Anatomy of the Female Reproductive System (Cantrell) Flashcards
SORRY this was the longest deck ever
term for the female external genitalia
vulva
superior pole of the ovary is the ____ end
tubal
inferior pole of the ovary is the ____ end
uterine
each ovary id suspended from the uterus by the
ovarian ligament
Which pole of the ovary does the ovarian ligament connect to?
inferior
the suspensory ligament of the ovary connects the ovary to the…
lateral wall of the pelvis
are remnants of the gubernaculum
ovarian ligament and round ligament
boundaries of the ovarian fossa:
anterior-lateral boarder?
posterior-medial?
anterior-laterally = external illiac vessels posterior-medial = ureter
transmits the ovarian a, v, and N supply
suspensory lig of ovary
runs within the cardinal ligmant
uterine a
when performing an oophorectomy, care must be taken to avoid damaging the ____ at the ___ boundary of the ovarian fossa
ureter medially (posterior-medially, specifically)
the ovarian a follows the _____ as it travels within the ______
follows suspensory ligament within the mesovarium
the ovaries receive their blood supply from …
ovarian a + anastamosies of the ovarian a with the uterine a
describe the venous system that drains the ovaries
ovarian v on the left directly connects to the IVC
ovarian v on the right connects to the left renal v
lateral to the ureter at the pelvic brim
suspensory lig of the ovary
how is the ovarian blood supply altered during pregnancy? how is this significant for a surgeon performing an oophorectomy?
the ovarian arteries enlarge and the anastomoses between the ovarian a and the uterine a become bigger(?, its 6 am and i can’t think of a better word, sorry) in order to increase the blood supply to the uterus ∴ these connections need to be ligated to avoid blood loss
the uterine a is a branch off of the ….
anterior division of the internal illiac artery
transport organ for the zygote
uterine tubes
aka infundibulopelvic ligament (IPL)
suspensory ligament of the ovary
trumpet end of the uterine tubes
infundibulum
most common site of conception
ampulla of the uterine tubes
all structures (a, v, N, lymphatics) directly servicing the ovary travel through the
suspensory ligament of the ovary
the margin of the infundibulum is rimmed with small finger-like projections called
fimbrae
how can the uterine tubes be examined?
endoscopically via a vaginal approach
laproscopically via an abdominal approach
projects laterally from the body of the uterus, arching superiorly and posteriorly, to open into the peritoneal cavity
uterine tube
medial to the infundibulim
ampulla of the uterine tubes
useful in trapping the ovum and sweeping it towards the opening of the uterine tube
movement of the fimbrae
sheet life fold of mesentary with anterior and posterior layers that encloses the uterus, ovary, and uterine tubes
broad ligament
ectopic pregnancy in the uterine tubes (when the tube ruptures) can causes…
can cause abdominopelvic hemorrage
the ampulla narrows to form the
isthmus
serves to keep the uterus positioned properly
broad ligament
part of the uterine tube that joins the body of the uterus
isthmus
suspended in the mesosalphinx of the broad ligmant
uterine tubes
extends from the lateral pelvic wall to the body of the uterus
mesometrium
most superior part of the broad ligamnt
mesosalphinx
the ______ suspends the ovary from its posterior aspect
mesovarium
posterior extension of the broad ligament
mesovarium
superior extension of the mesovarium
suspensory ligament of the ovary
suspends the uterine tubes in the pelvic cavity
mesosalphinx
the ovary is projected (ant or post) relative to the uterus
posteriorly
the round ligament of the uterus is enclosed in
the broad ligament (doesn’t say specifically what part and neither does wiki)
the uterus is enveloped in
mesometrium
part of the uterus that narrows inferiorly into the cervix
isthmus
part of the uterus above a line connecting the uterine tubes
fundus
connects the uterine cavity and the vagina
cervical canal
what organ/structure is anterior to the uterus? posterior?
anterior = bladder posterior = rectum
part of the uterus between the fundus and the cervix
body
uterine opening of the cervical canal
internal os
vaginal opening of the cervical canal
external os
neck of the uterus and is continuous with the vaginal canal
cervix
forms the anterior, posterior, and lateral fornices
infravaginal portion of the cervix
2 divisions of the cervix
supravaginal and infravaginal
the ureter is (superior or inferior) to the uterine a
inferior (water under the bridge)
**they are at 90ºs
lowest point of the abdominopelvic cavity when the pt is in the supine position?
rectouterine pouch aka pouch of douglas
what forms the boundaries of the rectouterine pouch?
between the posterior wall of the uterus (anteriorly) and the rectum (posteriorly)
the floor is the draping of the peritoneum
venous drainage of the uterus is via
pelvic plexus of veins
the ______ passes the pelvic floor from lateral to medial in the transverse cervical (aka cardinal) ligament (which is at the base of the broad ligament)
uterine a
describe the blood supply of the uterus
uterine a (branch of internal iliac) ovarian a (branch of abd aorta) 2 or 3 vaginal aa (branches of internal iliac)
at risk for perforation during cystoscopic procedures that use a vaginal approach?
rectouterine pouch
Pfannensteil’s incision
transverse suprapubic incision to remove the uterus thru the ant abd wall
the inferior end of the uterus projects towards the
posterior wall of the vagina
the uterine passes the pelvic floor from lateral to medial in the _______ which is at the base of ______
transverse cervical (aka cardinal) ligament which is at the base of the broad ligament
2 approaches for a hysterectomy
removal through the ant abd wall or the vagina
angle of enteflexion is the
angulation between the wall of the cervix and the axis of the body of the uterus
angle of anteversion is the
anglulation between the axis of the cervix and the axis of the vaginal canal
~100-110
in an anterverted and ante flexed position, the anterior surface of the uterus rests on
the superior surface of the bladder
in an anterverted and ante flexed position, the posterior surface of the uterus rests on
loops of small intesine
improper positioning of the uterus may contribute to…
▪︎ infertility
▪︎ complications during pregnancy and delivery
▪︎ inc tendency towards uterine prolapse
What are the cuases of uterine prolapse?
▪︎ trauma during childbirth
▪︎ improperly postioned uterus
▪︎ aging
how is uterine prolapse treated?
surgery or pessary (mesh-like prosthetic device)
What are the supporting structures of the female internal genitalia?
▪︎ bladder and rectum
▪︎ pelvic and UG diaphragms
▪︎ perineal body
▪︎ ligaments: transverse cervical (cardinal), pubovesical, uterosacral, and round
if any of these are damaged or atrophy you can get prolapse
the anterior wall of the vagina is posterior to the
base of the bladder and urethra
the posterior wall of the vagina is anterior/related to
the ampulla of the rectum, perineal bodym and the rectouterine pouch
describe the blood supply to the vagina
vaginal arteries which are branches off of the internal iliac artery
**there are also some anastomoses with the uterine a
describe the venous drainage of the vagina
pelvic plexus
culdoscopy is
a medical diagnostic procedure performed to examine the rectouterine pouch and pelvic viscera by the introduction of a culdoscope through the posterior vaginal wall
…. may impinge upon the walls of the vagina
herniations of the bladder (cystocle), rectum (rectocele), and bowel (enterocele)
may result in leakage of urine or feces from the vaginal orifice
fistulae formation
female homologs of the scrotum
labia majora and mons pubis
female homolog of the penis
clitoris
the hair bearing elevation of skin anterior to the pubis
mons pubis
encloses the clitoris
labia minora: foms the prepuce and the frenulum
what is the labia major filled with
CANDY! jk, fat and fibrous tissue
fourchette
the sharp fold fromed from the united posterior ends of the labia minora
describe the blood supply to the labia minora
internal pudental artery and external pudental branches of the femoral artery
describe the innervation of the labia minora
ilioinguinal N
genital branch of the genitofemoral N
posterior labial N (from perineal N)
posterior cutaneous N of the thigh
damn, that a lot of different places, our evolutionary ancestors really didn’t want us to lose feeling down there
the smooth area bounded by the labia minora
vestibule
how is the structure of the body of the clitoris different than the body of the penis
clitoris is formed by 2 (rather than 3) cylindrical bodies (corporus caveronsa)
small mass of erectile tissue that caps the body of the clitoris
glans
the root structure serves to support an anchor the clitoris to the
perineal membrane
the left and right crura of the clitoris are continuous with the
corpora cavernosa and the bulb of the vestibule
the bulb of the vestibule is firmly attached to the
UG diaphragm
what gives rise the the clitoris
bulb of the vestibule
extends from the perineal body to surround the orifice of the vagina and cover the vestibular bulbs
bulbospongiosus muscle
where does the ischiocavernosus muscle arise
ischiopubic rami
located just posterior to each half of the bulb of the vestibule
greater vestibular gland (aka Bartholin’s)
function is to decrease the size of the vaginal opening
bulbospongiosus muscle
innervation of the ischiocavernosus and bulbospongiosus muscles
perineal branch of the pudental N
where do the ducts of the greater vestibular glands open?
vestibule
function is to compress the deep dorsal vein of the clitoris to maintain erection
bulbospongiosus muscle
function is to secrete clear mucus to lubricate the vulva during sexual excitation
greater vestibular gland (aka Bartholin’s)
arteries that are responsible for erection of the clitoris
deep arteries of the clitoris
describe the venous drainage of the clitoris
superficial and deep dorsal veins → internal pudental v
function is to compress the crus of the clitoris to assist in erection
ischiocavernosus muscle
what provides the blood supply to the corporus cavernosa?
deep arteries of the clitoris
what provides the sensory innervation to the clitoris
dorsal N of the clitoris
erection is a vascular event generated by ____ innervation from spinal cord levels..
generated by parasympathetics (pelvic splanchnics) from S2-S4
SAME IN MEN AND WOMEN
describe the specifics of the innvervation of the clitoris
pregang para N fibers exit ventral rami S2-S4 via pelvic splanchnics and enter the inferior hypogastric plexus → postgang para N fibers derived from hypoglastic plexus innervate the clitoris via the cavernous N in the vesicular plexus
muscles of the pelvic diaphragm
levator ani and coccygeus muscles
what is the origin and insertion of levator ani?
O: pubis, tendinous arch, and ischial spine
I: midline connective tissue raphe
innvervation of levator ani
inferior rectal N and direct branches from S4
action of the levator ani
support of pelvic viscera and to keep the rectum and vagina closed
UG diaphragm stretches between
the ischiopubic rami
why is there a gap in the anterior fibers of the UG diaphragm?
small communication with the perineum and the pelvis
covers the inferior surface of the UG diaphragm
dense fibrous layer called the “inferior fascia of the UG diaphragm” or the “perineal membrane”
specialization just posterior to the free posterior margin of the UG diaphragm
perineal body
**provides additional support
what structures are at the greatest risk of tearing during childbirth?
perineum, levator ani, ligaments of the pelvic fascia
why is an episiomety performed?
to enlarge the birth canal and prevent tearing or excessive trauma
what is cut in an episiomety
perineum and inferoposterior vaginal wall (just typing that made me cringe)
What are the 3 options for regional anesthesia during childbirth?
- spinal nerve block
- caudal nerve block
- pudental nerve block
diff between spinal N block, caudal epidural block, and pudental N block
spinal: anesthesia introduced in SUBARACHNOID space at L3/L4 and causes complete paralysis from the waist down
epidural: anesthesia introduced in EPIDURAL space and bathes S2-S4 roots and does not affect the lower limbs
pudental: anesthetizes the S2-S4 DERMATOME
where is the pudental N block injected?
medial aspect of the ischial spine around the sacrospinous ligament
is the mother able to still feel the contractions with a pudental N block
yes
what nerve would have to be blocked to abolish sensation from the anterior portion of the perineum?
ilioonguinal N
where is the pudental N block injected?
medial aspect of the ischial spine around the sacrospinous ligament
is the mother able to still feel the contractions with a pudental N block
yes
what nerve would have to be blocked to abolish sensation from the anterior portion of the perineum?
ilioonguinal N
narrowest part of the pelvic canal from side to side
interspinous distance (between ischial spines)
What is the minimum distance for the estimated true conjugate to be in order to ensure a safe delivery
≥ 11 cm
How is the true obstetrical conjugate measured?
determine the diagonal conjugate (palpate the sacral prominence with the tip of the middle finger while using the other hand to make the levels of the inferior margin of the pubic symphysis on the examining hand)
the true obstetrical conjugate is estimated to be the tip of the INDEX finger (not middle) to the marked level of the pubic symphysis
narrowest fixed distance that the baby’s head must fit thru during a vaginal delivery
obstetrical conjugate
What is the minimum distance for the estimated true conjugate to be in order to ensure a safe delivery
≥ 11 cm
how is the interspinous distance determined to be wide enough for delivery
can fit 3 fingers wide
***this may get wider as the pregnancy continues due to hormones inducing relaxation of ligaments binding the pelvis
narrowest fixed distance that the baby’s head must fit thru during a vaginal delivery
obstetrical conjugate
