2.4 - Female Reproductive System

Question 1

What are the female internal reproductive organs? (4)

Answer 1

Uterus
Fallopian tubes
Vagina
Ovaries

Question 2

Which 3 structures constitute the birth canal?

Answer 2

Uterus
Vagina
Cervix

Question 3

What are the 3 layers of the uterus?

Answer 3

Peritoneum
Myometrium
Endometrium

Question 4

As pregnancy advances, the uterus phsyiologically has an ‘upper’ segment and a ‘lower’ segment, what constitutes each of these and what are their functions for birth?

Answer 4

Upper = fundus = contraction 
Lower = cervix and isthmus = dilation and distension

Question 5

Which part of the uterus is opened in a C-section?

Answer 5

Lower part

Question 6

What is the normal positioning of a uterus described as?

Answer 6

Anteverted and anteflexed

Question 7

What could happen if the uterus is very retroverted and retroflexed? (particularly in early pregnancy)

Answer 7

• Pregnancy - uterus can become incarcerated, meaning it gets wedged in the pelvis during growth (however this is rare)
• Other - increased incontinence/difficulty urinating, back pain, prone to uterine prolapse

Question 8

At any surgical management of miscarriage why might it be important to know prior to instrumentation of the uterine cavity whether the uterus is anteverted or retroverted?

Answer 8

To minimise risk of perforation of the uterus with instrumentation

Question 9

What are the names of the 2 peritoneal spaces on either side of the uterus?

Answer 9

Rectouterine pouch

Uterovesical pouch

Question 10

What are the fornices of the vagina?

Answer 10

Posterior and anterior

They are superior portions of the vagina extending into the recesses created by the vaginal portion of the cervix

Question 11

Through which vaginal fornix can you access the rectouterine pouch? What is the clinical significance of this?

Answer 11

Posterior fornix
Peritoneal dialysis for ESRF
Rectovaginal fistulae can also occur if the walls are weak

Question 12

Name 4 ligamentous attachments which firmly anchor the uterus and cervix into position in the pelvis

Answer 12

Ligament of ovary
Suspensory ligament of ovary
Round ligament of uterus
Broad ligament

Question 13

Which ligament (part of the pelvic fascia, which is one of the main supports of the uterus) is called the cardinal ligament of the uterus? (also pubocervical. uterosacral and sacrocervical (fascial) ligaments)

Answer 13

Lateral cervical ligament

Question 14

Apart from pelvic fascia, what other structure in the pelvis is also an important support of the uterus?

Answer 14

Bladder

Question 15

Name the 4 parts of the uterine tube

Answer 15

Infundibulum
Ampulla
Isthmus
Intramural/uterine part

Question 16

Which part of the uterine tube is the longest and widest?

Answer 16

Ampulla

Question 17

Fertilisation most commonly occurs in which part of the uterine tube?

Answer 17

Ampulla

Question 18

What is meant by a tubal/ectopic pregnancy?

Answer 18

Fertilised egg implants itself outside of the womb (usually in tube)

Question 19

What might a cornual ectopic be?

Answer 19

Pregnancy in part of the tube that penetrates muscular layer of the uterus

Question 20

What might repeated pregnancies do to the ovary?

Answer 20

Displace the position

Question 21

What happens to the ovary following menopause?

Answer 21

They become atrophied and fibrous

Question 22

What are the 2 ligaments associated with the ovary? What structures are they connected to?

Answer 22

Ligament of ovary/ovarian ligament - from uterus to ovary

Suspensory ligament - from ovary to lateral pelvic wall

Question 23

Which 2 major branches from the aorta provide blood supply to the gonads and genitalia?

Answer 23

Gonadal and internal iliac arteries

Question 24

At what vertebral level do the gonadal arteries originate?

Answer 24

L2

Question 25

Describe the pathway of the ovarian artery

Answer 25

Descends within the suspensory ligament to supply the ovaries via the broad ligament

Question 26

Which vessel does the ovarian artery freely anastomose with?

Answer 26

Uterine artery (and may in fact be replaced by it)

Question 27

Where does the left gonadal vein drain (this is the left testicular vein in men and the left ovarian vein in women)?

Answer 27

Left renal vein

Question 28

Where does the right gonadal vein drain?

Answer 28

IVC

Question 29

Where specifically does the uterine artery cross over the ureter? Hence which expression is used to remind us of an important anatomical relation during the ligation of uterine artery?

Answer 29

At the level of the ischial spine at the junction of cervix and lateral part of fornix of vagina
‘Water under the bridge’

Question 30

Lymphatic drainage of the internal pelvic organs largely follows the arterial supply and venous drainage by passing backwards through the nodes around the branches of which arteries?

Answer 30

Iliac arteries and abdominal aorta

Question 31

Lymph from the labia and distal part of the vagina drain into which group of lymph nodes?

Answer 31

Sacral and superficial inguinal

Question 32

Which group of lymph nodes receives lymph from the ovary?

Answer 32

Right and left lumbar via common iliac

Question 33

Which lymph nodes drain the fundus and upper body of the uterus?

Answer 33

Pre-aortic group

Question 34

Which lymph nodes drain the major part of the uterine body?

Answer 34

External iliac

Question 35

Which lymph nodes drain the uterine cervix and upper vagina?

Answer 35

Internal iliac and sacral

Question 36

Which lymph nodes drain the lower vagina?

Answer 36

Superficial inguinal