Female Anatomy Flashcards
**What is the size of the neonatal uterus?
3.5cm in length with a fundus to cervix ratio of 1:2
(the cervix is bigger than the fundus)
the uterine size is large due to mother’s hormones
**What is the uterine size at 2-3 months old?
2.5-3cm in length with a fundus to cervix ratio of 1:1
tubular configuration
the endometrial stripe echoes not visualized
endometrial fluid may be present
**What is the average size of the premenarchal uterus?
1-3cm in length with a width of 0.5-1cm
**What happens to a pediatric uterus?
it increases in size after the age of 7
**What is the size of the uterus in a pediatric girl?
5-7cm in length with a fundus-cervix ratio becoming 3:1
the fundus is larger than cervix
**What is the size of the uterus in menarchy?
6-8cm in length and 3-5cm wide
**With multiparity, what is the size of the uterus?
the uterus increases in size by 1-2cm
**What is the size of the uterus in postmenopausal women?
3.5-5.5cm in length and 2-3cm wide
**What is RI?
resistive index
(peak systole minus peak diastole) divided by peak systole
**What does RI indicate?
RI 0.4 or greater is normal
malignancy is considered below and benign is considered to be above the values
**What is PI?
pulsitality index
doppler measurement that uses peak systole minus peak diastole divided by the mean
**What are signs of malignancy with RI?
intratumoral vessels, low-resistance flow, absence of normal diastolic notch in Doppler waveform
**What does PI indicate?
PI 1.0 or more is normal
**What is the pulsatality index?
a measure of the variability of blood velocity in a vessel
**What is the resistive index?
a measure of pulsitile blood flow that reflects the resistance to blood flow
What bones are in the bony pelvis?
two innominate (coxal) bones (anterior and lateral margins), sacrum and coccyx (posterior wall)
What are the margins of the pelvis?
posterior wall: sacrum and coccyx
posterolateral wall: piriformis and obturator internus muscles
anterolateral wall: hip bones and obturator internus muscles
What are the muscles of the pelvis?
psoas major, iliacus, piriformis, obturator internus, levator ani, coccygeus
What are the muscles of the true pelvis?
piriformis muscle, obturator internus muscle, pelvic floor muscles
What is the most common muscle to be mistaken for the ovary?
piriformis muscle
What muscles form the pelvic floor?
levator ani (pubococcygeus, iliococcygeus, puborectalis muscles)
What muscles form the pelvic diaphragm?
levator ani (pubococcygeus, iliococcygeus, puborectalis muscles) and coccygeus (coccygeus and piriformis muscles)
What are the muscles of the false pelvis?
iliopsoas muscle (psoas major and iliacus)
What are other names for the rectouterine pouch?
posterior cul-de-sac or Pouch of Douglas
**What flow does the uterine arteries have?
high velocity and high resistance
in a pregnant woman, flow becomes low resistive in the first trimester
**What is the most consistent and successful area for assessing ovarian Doppler flow?
ovarian branch of uterine artery
**What flow does the ovarian artery have?
follicular phase: low velocity and high resistance
early luteal phase: high velocity and low resistance
late luteal phase: medium resistance and gradually increasing in follicular phase and develops low velocity
Where are arcuate vessels located in the myometrium?
between the outer and intermediate layers of the myometrium
What vessels are shed during menstruation?
spiral arteries along with zona functionalis
Where do the ovarian veins drain?
the left ovarian vein drains into the left renal vein and the right ovarian vein drains into the IVC
What is the relation between the vagina and urethra?
the anterior wall of the vagina is fused with the urethra
Which vaginal wall attaches higher on the cervix?
the posterior vaginal wall
What is the normal uterine position?
anteflexed and anteverted
What is uterine flexion?
refers to the axis of the uterine body relative to the cervix
What is uterine version?
refers to axis of cervix relative to vagina
What supports the uterus?
levator ani muscles, cardinal ligaments, uterosacral ligaments
(round ligaments hold uterus in anteverted position)
What supports the cervix?
cardinal ligaments hold cervix firmly in place
What is dextro/levoversion?
dextro: tilt to right of midline
levo: lilt to left of midline
What classifies premenarche?
prepuberty
What classifies menarche?
first menstrual bleeding/state of reproductive age
What classifies premenopause?
before menopause (can last 2-10 years)
What classifies menopause?
cessation of menses for one year
What are the layers of the uterus superficial to deep?
perimetrium (serous), outer myometrial layer, intermediate myometrial layer, inner myometrial layer (endometrial halo), stratum basalis and stratum functionalis (endometrium)
**What is the sonographic appearance of the endometrium during menstruation?
irregular endometrium measuring 3-4mm or less
endometrial canal appears hypoechoic and posterior enhancement in early menses
if flow is heavy, entire cavity can appear anechoic
as menses progresses, endometrial stripe is visible (2-3mm) as thin hyperechoic line
**How does the endometrium look sonographically in the early proliferative phase?
endometrial canal appears as thin strip with hypoechoic endometrium (4-8mm)
**What creates the three-line sign in the late proliferative phase?
the stratum basalis represents the first and third line and the endometrial cavity represents the second line
What happens during the proliferative phase?
the number of cells increase
What happens in the secretory phase?
the size of cells increase
**What does the endometrium look like sonographically in the secretory phase?
it is at it’s greatest thickness (7-14mm) and echogenicity with posterior enhancement
functionalis layer becomes isoechoic with basalis layer
**What is the sonographic appearance of a postmenopausal endometrium?
thin, homogeneous, echogenic (5mm or less)
**How thick is a postmenopausal endometrium if the woman is taking HRT?
10-14mm
How long are the fallopian tubes?
8-10mm
What are the sections of the fallopian tubes?
fimbriae, infundibulum, ampulla, isthmus, interstitial portion
What hormones do the ovaries secrete?
estrogen and progesterone
What is the function of the ovaries?
to mature oocytes until ovulation, synthesizes androgens to estrogen, production of progesterone after ovulation (for 10-12 weeks to sustain early pregnancy)
What happens to the ovaries as women go through menopause?
they atrophy
How do you calculate ovarian volume?
0.523 x length x thickness x width
What are the normal volumes of a premenarchal, menstruating, and postmenopausal ovary?
premenarchal: 3-8cm cubed
menstruating: 9.8-21.9cm cubed
postmenopausal: 5.8-8cm cubed
What is oogenesis?
the development of an oocyte
What is the definition of ovulation?
release of mature oocyte from ovary
What is the definition of fertilization?
when sperm meets with oocyte
What is a zygote?
result of fertilization
What is gravidity?
number of pregnancies
What is parity?
number of births/fetus past 20 weeks/fetus of 500g or more
What is the size of a mature follicle?
around 2cm
What is another name for a mature follicle?
Graafian follicle
How does a congenital anomaly occur?
when embryonic mullerian ducts do not: elongate, fuse, and form lumens between the seventh and twelfth week of embryonic development
If a mullerian anomaly is found, what other organ should be examined?
kidneys
**What is vaginal atresia?
when vagina is abnormally closed or absent
**What is a unicornuate uterus?
a uterus that has a single horn and a cigar shape
Does a unicornuate uterus cause infertility?
yes; ovulation is normal, but once baby starts to grow, there is not enough room causing 2nd trimester miscarriages
**What is uterus didelphys?
complete duplication of uterus, cervix, and vagina
Does a didelphys uterus cause infertility?
yes; ovulation is normal, but once baby starts to grow, there is not enough room causing 2nd trimester miscarriages
**What is a bicornuate uterus?
the duplication of uterus with a common cervix
What is the shape of a bicornuate uterus?
heart shaped
Does a bicornuate uterus cause infertility?
yes; ovulation is normal, but once baby starts to grow, there is not enough room causing 2nd trimester miscarriages
**What is a septate uterus?
two uterine cavities that are seen closely spaced with one fundus
Does a septate uterus cause infertility?
yes; ovulation is normal, but the septum is inadequate for plantation resulting in 1st trimester miscarriages
**What is a T-shaped uterus?
uterus is normal in size and shape externally, but the cavity is t-shaped with irregular contour
How is a T-shaped uterus developed?
related to exposure to drug diethlstibestrol (DES) in utero
What is the most common cause of precocious pseudopuberty?
excessive exogenous synthesis of gonadal steroids
What is the most common cause of female pseudohermaphrodites?
congenital virilizing adrenal hyperplasia
**What is the normal sonographic appearance of the ovaries?
varies with age and menstruation
homogeneous, more echogenic medulla, follicles around periphery
What is the sonographic difference between an ovulatory follicle and a subdominant follicle?
a subdominant follicle will not ovulate, it will be misshapen, thin walls, scalloping, less vascularized
**What does the endometrium measure in the late proliferative phase, around ovulation?
6-10mm
**Summarize all uterine sizes during a lifetime.
neonatal: 3.5cm long (f-c ratio 1:2) 2-3 mo: 2.5-3cm long (f-c ratio 1:1) pediatric: increases in size after age 7 pediatric: 5-7cm long (f-c ratio becoming 3:1) average premenarchal: 1-3cm long; 0.5-1cm wide menarchal: 6-8cm long; 3-5cm wide multiparity: increases by 1-2cm menopausal: 3.5-5.5cm long; 2-3cm wide
**Summarize all endometrial thicknesses throughout menstruation.
during menstruation: hypoechoic canal (3-4mm); heavy menses is anechoic canal and enhancement; late menses is thin, hyperechoic endometrium (2-3mm)
early proliferative: hypoechoic (4-8mm)
late proliferative: three line appearance (6-10mm)
secretory: increasing thickness and echogenicity, endometrium becoming isoechoic (7-14mm)
postmenopausal: thin, echogenic strip (<5mm)
HRT postmenopausal: 10-14mm
