Applied Anatomy of the Female Reproductive System Flashcards
What is the pelvis floor?
Divides main pelvis cavity above and perineum below
What forms pelvic floor?
Levator ani muscles
Coccygeus muscles
Covering fascia
What is the function of pelvic floor?
Maintains pelvis viscera in position
Resist intrapelvic pressure and expulsive efforts of abdominal muscles
What are gaps in muscular pelvis floor?
Urethra
Vagina
Rectum
Where does puborectalis start and end?
Pubic symphysis to rectum
What does puborectalis do?
Form sling around anal canal
What does sphincter vaginae do?
Form sling around urogenital hiatus
What is pubococcygeus start and end?
From pubic to annococcygeal body
What is annococcygeal body?
Fibrous mass between tip of coccyx and anal canal
Where does iliococcygeus start and finish?
Ischial spines anococcygeal body and coccyx
Where does coccygeus start and finish?
Ischial spine to coccyx/sacrum
Where does perineal membrane lie?
Beneath the anterior urogenital triangle
What is between the superior pubic ramus and inferior pubic ramus?
Obturator Ex
Obturator Int
What is the deep perineal pouch?
Bounded by obturator ext, levator ani and perineal membrane
What is in the urogenital diaphragm?
External urethral sphincter
deep perineal muscles
What is the lower space beneath the perineal membrane?
Superficial perineal pouch
What is beneath the superficial perineal pouch?
Colles fascia
What is inferior to colles fascia?
Skin
What is within superficial perineal pouch?
Erectile tissue/muscles + glands
Where is bartholin’s gland?
Superficial perineal pouch
Where is urogenital diaphragm located?
Deep perineal pouch
What is urogenital diaphragm formed by?
EUS,
sphincter urethrovaginalis
Compressor urethrae
Deep transverse perineal muscles
What are the 3 masses of erectile tissue?
Bulb of vestibule
Crura or clitoris
What is bulb of vestibule attached to?
Urogenital diaphragm
What 3 muscles are in SPP?
Bulbospongiosus
Ischiocavernosus
Superficial transverse perineal muscle
What does the bulbospongiosus surround?
Vaginal orifice and covers vestibular bulbs
What does Bartholin’s gland do?
Secretes mucus into vestibule area
What does pelvis floor do during child birth?
Supports foetal head while cervix is dilating
Which parts of levator ani are most often torn?
Pubococcygeus
Puborectalis
What can happen if muscles pubococcygeus and puborectalis are torn?
Incontinence
What can be used to help prevent injury to pelvic floor?
Controlled episiotomy
Prenatal (e.g. Lamaze) classes
What is episiotomy?
If labour is prolonged, may have posterolateral incision
What is the broad ligament?
Double fold of peritoneum which attaches internal genitalia to pelvis
What are mesosalpinx?
Fallopian tubes
What do mesovarium do?
Ovaries o broad ligament
What do mesometrium do?
Ovaries to uterus
What does suspensory ligament do?
Ovary to wall of pelvis
What do ligament of ovary do?
Ovary to lateral uterus
Where does round ligament (caudal gubernaculum) originate?
Uterine horns
Where does round ligament exit
abdominal cavity
Where does round ligament pass through
inguinal canal
Where does round ligament end?
Labium majora
Where do ovaries lie?
Lateral wall of pelvis in ovarian fossa (may also be found in pouch to Douglas)
What supports superior aspect of uterus?
Ovarian + round ligaments
What supports vagina?
Levator ani
Perineal body
What supports middle aspect of uterus?
Uterosacral ligaments
Transverse cervical ligaments
Pubocervical ligaments
Where does uterosacral ligaments start and end?
Cervix to sacrum
Where does transverse cervical ligaments start and end?
Cervix/vagina to lateral pelvic wall
Where do pubocervical ligaments start and end?
Cervix to pubis (either side of bladder)
What is the normal position of the uterus?
Anteverted
Anteflexed
What can retroverted uterus cause?
Vaginal prolapse
When is uterus prolapse most common?
After menopause when pelvis viscera tend to atrophy
What happens in rectouterine pouch?
Accumulation of blood or pus
Commonly violated by instruments that pierce the post fornix
What is the vesicouterine pouch?
Formed from peritoneum over uterus and bladder
Where does vagina extend?
Vulva to uterus
What pierces upper end of vagina?
Cervix
How many fornices are formed in vagina?
4
1x Anterior
1x Posterior
2x lateral
What is anterior to vagina?
Bladder
urethra
What is posterior to vagina
Pouch to douglas
ampulla of rectum
perineal body
what is lateral to vagina?
Ureters
lecator ani
urogenital diaphragm
bulb of vestibule
What plexus is mixed of parasympathetic and sympathetic?
Inferior hypogastric plexus
What supplies IHP (parasympathetic)?
S2, S3, S4 (pelvic splanchic nerves)
What supplies IHP (sympathetic)
Superior hypogastric plexus (lies around L3, L4)
What feeds into SHP?
Thoracic (greater,lesser + least)/ lumbar splanchic nerves
What comes off SHP?
Right and left hypogastric nerves (follow pathway of common iliac arteries)
What also originates from S2, S3, S4?
Pudendal nerve (somatic)
What innervates levator ani?
Branches from S4
What are obstetric anaesthetic options?
Spinal anaestheia
Caudal epidural block
Pudendal nerve block
What is spinal anaesthia?
Subarachnoid space L4-5
Complete anaesthia below waist
What is caudal epidural block?
Anaesthetic administered to catheter in sacral canal
What happens in pudendal nerve block?
Peripheral nerve block S2-4
Perineum and lower 1/4 vaginal
Mother can still feel contractions
What is landmark for issuing pudendal nerve block?
Ischial spine
