female reproductive system: ovaries, uterus, pregnancy, cervix, delivery Flashcards
what are the organs of the reproductive system? (3)
gonads
reproductive tract
external genitalia
what is the function of gonads?
solid organs, gametes + organ production
what is the function of the reproductive tract?
hollow organ, gamete transport, embryofetal development
what is the function of external genitalia
coitus, the transit of gamete and fetus
what does internal genitalia consist of?
ovaries + genital tract
how is the genital tract split?
superiorly: uterine fallopian tubes, uterus, cervix
inferiorly: vagina and vulva (exterior)
what is the pelvic peritoneum?
it covers the superior genital tract
what are the boundaries of the pelvic peritoneum?
Ant: uterovesical pouch
Post: rectovaginal uterine pouch
Lat: broad ligaments
How is the broad ligament structured?
3 portions
what is the name of the superior portion of the broad ligament?
mesosalpinx
what is the name of the posterior portion of the broad ligament?
mesovarium
what is the name of the inferior portion of the broad ligament?
mesometrium
what are ovaries ?
paired solid organs
where are the ovaries located ?
suspended in pelvic cavity through mesovarium, close to pelvic walls, in ovarian Krause fossa
what is the size and appearence of the ovary
it is whitish, 4x2x3, in non pregnant woman doubles in size during pregnancy halves in menopause smooth surface before ovulation starts rough afterwards
what are the 2 surfaces of the ovary?
lateral surface (parietal peritoneum in ovarian fossa) medial surface (uterus and uterine vessels in broad ligament)
what are the 2 poles of the ovaries?
uterine pole(uterus lateral surface (ovarian ligament), tubal pole (uterine tube through ovarian fimbria and suspensory ligament),
what are the 2 borders of the ovaries?
anterior border(insertion of mesovarium) posterior border(free, indirectly relates to internal iliac vessels and ureter through parietal peritoneum).
what is the trajectory of the ovarian artery?
after crossing external iliac vessels–> enters in true pelvis–>enters in suspensory ligament–>branches into mesovarian branch (to ovary) and mesoalpinx branch (to tube)–>anastomosis with uterine artery on lateral border of uterus.
where does the ovarian artery originate from ?
from abdominal aorta below renal aorta
what is the trajectory of the ovarian veins?
usually merge distally, drain in inferior vena cava(right) and renal vein(left).
where do the ovarian veins originate from ?
from pampiniform venous plexus in mesovarium and suspensory ligament
what is the lymphatic drainage of the ovaries ?
lymphatic vessels follow ovarian veins
mostly drain in paraortic node(near renal arteries), partly in pelvic nodes in inferior paraortic nodes, rarely through inguinal nodes (through round ligament).
what is the imaging technique used for ovaries ?
ultrasound and laparoscopic evaluation
what are the 3 ligaments or support of the ovaries
Infundibulopelvic (suspensory) ligament
utero-ovarian ligament (ovarian)
mesovarium
how does the suspensory ligament support the ovary?
from lateral surface of ovary to pelvic wall, terminal portion of the broad ligament of the uterus, houses ovarian vessels
how does the ovarian ligament support the ovary?
fibro-muscular, connects ovary to lateral surface of the uterus, in broad ligament of the uterus
how does the mesovarium support the ovary?
short peritoneal fold, connects ovary to posterior portion of broad ligament
where is the ovarian fossa?
anterior to sacroilliac joint
1.5cm below pelvic inlet
what are the boundaries of the ovarian fossa?
sup: external iliac artery and vein
ant-inf: broad ligament of the uterus
post: ureter, internal iliac artery and vein
inf: obturator nerve, artery and vein
what is the Polycystic ovary syndrome?
excess LH, impaired follicle maturation, multiple follicular cysts, increased androgens production, infertility, insulin resistance, cardiometabolic features, obesity acne, hirsutism.
what is the ovarian torsion?
rotation of ovary around infundibulopelvic ligament, ovarian vessel occlusion, causes: irregular enlargement of the ovary such as cysts, enlarged follicle or corpus luteum…
what are uterine fallopian tubes?
paired hollow organs
where are uterine fallopian tubes?
intraperitoneal within the broad ligament (mesoalpinx).
where do the uterine fallopian tubes originate from?
Originate medially from superior lateral corners of uterus where opening in uterine cavity.
what is the trajectory of the uterine fallopian tubes ?
Run lateral superiorly to bend inferomedially to reach ovaries.
what are the 4 structural features of the uterine fallopian tubes?
intramural part
isthmus
ampulla
infundibulum
where is the intramural part of the fallopian tube?
within uterine wall, starts at uterine ostium (1x0.6cm)
what is the isthmus of the fallopian tube?
fixed muscular portion (5x0.03cm)
what is the ampulla of the fallupian tube?
enlarged with thin walls and irregularly folded internal surface (5x1cm)
what is the infundibulum of the fallopian tube?
trumpet shaped, opens laterally with the abdominal ostium, rimmed end with fimbriae, opens in peritoneal cavity
what provides the arterial blood supply to the fallopian tubes?
Lateral third: ovarian artery (branches in the mesosalpinx)
Medial 2 thirds: uterine artery
what provides the venous blood supply to the fallopian tubes?
lateral 2 thirds: pampiniform ovarian plexus–> ovarian veins (IVC and renal vein)
Medial third: uterine venous plexus–>internal iliac vein
what provides the lymphatic drainage to the uterine fallopian tubes ? (2)
ovarian lymph vessels (para-aortic nodes)
uterine lymph vessels (internal iliac nodes chain (through round ligament))
what is the uterus?
unpaired hollow organ, thick fibromuscular wall, uterine tube openings, vagina opening
where is the uterus located?
in true pelvis between bladder and rectum, in pelvic cavity (exact location varies with degree of distension of the bladder and age)
what is the shape and positioning of the uterus?
pear like shaped, flattened antero-posteriorly, normally anteverted(makes right angle with longitudinal axis of the vagina) and anteflexed(the longitudinal axis of the uterine body makes obtuse (170°) with cervix
What defines an abnormal positioning of the uterus?
excessive anteversion, retroversion, retroflexion.
what are the relations of the uterus?
ant: bladder and vesico-uterine pouch
post: rectum and recto-uterine pouch, sigmoid colon,
lat: broad ligaments, tubes at utero-tubal junctions (horns)
sup: small intestine and sigmoid colon
inf: vagina
what are the 5 types of support the uterus receives?
tone of pelvic floor = primary support ovarian ligament cardinal ligament uterosacral ligament round ligament
how does the cardinal ligament suport the uterus?
at the base of broad ligament, from cervix to pelvic walls, contains uterine vessels
how does the uterosacral ligament support the uterus?
it attaches it from cervix to sacrum
how does the round ligament support the uterus?
remnant of gubernaculum
extends from uterine horns to labia majora via inguinal canal
maintains anteverted position of uterus
how does the ovarian ligament support the uterus?
attaches ovaries to uterus
which artery irrigates the uterus
uterine artery
how does the ascending branch of the uterine artery irrigate the uterus?
ascending branch supports body and fundus and anastomoses with the ovarian artery
how does the descending branch of the uterine artery irrigate the uterus?
descending branch supports the cervix and anastomoses with vaginal artery.
how do the small curvy branches of the uterine artery irrigate the uterus?
Small curvy branches from each branch of uterine artery, through uterine wall, circumferentially in lateromedial direction
anastomoses across the midline on anterior + posterior wall
terminal (helicine) arteries form capillary plexa in myometrium and endometrium.
how is the venous drainage of the uterus working?
drains deoxygenated blood from uterus into uterine veins (2 on each side)
uterine veins then reach internal iliac vein.
Uterine plexus anastomosis with ovarian and vaginal plexa
what is the lymphatic drainage of the uterus?
Lymphatic vessels (superficial (below the peritoneum)and deep in uterine walls) Most collectors (body and cervix) drains into nodes in the parametrium (External iliac nodes, Internal iliac nodes, Obturator nodes)
how is the isthmus lymphatically drained?
drained through the round ligament in superficial inguinal nodes
what are the 3 portions of the uterus?
fundus
body
cervix
what is the fundus of the uterus?
lies above the utero-salpinx junctions (uterine horns), round ligaments found anteroinferior to the horns, ovarian ligaments found posteroinferior to the horns
what is the body of the uterus?
delimited by uterotubal junctions and internal orifice
what is the cervix of the uterus?
narrow tube in non-pregnant adults, communicating with the body through internal uterine orifice (IUO) and with the vagina through external uterine orifice (EUO).
what are the 2 different portions of the cervix?
supravaginal and vaginal
what is the supravaginal portion of the cervix?
separated from bladder by parametrium
what is the vaginal portion of the cervix?
protrudes into the vaginal canal
Based on different epithelial coverings, the cervix is divided into 2 other portions. What are they?
endocervix
ectocervix
what is the endocervix?
canal-like portion of the cervix continuing from the uterus below the IUO
what is the ectocervix?
protrudes into vaginal cavity–> visible and touchable during obgyn investigation
what are the imaging techniques used for the uterus ?
hysteroscopy, hysterosalpingography
what happens to the uterus during pregnancy?
increases in size and weight (from 50g to 1Kg) due to Hyperplasia, hypertrophy of tissues and vessels, Stretching of muscle fibers, Fluid retention.
what is the uterus size during pregnancy?
10 weeks: fills the entire pelvis 12 weeks: rises above the symphisis 20 weeks: umbilicus 36 weeks: xyphoid process of sternum 40 weeks: three fingers width below the costal arch.
what happens to the isthmus during pregnancy?
Isthmus progressively expands-> turns into the lower uterine segment (LUS) at 3° trimester
what is the lower uterine segment or LUS?
between the attachment of peritoneum of the vesicouterine pouch superiorly and the internal uterine orifice inferiorly.
Evaluated through bimanual palpation: assessment of compressibility, softening of LUS, while the cervix is still firm
what happens to the cervix during pregnancy and delivery?
During pregnancy (enables uterine self-constraint, supports the weight of the fetus) during last weeks of gestation (softens and shortens (changes in matrix composition and organization) during delivery (Expands to allow the fetus passing through the birth canal)
