Female Reproductive Anatomy Flashcards
What is the pelvic skeleton composed of?
- sacrum and coccyx
- two innominate bones (os coxae)
What do the sacrum and coccyx form?
posterior wall
What do the two innominate bones form? What do the innominate bones consist of?
- anterior and lateral walls
- consist of the fused ilium, ischium and pubis
What are the 3 functions of the female pelvis?
- provide a weight-bearing bridge between the spinal column and bones of the lower extremities
- direct the pathway of the fetal head during childbirth
- protect the organs of reproduction
What is the line terminalis?
- imaginary line extending from the sacral promontory to the symphysis pubis
- divides the pelvic cavity into 2 regions
Where is the false pelvis? What are it’s boundaries? What is another name for it?
AKA greater pelvis
- located above linea terminalis
Boundaries:
- abdominal wall
- base of sacrum
- iliac wings (lateral)
Where is the true pelvis? What are it’s boundaries? What is another name for it?
AKA lesser pelvis
- located below the linea terminalis
Boundaries:
- pubis and pubic rami (anterior)
- sacrum and coccyx (posterior)
- ilium and ischium (lateral)
- muscles of pelvic diaphragm (inferior)
In a non-gravid patient, where are the uterus, ovaries and adnexa located?
true pelvis
The ______ ligaments connect the pelvic bones together and the ______ ligaments support the uterus and ovaries.
- osseous
- suspensory
Name the 4 osseous ligaments and what they involve.
- sacroiliac – attach sacrum and iliac bones
- sacrosciatic – sacrum, iliac and coccyx
- sacrococcygeal – sacrum and coccyx
- pubic – the two pubic rami
Name the 7 suspensory ligaments.
- cardinal (lateral cervical)
- broad
- uterosacral
- round
- ovarian
- mesovarium
- infundibulopelvic (suspensory)
Pelvic ligaments are generally seen sonographically only in the presence of ______.
ascites
Describe the cardinal ligament and what it supports.
- connects to uterus at the level of the cervix (lateral cervix)
- supports the uterus and cervix
Describe the broad ligament.
extends from the lateral aspects of the uterus and attach to the lateral pelvic side wall
Which ligament is the only one we can see in the pelvis?
broad ligament
Which ligament provides posterior support?
uterosacral
Describe the round ligament.
- situated anterior and inferior to the broad ligaments and fallopian tubes
- attaches the uterine cornu to the anterior pelvic wall
Which ligament can cause low anterior pain in pregnancy?
round ligament
Describe the ovarian ligament.
attaches the inferior ovary to the uterine cornu
Describe the mesovarium ligament.
attaches the ovary to the posterior layer of the broad ligament on each side
Describe the infundibulopelvic ligament? What is another name for this?
AKA suspensory ligament
- attaches the lateral ovary to the posterolateral pelvic wall and transmit the ovarian vessels and nerves
The rectus abdominus muscle forms much of the _________ body wall and extends from ______ to _________.
anterior
xiphoid to pubic symphysis
Which muscle is responsible for refraction/ghosting artifact sometime seen while imaging the midline pelvis transversely?
rectus abdominus
The psoas major muscle originates from __________ and ____________. It courses _______ and _______ through the abdomen.
lower thoracic and lumbar vertebrae
laterally and anteriorly
Which muscle is most likely to be mistaken for an ovary sonographically?
iliopsoas muscle
Below the level of the ________, fibers of the psoas major muscle begin to merge with fibers from the medial aspect of the _______ muscle. This forms the _________ muscle.
- iliac crest
- iliacus
- iliopsoas
Which muscle inserts on the lesser trochanter of the femur?
iliopsoas muscle
The iliacus muscle arises at the _________ and extends _________ until it merges with the _________.
- iliac crest
- inferiorly
- psoas major
Which muscle forms part of the lateral margins of the pelvic basin?
iliacus muscle
The obturator internus muscle is a _______ sheet of muscle anchored along the brim of the _____ pelvis.
- triangular
- brim
The obturator internus muscle extends ________ and _______ along the side wall of the ____ pelvis. It passes beneath the ________ to exit through the ______________.
- posteriorly and medially
- true pelvis
- levator ani
- lesser sciatic foramen
The obturator internus is a ________ muscle.
hypoechoic
Piriformis muscle is located __________ in the _______ pelvis.
deeply posterior, true pelvis
Which muscle is not well seen due to it’s deep location?
piriformis muscle
What muscles is the pelvic diaphragm composed of?
- coccygeus
- levator ani
Name the pelvic diaphragms 2 functions.
- resist increased intra-abdominal pressure (coughs, sneezes, Valsalva)
- resist gravity (standing up)
(supports urethra, rectum and vagina like a sling)
Which orifices pass through the levator ani? Name them from anterior to posterior.
- urethra
- vagina
- rectum
The levator ani muscle group is located between the ______ and ______. It forms the ____________________.
- pubis and coccyx
- anterior/middle pelvic floor
Which muscles are located in the true pelvis and which in the false pelvis?
True:
- obturator internus
- piriformis
- coccygeus
- levator ani
False:
- iliacus
Name the following muscle’s locations:
- rectus abdominus
- psoas major
- iliacus
- obturator internus
- piriformis
- coccygeus
- levator ani
- rectus abdominus: anterior wall
- psoas major: posterior wall
- iliacus: iliac fossa
- obturator internus: lateral wall
- piriformis: posterior wall
- coccygeus: posterior floor
- levator ani: middle and anterior floor
The urinary bladder is a hollow _____________ organ that is located between the ________ and _________.
- musculomembranous
- symphysis pubis and vagina
Where do the ureters insert on the bladder?
trigone: the inferior/posterior portion of the bladder
Name the 3 layers of the bladder wall
- outer epithelial layer
- middle muscular layer
- inner mucosal layer
The empty bladder has mucosal folds known as ______, and the walls are _____ so they can be demonstrated sonographically.
- rugae
- thick
When the bladder is distended, the _______ is stretched and no longer recognized as a distinct layer.
mucosa
When is the bladder considered adequately full?
when the dome (superior portion) of the bladder extends above the uterine fundus
How long is the vagina?
7-10cm
The vagina is a canal of _____ muscle that extends from the __________ to the _________.
- smooth
- external vaginal introitus to the uterine cervix
The ______ vaginal fornix is smaller than the ________ vaginal fornix.
anterior, posterior
Which fornix is a frequent site of vaginal fluid collections? What is this due to?
posterior, gravity dependence
What are the lateral fornices?
They surround the lateral aspect of the external cervix on either side
The uterus is located between the _______ and _______.
urinary bladder and rectum
The isthmus is also referred to as the ______________.
lower uterine segment
Which portion of the uterus is the most flexible portion and grows at the most rapid rate during pregnancy?
isthmus
What is the function of the cervix?
- provides an alkaline secretion favorable for sperm penetration
- acts as a sphincter during pregnancy
What is the endocervical canal?
the continuation of the endometrial cavity into the cervix
The cervix has an ________ os opening from the cervix into the uterus and an ________ os opening from the cervix into the vagina.
- internal
- external
A newborn uterus is ______ cervix, ______ body and fundus.
2/3 cervix, 1/3 body and fundus
A pediatric uterus is ______ cervix, ______ body and fundus.
1/2 cervix, 1/2 body and fundus
A postmenopausal uterus has ___________ proportions, which is ______ cervix, ______ body and fundus.
- normal adult proportions
- 1/3 cervix, 2/3 body and fundus.
What is the length and AP measurement of the uterus for the ages 2-8?
length: 33, AP: 7.5 (mm)
What is the length and AP measurement of the uterus for the ages 9-menarche?
length: 43, AP: 13 (mm)
What is the length and AP measurement of the uterus for the nulliparous?
length: 80, AP: 30 (mm)
What is the length and AP measurement of the uterus for the multiparous?
length: 90, AP: 40 (mm)
What is the length and AP measurement of the uterus for the postmenopausal?
varied, based on parity and years since menopause
Which layer of the uterus is the outer serosal layer, which is part of the visceral peritoneum?
perimetrium
Laterally, the perimetrium becomes the _________, anteriorly it forms the ___________ and posteriorly forms the ______________.
- broad ligament
- vesicouterine pouch (anterior cul-de-sac)
- rectouterine pouch (pouch of Douglas/posterior cul-de-sac)
What is the most dependent recess in the body?
rectouterine pouch
The _________ is the middle muscular uterine layer.
myometrium
The myometrium is composed of ___ layers of ______ muscle that contract during parturition. How does the myometrium appear sonographically?
- 3 layers of smooth muscle
- homogeneous
The inner portion of the myometrium sometimes looks hypoechoic, this is referred to as the __________.
junctional zone
What is the parametrium?
refers to the tissues surrounding the uterus (not a uterine layer!)
The endometrium is the _________ layer, which consists of the _________ layer and _________________ layer.
- inner mucosal
- superficial functional layer (stratum functionalis)
- deeper permanent basal layer (stratum basalis)
Measurements of the endometrium should be obtained in a _______ view and are taken in the _______ dimension.
sagittal, AP
Order the uterine layers from outer to inner.
perimetrium > myometrium > basal layer of endometrium > functional layer of endometrium
Describe anteversion.
Forward placement of the uterus at the cervix
- forms 90 degree angle with the vagina
Describe retroversion.
Tilting backward of the uterus at the cervix
- oriented more linearly in relationship to the vagina
Describe anteflexion.
bending forward of the uterus at the body
Describe retroflexion.
bending backward of the uterus at the body
- may become incarcerated during pregnancy
What is a symptom of incarceration with pregnancy?
urinary retention
What is the most common uterine position?
anteverted/anteflexed
What type of transducer is used for TV?
- higher frequency (>7.5 MHz)
- convex or phased array
How should a transvaginal transducer be cleaned?
high level disinfectant — NO autoclaving! (will lose PZT potential)
How do you decide if the uterus is flexed or verted?
x axis = flex
y axis = vert
What is the size and mean volume of an ovary before menopause? (varies with ovulatory stage)
size = 3.5 x 2.0 x 1.5 cm (up to 5cm in any one place is normal)
mean volume = less than or equal to 9.8 cm cubed
What is the size and mean volume of an ovary postmenopause? (varies with number of years since menopause)
size = 2.0 x 1.0 x 0.5 cm
mean volume = less than or equal to 5.8 cm cubed
What is the equation for ovarian volume in cm cubed?
length x width x AP x 0.523
What are the two layers of the ovary?
- cortex - outer functional layer
- medulla - inner ovary
The _______ of the ovary contains blood vessels and connective tissue/stroma.
medulla
The ______ of the ovary constitutes the bulk of the ovary and contains a large number of primordial and developing follicles.
cortex
Where is the hilum of the ovary located? What does this do?
- anterior surface
- channels the ovarian vessels and nerves
Where to the suspensory ligaments and fimbraiae of the Fallopian tube attach to the ovary?
superior surface
How long are the fallopian tubes? What is their function?
- 7-14cm
- transport fertilized ovum to the uterus by means of peristaltic contractions
Which region of the fallopian tube is narrow and relatively straight, located within the uterine wall (cornu)?
interstitial/intramural
Which region of the fallopian tube is the medial portion closest to the uterus (medial 1/3)?
isthmus
Which region of the fallopian tube is the longest portion?
ampulla
Which region of the fallopian tube is the outer portion with a trumpet shaped end?
infundibulum
Which region of the fallopian tube curves around the ovary and is thin walled and distendable?
ampulla
Which region of the fallopian tube has numerous finger-like projections that maintain a close relationship between the tube and ovary?
fimbriae
Which region of the fallopian tube is normally the fertilization?
ampulla
The space of retzius is also known as what? Where is it located?
AKA retropubic or prevesical space
- between the pubic bone and anterior urinary bladder wall
The vesicouterine space is also known as what? Where is it located? This space is usually ______, but may contain ______.
AKA anterior cul-de-sac
- anterior to the uterus and posterior to the bladder
- empty, may contain loops of bowel
The rectouterine space is also known as what? Where is it located?
AKA posterior cul-de-sac, pouch of Douglas
- posterior to the cervix, anterior to the rectum
Complex free fluid in the peritoneal recesses is associated with ________ or _______.
hemorrhage or infection/pus
Where does the abdominal aorta bifurcate?
L4
The external iliac arteries course through the ______ pelvis, adjacent to the ______ muscles and exit the pelvis through the femoral canals to supply the lower extremities.
- false
- psoas
The internal iliac (or ________) arteries dive deep into the pelvis and divide into ______ and ______ trunks. The anterior branches give rise to several arteries, including the _______ and ______ arteries.
- hypogastric
- anterior and posterior trunks
- uterine and vaginal arteries
The uterine arteries cross the _______ on each side and at the _____ ascend the lateral portion of the uterus within the _____ ligament. At the ______, they course laterally to reach the ______, where they end by joining each ________.
- ureters
- cervix
- broad
- cornu
- ovary
- ovarian artery
Name the branches of the uterine arteries from outer to inner (superficial to deep).
uterine > arcuate > radial > spiral
U are really smart
Which arteries supply the myometrium? Which arteries supply the deeper layers of the myometrium and endometrium? Which arteries supply just the endometrium?
myometrium = arcuate arteries
deep myometrium and endometrium = radial arteries
endometrium = spiral arteries
The uterine artery comes from the ________.
internal iliac artery
The ovarian arteries are lateral branches of the ______ and arise just below the level of the _______. They course to the pelvis and reach the ovarian ______ via the ________ ligament.
- aorta
- renal arteries
- hilum
- infundibulopelvic
In what region do the ovarian and uterine arteries anastomose and give rise to numerous branches?
uterine cornua
The venous anatomy of the pelvis _______ the arterial anatomy.
parallels
The right gonadal/ovarian vein empties into the ______ just below the level of the _______, wheel the left gonadal vein empties into the _______.
- IVC
- right renal vein
- left renal vein
The uterine venous plexus is ______ than the associated arterial channels and is seen sonographically.
larger
What veins may be associated with pelvic congestion syndrome?
dilated tortuous veins (>4-5mm) near the uterus and/or in the adnexa
What is a treatable cause of pelvic pain?
pelvic congestion syndrome
- veins can be embolized to reduce pain for pt
If the arterials don’t need much blood supply, they _______ or become ____ resistance.
clamp down, high resistance
Describe the Doppler characteristics of the uterine arteries in a non-gravid patient in regards to velocity and resistance. What is the difference in resistance between proliferative and secretory phase and in postmenopausal women vs women of reproductive age?
- moderate to high velocity
- high resistance flow
- higher resistance flow in proliferative than in secretory
- higher resistance flow in postmenopausal than in women of reproductive age
The radial arteries will have ______ resistance flow in proliferative phase than in secretory phase. These arteries are _______ to visualize in _________ women.
- higher
- difficult, postmenopausal
In the ovarian arteries during the follicular phase, flow is often _____ velocity and _____ resistance. In the periovulatory period and luteal phase, resistance _______ dramatically on the side with the ____________ (_____ PI and RI).
- low velocity
- high resistance
- drops
- dominant follicle
- lower PI and RI (low resistance flow)
In postmenopausal women, the RI’s of the ovarian arteries approaches ____ (_____ resistance) with increasing age.
1.0, high resistance
Any organ that is _______ to life will have high resistance and any organ that is ______ to life will have low resistance.
non-vital to life = high resistance
vital to life = low resistance
