9 - Repro - Pelvis osteology + Female repro system

Question 1

Name the bones which make up the pelvis:

Answer 1

2 x Innominate bones
Sacrum
Coccyx

Question 2

What is the innominate bone?

Answer 2

Bone formed from the fusion of the ilium, ischium and pubis = ‘Hip bone’

Question 3

What is the linea terminalis?

Answer 3

Line which separates the true pelvis from the false pelvis

- Made up of arcuate line, pectineal line and pubic crest

Question 4

What is a gynecoid pelvis?

Answer 4

The most common type of female pelvis, which is ideal for childbirth:

• Round inlet
• Straight side walls
• Ischial spines are not too prominent
• Well-rounded greater sciatic notch
• Well-curved sacrum
• Pubic angle > 90’

Question 5

Name the 2 clinically useful pelvic conjugates:

Answer 5

1) Obstetric conjugate

2) Diagonal conjugate

Question 6

What is the obstetric conjugate? How is it measured?

Answer 6

AP diameter from the midpoint of the pubis, to sacral promontory. Usually ~ 10 cm.
- Only measured via imaging. Instead use diagonal conjugate.

Question 7

What is the diagonal conjugate? How is it measured?

Answer 7

AP diameter from inferior border of pubis to sacral promontory.
- Measured via inserting 2 fingers into vagina and palpating sacral promontory, and noting on hand the lower border of the pubis

Question 8

What is the minimum size of the diagonal conjugate to allow childbirth?

Answer 8

~ 11.5 cm

Question 9

Which pelvic conjugate is easily measured?

Answer 9

Diagonal conjugate

Question 10

Name the layer of connective tissue which lies under the epithelium of the ovaries:

Answer 10

Tunica albuginea

Question 11

What is the mesovarium?

Answer 11

Portion of the broad ligament of the uterus, which suspends the ovaries

Question 12

What is the arterial supply to the ovaries?

Answer 12

Ovarian arteries (from abdominal aorta, below renal arteries)

Question 13

What is the venous drainage of the ovaries?

Answer 13

Ovarian veins:

• Left drains into left renal vein
• Right drains into IVC

Question 14

To which nodes do the lymphatics of the ovaries drain into?

Answer 14

Para-aortic nodes

Question 15

What are ovarian cysts usually developed from?

Answer 15

Ovarian follicles

Question 16

The majority of ovarian tumours are derived from which tissue?

Answer 16

Epithelium = Ovarian adenocarcinomas

Question 17

Are ovarian teratomas usually benign or malignant?

Answer 17

Benign

Question 18

Name the pouch located anterior to the uterus:

Answer 18

Uterovesical pouch

Question 19

Name the pouch located posterior to the uterus:

Answer 19

Rectouterine pouch

Question 20

If need to drain the uterovesical or rectouterine pouches, how are they accessed?

Answer 20

Via anterior or posterior fornices of the vagina

Question 21

What is the ideal position of the uterus?

Answer 21

1) AnteVerted in relation to the Vagina

2) AntefleXed in relation to the cerviX

Question 22

Name the ligaments which support the position of the uterus:

Answer 22

• Transverse cervical ligament = thickening of base of broad ligament to support cervix
• Uterosacral ligament = Maintains anteversion

Question 23

What is the arterial supply to the fallopian tubes and the fundus of the uterus?

Answer 23

Ovarian arteries (from abdominal artery)

Question 24

What is the arterial supply to the uterus?

Answer 24

• Ovarian arteries
• Uterine arteries
• Branches of vaginal arteries
• Branches of internal pudendal arteries

Question 25

What is the venous drainage of the uterus?

Answer 25

Uterine venous plexus

• into uterine veins
• into internal iliac veins

Question 26

To which nodes do the lymphatics of the uterus drain to?

Answer 26

• Para-aortic
• Internal iliac
• External iliac
• Sacral
• Inguinal

Question 27

What is salpingitis, and what are some complications of this?

Answer 27

Infection of the fallopian tubes

= Can cause adhesions, leading to ectopic pregnancies or infertility

Question 28

What is an ectopic pregnancy? Where does this usually occur?

Answer 28

Implantation at site other than the uterus

- 95% in ampulla or isthmus of fallopian tube

Question 29

Why can pain sometimes be felt in the left shoulder if patient has an ectopic pregnancy?

Answer 29

Can cause haemorrhage

• when lying down, blood may irritate diaphragm, sensed by phrenic nerve (C3-5)
• C5 dermatome = shoulder

Question 30

Why is a patient at high risk of prolapse if they have a retroverted uterus?

Answer 30

Uterus is positioned directly over the vagina