tube.
Describe the round ligament:
A reflection off of the uterus, runs through the inguinal canal. Embryologically was the gubernaculum. Attaches to the labia majora. Can be a source of pain during pregnancy as the expanding uterus puts presure on the ligament. Also keeps anteflexion of the uterus during pregnancy.
What is the normal position of the uterus?
Describe the blood supply no drainage of the ovary:
Ovarian artery - from abdominal aorta
Some anastomoses with the uterine artery from internal iliac
Ovarian vein left side into the left renal vein and right side direct into inferior vena cava.
Describe the blood supply to the uterine artery:
Uterine artery from the anterior division of the internal iliac artery.
Also anastomoses with ovarian artery
Describe the blood supply to the vagina:
Vaginal arteries - anterior division of the internal iliac arteries.
Describe the blood supply to the external genitalia:
Internal pudendal artery - anterior branch of the internal iliac artery
Describe the lymphatic drainage of the reproductive system:
Ovary - para-aortic nodes
Fundus - aortic nodes
Body - external iliac nodes
Cervix - internal and external iliac nodes
Vagina - internal iliac nodes and superficial inguinal nodes.
What does the labia majora enclose?
What does the labia minora enclose?
What is contained within the vestibule?
Entrance into the vagina
Entrance into the urethra
What is a fornix?
A recess that surrounds the cervix. There are anterior posterior and two lateral fornices.
Describe the innervation if the uterus and the vagina:
Inferior 1/5 of vagina is somatically innervated by the pudendal nerve.
Superior 4/5ths and uterus is supplied by the uterovaginal plexus. This supplies both sympathetic and parasympathetic innervation.
Describe the innervation of the perineum:
Via the pudendal nerve + ilioinguinal nerve
Pudendal nerve exits via greater sciatic notch and then enters perineal area by lesser sciatic notch.
What are the good feature of a pelvis for childbirth?
Not too prominent ischial spines
Straight side walls
Well rounded greater sciatic notch
Well curved sacrum
Sub-pubic arch >90 degrees
What is the relevance of ligaments in producing a good pelvis for childbirth?
The sacrospinous and sacrotuberous ligaments that for the greater and lesser sciatic foramen can soften under the influence of progesterone which can widen the pelvic outlet.
What is the true pelvis?
The lesser pelvis or the area inferior to the linea terminalis. The linea terminalis is the ring of bones which forms the pelvic inlet. It is a bony canal which is solid and immobile. This bony ring consists of the alar of the sacrum, the arcuate line (of the ischium), the pectineal line, and the pubic crest.
What are the differences between the gynecoid and android pelvis?
Gynecoid pelvis has a greater pubic angle
Has a more rounded greater sciatic notch
Has a less prominent ischial spine
What dimensions are assessed when considering whether a vaginal delivery is suitable?
AP diameter i.e pelvic inlet
How is the AP diameter of the pelvis calculated?
Obstetric conjugate - From the mid point of the public symphysis to the sacral promontory