Female Pelvic Anatomy - Clinical Correlates Flashcards
In a standing female, the female pelvis is oriented such that the _____ and the edge of the pubic symphysis are in the same vertical plane.
anterior superior iliac spine (ASIS)
The _______ is measured during pelvic examination to help assess the space to allow vaginal childbirth
superior pelvic aperture/pelvic inlet
The _____ diameter is from the pubic symphysis to the midpoint of the sacral promontory
anterior posterior diameter (AP)
The _____ diameter is the greatest width of the pelvic aperture measured between the _______.
transverse diameter between the linea terminalis (iliopectal line/pelvic brim)
Which is larger? anterior/posterior diameter or transverse diameter
transverse diameter
The distance between the iliac spines may be a barrier to childbirth if the distance is less than ______ cm
9.5
The ______ female pelvis has a wide, circular superior pelvic aperture with a wide pubic arch and widely spaced ischial spines – considered the most accommodating for vaginal delivery
gynecoid
M/F has a pelvis that is wider, shallower, and with a larger superior and inferior pelvic aperture
F
Why are women with a less vertically oriented pelvic inlet at an increased risk for pelvic organ prolapse?
because abdominal forces may have less transmission to the pubic symphysis and more pressure is directed towards the pelvic viscera and fibromuscular supports of the pelvic floor.
Women with a larger ______ diameter may be at a higher risk for pelvic organ prolapse due to a larger diameter for abdominal pressure transmission to the pelvic floor.
transverse diameter
Key pelvic muscles (skeletal)
levator ani, coccygeus, external anal sphincter, striated urethral sphincter, deep and superficial transverse perineal muscles
The levator ani complex is formed by what three muscles?
he pubococcygeus, the puborectalis, and the iliococcygeus.
The iliococcygeus muscle originates from the ________, a linear thickening of the fascial covering of the obturator internus
arcus tendineus levator ani (ATLA)
“Pelvic diaphragm” is composed of which 2 muscles/groups?
levator ani and coccygeus
T/F The skeletal muscles of the pelvic floor have the capacity to contract quickly at the time of an acute stress, such as a cough or sneeze, in order to maintain continence and to relax during voiding or defecation
T
During childbirth, the ________ portion of the levator ani muscle is the most likely skeletal muscle of the pelvic floor to be injured.
puborectalis
Injuries to the pelvic fascia and pubococcygeus muscles may result in a herniation of the bladder into the vagina called ______
cystocele
Herniation of the rectum into the
vagina is called _____
rectocele
Weakening of the __________ portion of the levator ani may result in urinary incontinence
pubovaginalis
Which pelvic wall muscles also rotates the thigh laterally?
obturator internus and piriformis
Which pelvic wall muscle also abducts the thigh?
piriformis
4 main arteries that enter the pelvis
middle sacral, internal iliac, superior rectal, ovarian
Anterior internal iliac artery branches
umbilical, obturator, vaginal, uterine, middle rectal, internal pudendal, inferior gluteal
Posterior internal iliac artery branches
superior gluteal, iliolumbar, lateral sacral
The sacral plexus is formed by the _____ trunk and the ventral rami of _________
lumbosacral trunk and ventral rami of S1 to S4
The
sciatic nerve is formed by the ventral rami of ____
L4-S3
The pudendal nerve arises from the ventral rami of ______
S2-S4
The pudendal nerve travels around the _____ ligament to enter the perineum through the _________ foramen.
sacrospinous ligament and lesser sciatic foramen
During childbirth, the fetal head may compress what structures producing lower limb and perineal pain?
pudendal nerve and sciatic nerve
The _____ originates from S3, S4, and/or S5 to innervate the coccygeus and the levator ani complex muscles
levator ani nerve
The obturator nerve arises from ______
L2-L4
The obturator nerve exits the pelvis through the ________
obturator foramen
____ course posteroinferiorly on the lateral wall of the pelvis, external to the parietal peritoneum and anterior to the internal iliac arteries.
ureters
The _____ adheres to the parietal peritoneum and runs anterior to the ureter on the posterior abdominal wall.
ovarian artery
As the ureter descends, it passes medial to the origin of the uterine artery and continues to the level of the ischial spine, where it is crossed superiorly by the ________.
uterine artery
Why is the ureter vulnerable to injury during pelvic surgery in women?
The ureter may be inadvertently damaged during a hysterectomy when the uterine artery is tied off. The point of crossing of the uterine artery and ureters lies about 2cm superior to the ischial spine. The left ureter tends to be very close to the later aspect of the cervix. The ureter also lies close to the ovarian vessels and can be damaged during oophorectomy
The bladder is separated from pubic bones by the _____ space
retropubic
In the female, the peritoneum is reflected from the superior surface of the bladder near its posterior border onto the anterior wall of the uterus forming the _______ pouch of the peritoneum.
vesicouterine
Lymphatic drainage of the superior bladder is through the _________
external iliac lymph nodes
Lymphatic drainage of the inferior bladder is through the ______
internal iliac lymph nodes
Why is the urethra more prone to infection in the female?
it is open to the vestibule oft he vagina and shorter than in the male
The _____ is a recess around the cervix.
Fornix
The posterior fornix is called the _______.
rectouterine pouch
Through what pouch can the peritoneal cavity be accessed vaginally.
rectouterine pouch
What procedure is commonly performed through the rectouterine pouch as part of in vitro fertilization?
oocyte retrieval
How is vaginal distention limited laterally?
by the space between ischial spines
What tools are used to visualize the vagina and cervix?
speculum and colposcope
The upper 2/3 of the vagina drains lymph via ____
internal and external iliac lymph nodes
The lower 2/3 of the vagina drains lymph through the _____
superficial inguinal lymph nodes
In _____ women, the uterus is inclined and bent anteriorly (anteverted and anteflexed)
nulliparous
A ____ uterus is inclined posteriorly
retroverted
3 layers of the uterus
endometrium, myometrium, serosal
5 ligaments of the uterus
uteroovarian, round, broad, cardinal, uterosacral
Which ligaments are important for supporting the uterus and vagina in the pelvis?
uterosacral and cardinal ligaments
How does the fundus of the uterus drain lymph?
aortic, external iliac, superficial inguinal lymph nodes
How does the uterine body drain lymph?
external iliac lymph nodes
How does the cervix drain lymph?
internal iliac and sacral lymph nodes
4 parts of the fallopian tubes
infundibulum, ampulla, isthmus, uterine
Where is the oocyte fertilized?
ampullla of the fallopian tube
How is tubal obstruction diagnosed?
hysterosalpingography (radiographic procedure)
What is a common cause of female infertility that involves the fallopian tubes?
tubal obstruction
What kind of common female sterilization is performed laparoscopically or via abdominal incision?
tubal ligation
______ is inflammation of the fallopian tubes and is often associated with ______ in women.
salpingitis associated with pelvic inflammatory disease (PID)
How does the anatomy of the pelvic viscera make women prone to salpingitis?
Because the female genital tract is in direct communication with the peritoneal cavity. Bacteria that invade the vagina may ascend through the cervical canal, endometrial cavity and through the fallopian tubes to cause a peritoneal infection.
______ is the most common ectopic gestation.
tubal pregnancy –> zygote implants in mucosa of fallopian tube
What may be a consequence of not diagnosing tubal pregnancy early?
rupture of the fallopian tube with massive intra-abdominal bleeding
How do the fallopian tubes drain lymph?
aortic lymph nodes
T/F after menopause, ovaries atrophy
T –> 1/2 size
Where in the pelvis are ovaries located?
ovarian fossa
The _____ ligament forms the anterior boundary of each ovary
medial umbilical ligament
Ovaries are bounded posteriorly by what structures?
ureter and internal iliac artery
What structure contains the ovarian vessels and nerves?
suspensory ligament of the ovary
How do the ovaries drain lymph?
aortic lymph nodes
A line connecting the ischial tuberosities divides the perineum into what 2 triangles?
anal and urogenital
the _____ is a thick fibrous sheet that spans the urogenital triangle and fixes the distal urethra, distal vagina, and perineal body to the pubic arches
perineal membrane/urogenital diaphragm
the ______ lies between the perineal membrane and the inferior aspect of the levator ani muscles
deep perineal space
What structures lie in the deep perineal space?
external urethral sphincter, deep transverse perineal muscles
What structures lie within the superficial perineal space?
bulbospongiosus, ischiocavernosus, superficial transverse perineal muscles
The ______ is a fibromuscular mass anterior the anus that is formed by a portion of the puborectalis, bulbospongiosus, superficial transversus perineal, and the anterior portion of the external anal sphincter//and plays a role in support of the distal vagina and in normal anorectal function.
perineal body
How does trauma to the perineal body during childbirth promote pelvic organ prolapse?
Tearing at the PB can result an enlarged vaginal orifice with subsequent prolapse of the vaginal wall.
______ is a relaxing incision made through the posterior vaginal mucosa, perineal skin, perineal body, and the superficial transverse perineal muscle.
episiotomy
Why is episiotomy performed during childbirth?
to prevent inevitable tears during final stages of childbirth
What is a common complication of a midline episiotomy?
incision extends to involve external anal sphincter
What is a mediolateral episiotomy?
involves incising the posterior vagina, skin, and bulbospongiosus muscle to avoid the external anal sphincter
