Applied Anatomy of the Female Reproductive system Flashcards
What are the three parts that make up the pelvis
= Ileum
= pubis
= ischium
Where are the pelvis joined together
Joined at the sacroiliac joint posterior and pubic symphysis anteriorly
what kind of joint is the pubic symphysis
cartilaginous
what kind of joint is the sacroiliac joint
partially cartilaginous and partially synovial,
where do the ileum, pubis and ischium all meet
acetabulum
what are in vertical alignment with each other in the bony pelvis
The ASIS and pubic symphysis
describe what makes up the ileum
Iliac crest
Posterior superior iliac spine
Anterior superior iliac spine – inguinal ligament and satrious
Anterior inferior iliac spine – attachment for rectus femoris
what makes up the pubis
Pubic tubercle
Inferior pubic ramus
Superior pubic ramus
what bones form the obturator foramen
pubic bone and ischium
what are the two important parts of the ischium
- Ischial tuberosities – large bony parts that we sit on
- ischial spine
What goes through the obturator foramen
- Obturator artery – goes through the obturator foramen and then in the medial compartment of the thigh where it supplies the medium compartment of the thigh
- Obturator nerve
- Obturator vein
What goes under the inguinal ligament
- Femoral artery
- Femoral nerve
- Femoral vein
- These pass into the anterior aspect of the thigh and supply the anterior aspect of the thigh
where is the sacrospinous ligament versus the sacrotuberous ligament
Sacrospinous ligament
- Ischium spine and sacrum
Sacrotuberuous ligament
- Ischial tuberosity and sacrum
describe the pelvic inlet
extends from the top of the sacrum and round, extends along the ileum and the pubis towards the pubic symphysis and then back around
describe the pelvic outlet
this is coccyx posteriorly extends towards the ischial tuberosity and pubic symphysis then back to the ischal tuberitiy and cocylx
describe the structure of the female pelvis
Wide sub-pubic angle (greater than 80°)- allow baby out
Wide pelvic inlet and outlet if the baby goes through he pelvis inlet it needs to go out of the pelvic outlet
Thin and light structure
describe the structure of the male pelvis
Narrow sub-pubic angle (less than 70°)
Narrow pelvic inlet and outlet, pelvic inlet is larger than pelvic outlet
Thick and heavy structure - thicker muscles attach here
what is above and below the pirmforis muscle
above is the greater sciatic foramen and superior gluteal neurovascuarl
Below piriformis is the lesser sciatic foramen and inferior gluteal neurovascualr bundle
what goes out of the greater sciatic foramen
- Gluteal arteries
- Gluteal veins
- Gluteal nerves
- Sciatic nerve
- Pudendal nerve
what goes in the lesser sciatic foramen
- Pudendal nerve
what does the common iliac artery divide into
into the external and internal iliac artery
where does the external iliac artery go
- External iliac artery goes underneath the ilignual ligament and becomes the femoral artery
how many branches leave and stay in the internal iliac artery in the pelvis
- 4 branches leave the pelvis 3 remain
describe the 4 branches that leave that branch of the internal iliac artery out of the pelvis
= obturator artery- leaves via the obturator foramen,
= gluteal arteries – leaves via greater sicatic foramen, inferior below primforis, superior above primforis
= internal pudendal artery also goes out the greater sciatic foramen
name the three arteries from the internal iliac artery that remain
- Uterine artery – goes to the uterus
- Superior vesicular artery – goes to the bladder
- Middle rectal artery – goes to the rectum
In males wouldn’t have a uterine artery instead you would have an inferior vesicular artery
what 4 muscles is the pelvic floor made out of
levator ani
- puborectalis
- pubococcygeous
- illococcygeous
and
- cocygeous
what is the role of puborectalis
- go from the pubic bone, wrap around the rectum and then go back to the pubic bone,
- they wrap around the rectum at the point where the rectum becomes the anal canal,
- when they contract they cause an acute angle and when they relax they straighten out of the angle between the rectum and anal canal
where is cocygeous
= just superior to the sacrospinous ligament
what is the pelvic floor
a musical sheet which closes the pelvic outlet
what overlies piriformis
the sacral plexus
what muscle fills the majority of obturator foramen
obturator interns
what does obturator interns help create
it creates a tendinous arch which levator ani attached to
what is above and below the pelvic floor
- above the pelvic floor is the pelvic organs
- below the pelvic floor is the perineum
what triangles is the perennial membrane made out of
- urogenital triangle anteriorly
- anal triangle posteriorly
what is the perennial membrane
- thick membrane underneath the pelvic floor
what is on the perenial membrane
all the external genital
what traverses the perineal membrane
The urethra, vagina and anal canal all transverse the floor
describe the male perineal membrane
Penis
- this is made out of the corpus cavernous and corpus spongosium
- the corpus cavernous attaches laterally to each side of the perineum as the crura of the penis
- the corpus spongiosum attaches the perineal membrane but in the midline where it becomes the bulb of the pneis
describe the female perineal membrane
- the crura of the clitoris attaches to either side of the perineum, these extend down into the clitoris itself
- bulb of the vestibule which is attached to the midline of the perineal membrane
- bulb of the vestibule splits into two and forms the vaginal and urethra in between
- also have bartholin glands (greater vestibular glands)
where do the greater vestibular glands drain
into the vestibule of the vagina
what happens if the bartholin glands/ greater vestibular glands have a blockage
- If they block this then form a Bartholin cyst
- If they become infected then they can form an abcess
- Bartholin glands or greater vestibular gland are blocked and swell
what causes blockage of a bartholin gland or greater vestibular gland
- Obstruction typically secondary to trauma or inflammation
- Then can develop secondary infection leading to abscess formation
What are the muscles of the perineal membrane
- Over the bulb of the vestibule there is the bulbospongius
- Over the cruca of the clitoris there is the ischiocavernous muscle
- Have transverse perineal muscles on each side
- Perineal body
- Have external anal spincher
what is the perineal body
- this is a fibromuscualr mass which is the site of convergence of the perennial and pelvic floor muscles
- it is the final support of the pelvic viscera
what can disruption of the perineal body result in
disruption of the perineal body can result in prolapse of the pelvic viscera
what is susceptive to tear during childbirth and how do you treat this
- The perineal body is particularly susceptible to tearing during childbirth.
- episiotomy may be performed to prevent tear
what is an episiotomy
surgical incision of the pernium and posterior vaginal wall
what are the two types of episiotomy
- Midline episiotomy and mediolateral episiotomy
describe the benefits and negatives of the two types of epiostomy
Midline Episiotomy
- go from the posterior aspect of the labia minor along the midline
- scar tissue will be in similar composition to the perineal body therefore there is better healing
- but this tear goes towards the anal so risk of tearing anal canal
mediolateral episotomy
- labia minora posterior aspect towards midpoint between ischial tuberosity and anus
- direct tearing away from the anus but muscle won’t heal as well
- done in the UK
where does the pudendal nerve travel
It branches from the sacral plexus and leaves the pelvis through the greater sciatic foramen, before turning back to enter the lesser sciatic foramen to enter the perineum
what does the pudendal nerve innervate
sensory and motor innervation to the perineum and is therefore sensory to the genitals and motor to the external urethral and anal sphincters.
what spinal roots does the pudendal nerve emerge from
S2-S4
describe the structure of the uterus
- fundus
- body
- cervix
- Fallopian tube join it
name the 4 parts that make up the Fallopian tubes
- Fimbrae – closet to the ovary
- Infundibulum – starts to funnel down
- Ampulla – slight swelling
- Isthmus – narrowed portion going towards the uretuer
What is the blood supply from the female reproductive system derived from
- Blood supply to the female reproductive system is derived from the uterine artery (int. iliac artery) and the ovarian artery (abdominal aorta).
what does the uterine artery pass over and why is this a problem
- The uterine artery passes over the ureter. The ureter is therefore at risk during hysterectomies
the uterine artery gives off
- Uterine artery gives of the vaginal artery
what is an ectopic pregnancy
- Implantation happening anywhere other than the uterine wall then there is an ectopic pregnancy
where does fertilisation tend to take place
ampulla
what is the most common type of ectopic pregnancy
- Most common type is tubule ectopic pregnancy where it is implanted into the fallopian tube as opposed to the uterus
- These are not viable as cannot stand the size of the fallopian tube
- Happens in the isthmus or ampulla
what happens if an ectopic pregnancy is left
- If they continue grown and rupture then you can get perfused bleeding which can be life threatening
name the normal position of the uterus
anteverted and anteflexed
describe what
- anteverted
- anterflexed means
- Normally the cervix is anterior positioned with respect to the vagina therefore this is anteversion this means an anterior position of the cervix
- If you look at the fundus of the uterus this is anteriorly positioned with respect to the cervix and vagina therefore this is ante flexion
what does
- retroverted
- retroflexed mean
- Retroverted uterus – this is when the funuds is orientated anterior but the cervix is posionted posterior
- Retroverted and retroflex – cervix and fundus are both positioned posteriorly
how is the uterus supported
- ligaments aid in supporting the uterus
- ligaments originate from the fascia of obturator interns and run across the cervix = cardinal ligaments
- uretroscaral and pubocervical ligaments helps keep the uterus in its position
what is uterine prolapse
- Descent of the uterus into the vagina
- - caused by pelvic floor and uterine ligament dysfunction
How do you treat uterine prolapse
- Ring pessary – plastic ring that can be poisoned within the vaginal and this helps supports the uterus and prevent it from prolapsing
name two ligaments that are associated with the uterus and derived from the peritoneum
- Rectouterine pouch of douglas – rectum and uterus
- Vesicouterine pouch – baladder and uterus
what is the clinical use of the rectouterine pouch
- most inferior part of the pierneal cavity so can collect blood
- can assess this blood and samples through the posterior fornix
describe the ligaments of the female reproductive system
- Suspensory ligament of the ovary – has blood vessels coming towards the ovary
- Broad ligament – where the peritoneum folds on the top
- Round ligament of the uterus – remnant of the foetal gubercunulm – attaches to the anterior abdominal wall
- Ovarian ligament – between ovary and uterus
what does the gubernaculum do
- in foetal life if guides the descent of the ovaries from the abdomen
describe how the size of the uterus changes over adulthood
- In childhood the uterus is the same size as the cervix and due to the small size of the childhood pelvis the majority of the uterus is abdominal.
- During puberty the body of the uterus rapidly grows to obtain adult proportions.
- Following puberty the uterus is pear-shaped and lies in the pelvic cavity.
- During pregnancy the uterus expands to accommodate the foetus.
- During menopause the uterus decreases in size.
describe the anatomy of the cervix
- highly muscular
- made up of an internal os, cervical canal and external os
what is a function of the cervix
- keeps bacteria out of the uterus
describe the somatic nervous system
- Sensory and motor
- Distributed to the somatic; musculoskeletal system and skin
- Senses and reacts mainly to the external environment
describe the visceral nerve system
- Sensory and motor
- Motor split into parasympathetic and sympathetic
- Distributed to the viscera (organs)
- Senses and reacts mainly to the internal environment
what is the only parasympathetic supply to the pelvis
S2-S4 pudnendal nerve
below and above the peritoneum what is pain sensation carried by
- Below the peritoneum pain sensation is carried by parasympathetic fibres (S2-4). At the level of the peritoneum and above, pain is carried by sensory fibres (T1-L2).
what causes pain sensation in the uterus
Uterus is intraperitonum – pain sensation is carried by sympathetic nerves
what is pain from the cervix and upper part of the vaginal canal carried by
Pain from the cervix and upper part of the vaginal canal is carried by parasympathetic nerves S2-S4
describe a lumbar block
- Subarachnoid space L4-5. Complete anaesthesia below waist monitoring of uterine contractions. Commonly followed by headache
- Cant go higher than L4/L5 as spinal cord ends at ;L1/L2
- Block all feeling from the waist down and all feeling in the uretus, also block all motor so you cant participate in childbirth therefore this is used for a C section normally
describe a caudal epidural block
- Anaesthetic administered to Cather in sacral canal but most done in advance
- Blocks from parasympathetic nerves and sympathetic nerves
- Most anaesthetic can be administered in necessary
- Limbs still unaffected
- Can still participate in birth
describe a pudendal nerve block
- Peripheral nerve block S2-4 – perineum and lower ¼ vagina – mother can feel/assist contractions
