Applied Anatomy of the Female Reproductive System Flashcards
What are the 4 main ligaments?
Broad
Suspensory
Ovarian
Round
What is the broad ligament?
Peritoneal fold suspending uterus and uterine tubes
What are the 3 parts of the broad ligament?
- mesovarium (suspends ovaries)
- mesosalpinx (extends from ovaries to uterine tube)
- mesometrium (majority of broad ligament)
What is the suspensory ligament?
Extends out from ovary to wall of pelvis
Contains ovarian vessels and nerves
What is the ovarian ligament?
Holds ovaries to uterus
What is the round ligament?
Remnant of gubernaculum
- reflects uterus keeping it anteverted and anteflexed
- passes into inguinal canal ending in labia majora
What are the 4 parts of the uterine tube?
- isthmus (most narrow part)
- ampulla (middle part of tube)
- infundibulum (uterine tube opens towards ovaries)
- fimbriae(collects ovules)
What is the most common site of fertilisation?
Ampulla of the uterine tube
What is the internal and external os?
Internal and external orifice of the uterus
What is the cervix?
Lower part of uterus angling towards vagina
What is the position of the uterus?
Anteverted and anteflexed
- can also be retroverted/retroflexed
- anteverted = angle between cervix and vagina = 90 degrees
- anteflexed = angle between cervix and uterine body = 170 degrees
What is the vesicouterine pouch?
Angle between bladder/uterus
What is the pouch of douglas?
Rectum/uterus
- fluid can accumulate here in pathologies
When does an ectopic pregnancy occur?
When fertilised egg implants outside of intra-uterine cavity
- most commonly fallopian tube
What happens an ectopic pregnancy occurs in the fallopian tube?
- growing foetus stretches
- ruptures wall of tube = bleeding
- life threatening
- symptoms: abdominal cramps, bleeding, dizziness, pain in shoulder/neck/rectum, vomiting
What are the 4 main supports of the uterus?
- levator ani muscles and perineal body
- transverse cervical ligaments (fibromuscular from lateral pelvic walls to cervix and upper vagina)
- pubocervical ligaments (firm bands CT from pubis to cervix on either side of bladder)
- uterocervical ligaments (fibromuscular bands cervix to sacrum)
What main vessels supply blood to pelvic viscera?
Internal iliac -> anterior and posterior divisions
What arteries make up the anterior division?
Obturator
Uterine
Vaginal
What arteries make up the posterior division?
Superior gluteal (GSF) Inferior Pudendal (LSF) Inferior Gluteal (GSF)
What is the path of the uterine artery?
Internal iliac -> uterine -> with ovarian artery coming of abdominal aorta goes into circuit -> gives off vaginal branch (Upper 1/3 of vagina and cervix) and ascending branch (uterus)
What arteries supply the vagina?
Lower 2/3 vaginal artery off internal iliac
Upper 1/3 branch off uterine artery
What is the pelvic floor?
Group of muscles dividing the main pelvic cavity from peritoneum below
- pelvic diaphragm
What makes up the pelvic floor?
Coccygeal
Levator ani group
Covering fascia
What makes up the levator ani?
(anterior to posterior)
- levator sphincter vaginae/prostate (sling around inserting into perineal body)
- puborectalis (sling from pubic bone around rectoanal junction)
- pubococcygeus (pubic to anococcygeal body)
- iliococcygeus (ilium to anococcygeal body and coccyx)
What is the anococcygeal body?
Fibrous mass between tip of coccyx and anal canal
What are the external rotators of the hip?
Obturator Internus
Piriformis
Where is the obturator internus?
Through lesser sciatic foramen
Inserts into greater trochanter of femur
Where is the piriformis?
Originates from anterior aspect of sacrum
Passes out pelvis through GSF
To greater trochanter of femur
External rotator of hip
What are the 2 main disorders of the pelvic floor?
- prolapse of uterus
- damage during childbirth
What is prolapse of the uterus dependent on?
Tone of levator ani
- if damage = downwards displacement of uterus
When does uterus prolapse most commonly occur?
After menopause as viscera atrophy
What is uterus prolapsed always accompanied by?
Vagina prolapse
- first degree: no external signs, urgency symptoms
- second degree: cervix down into vagina opening
How can there be damage to the pelvic floor during childbirth?
- pelvic floor supports foetal head while cervix dilates permitting delivery
- injury = tearing levator ani
= incontinence - controlled episiotomy
Which part of the levator ani normally tears in childbirth?
Puborectalis
Pubococcygeus
What structures make up the female superficial pouch?
- masses of erectile tissue
- 3 muscles
- greater vestibular gland
- perineal body
What are the erectile tissue masses in the superficial pouch?
- crus of clitoris (attached to urogenital diaphragm)
- bulb of vestibule (erectile tissue of vestibule)
What are the 3 muscles of the superficial pouch?
- bulbospongiosis
- ischiocavernous
- superficial transverse perineal muscle (fixed perineal body)
attached to perineal body
What is the greater vestibular gland?
Bartholin’s cyst - small fluid filled sac
- inside opening of woman’s vagina
What is the perineal body?
- posterior border of urogenital triangle
- structure in muscles of pelvic floor/perineum attach
Where do the nerves supplying the pelvic floor come from?
Lumbar and sacral levels
- enter lumbar sacral plexi
Where is the lumbar plexis?
Situated behind psoas major
What are the important branches of the lumbar plexis?
- L2,3,4 femoral (anterior compartment of thigh)
- L2,3,4 obturator (medial compartment of thigh)
- L1,2, genitofemoral (skin of scrotum/cremaster muscle/labium majorum)
What is the lumbosacral trunk?
Fibres from L4 and L5 join
- emerges medial to psoas major
- inferiorly over pelvic brim
- joins sacral plexus
What is the sacral plexus?
- posterior in pelvis
- branches immediately
- exits pelvis via GSF
- sciatic and gluteal branches
What is the course of the pudendal nerve?
S2,3,4
Leaves pelvis via GSF
- enters perineum through LSF around sacrospinous ligament
- through pudendal canal with pudendal artery and vein
Course of pelvic parasympathetic pelvic viscera?
S2,3,4
Function of pelvic parasympathetic nerve?
Micturition, defecation, genital erection
What is the function of the sympathetic supply?
Bladder filling IUS contraction (hypogastric) Contraction of seminal vesicles and vas deferens
What are the 3 obstetric anaesthetic options?
- spinal anaesthesia
- pudendal nerve block
- caudal epidural block
How is spinal aesthesia done?
- subarachnoid space L4-L5
- complete below waist monitoring uterine contractions
How is pudendal nerve block done?
- peripheral nerve block S2-S4
- perineurium and lower 1/4 vagina
- mother feels contractions
How is caudal epidural block done?
Administer to catheter in sacral canal (S1-S5)
- limbs unaffected
What is the penis drained by?
Deeper inguinal lymph nodes
What are the ovaries/testes drained by?
Preaortic lymph nodes
What does horizontal/superficial lymph node swelling indicate?
Vulva/scrotal cancer
