Module 1 : Female Pelvis Flashcards
Bones of the pelvis
Innominate
Sacrum
Coccyx
Innominate bones
Ilium
Ischium
Pubis
ALL MEET AT THE ACETABULUM
Boundaries of the pelvis
True pelvis and false pelvis divided by the ARCUATE LINE
Anteriorly
Superior margin of the symphysis pubis
Posteriorly
Sacral prominence
Arcuate Line
divides the true pelvis from false pelvis
LINEA TERMINALIS
PELVIC BRIM
ILIOPECTINEAL LINE
Structures in true pelvis and false pelvis
Inferior - uterus, ovaries, Fallopian tubes, vessels, muscles, some bowel, lymph nodes
Superior - bowel
Uterus segments
Fundus - right at the top
- Fallopian tubes enter here
Corpus (body)
Isthmus - between body and cervix PLACE WHERE UTERUS BENDS
Cervix - part of uterus; not its own thing
Uterine positions
Anteflexed - normal bend forward
Anteverted - normal tilt forward
Retroflexed - bend backward ( fundus lower than cervix)
Retroverted- tilt backwards ( unverted)
Uterus shape
Pear shaped in reproductive years and postmenopausal years
Bilobed in newborns and infants
Hollow structure
Uterus size
Infantile about 3cm long and 1cm thick
Neonatal is slightly larger than infant
REPRODUCTIVE : NULLIPAROUS 8x5x4 cm
- add one cm in all directions for multiparous
- coronal Plane is better for interrogation of endometrial canal
Uterine layers
Endometrium
-stratum functionalis (decidual)
\+ layer that is shed
-stratum basalis
\+ never shed; next layer of functionalis
Myometrium
-muscle layer
Perimetrium (Serosa)
-peritoneal coat
-Endometrium
Proliferative Phase (3 stripe phase) - 4 to 8mm (double layer) Secretory Phase (after ovulation) -7 to 14mm (double layer)
POSTMENOPAUSAL BLEEDING : <5mm (sign of cancer)
WITHOUT BLEEDING <9mm
POSTMENOPAUSAL BLEEDING MAY BE NORMAL IF WOMEN IS HRT (hormone replacement therapy)
Endometrial phases
Menstrual - <1mm Proliferative - 5 to 8mm Secretory - 9 to 14mm
- women on BCPs will have thin endometrium
Vagina relationships
Encases the cervix and creates fornices
Fornices - potential space around the cervix
Vagina attaches at level of the internal os
Cervix
Between vagina and uterus
External os- opening into vagina
Internal os- opening into uterus
Adnexa/ Fallopian tubes
Contained in the mesosalpinx of broad ligament
Fallopian tube - segments
Interstitial - narrowest
Isthmus - directly adjacent
Ampulla - longest and widest
-where fertilization takes place
- most common place of ectopic pregnancy
Infundibulum - contains fimbriae
Ovaries - location
Location is variable
- fossa of waldeyer
- LANDMARK FOR OVARIES IS INTERNAL ILIAC ARTERIES
Ovaries - structure
Cortex -outer -where follicles live Medulla -inner
Ovaries - size and shape
Reproductive years -ALMOND SHAPED - 6cc VOLUME - 3x2x2 CM - CAN BE UP TO 20cc Neonatal -wide range up to 3.66cc Infants -sausage shaped To menarche - upper normal of 8cc Post menopausal -1 to 5.8 cc - >8cc abnormal Normal adult -length 2.5 to 5 cm -width 1.5cm to 3cm - AP .6 to 2.2cm - volume 6cc
Blood supply for uterus
Aorta - CIA - IIA (hypogastric) - Anterior branch of IIA- uterus
Uterine Artery - arcuate Artery - radial Artery- straight arterioles ( supply basal layer) - spiral arterioles (supply decidual layer)
Venous return from uterus
Venous plexus (veins around uterus) - uterine vein - IIV - CIV - IVC
Blood supply for ovaries
Abdominal aorta to ovarian arteries to hilum of ovary
Venous return
- RIGHT OVARIAN VEIN TO IVC
- LEFT OVARIAN TO KEFT RENAL VEIN
- OVARIAN ARTERIES WILL FORM ANASTOMOSES WITH THE UTERINE ARTERIES (of ovary twists collateral blood supply comes from uterus this doesn’t happen in males)
Ligaments
2 broad ligaments (double fold peritoneum)
2 round ligaments
2 uterosacral ligaments
2 ovarian ligaments
2 suspenseful ligaments ( infundibulopelvic)
2 mesosalpinx and 2 mesovarium
Broad Ligament
Double fold of peritoneum that drapes over uterus and Fallopian tubes
- mesosalpinx
+ drapes over Fallopian tubes
- mesovarium
+ posterior portion of the peritoneum that attaches to the ovary
- project from broad ligament
Round ligament
Help hold uterine fundus and body in a forward position
- retroflexed uterus = weak round ligaments
Uterosacral ligaments
Help to anchor cervix posteriorly
Ovarian ligaments
Attach ovary to uterus
Suspensory ligaments of infundibulopelvic
Attach ovary to lateral pelvic wall
Muscles in abdominopelvis
Rectum abdominus - anterior wall of abdomen -linea alba \+ aponeoroses that fuse 2 rectus muscles as well as oblique and transverse muscles at the midline \+ very dense and gets in the way Psoas - posterior abdominal wall - part of iliopsoas muscle - extreme lateral aspect of pelvis
Muscles in false pelvis
Iliopsoas
- anterior and lateral in pelvis
- lateral to external iliac vessels
Muscles in true pelvis
Obturator internus muscle
Piriformis
Levator ani
Coccygeus
Obturator internus muscle
Side walls of pelvis
directly lateral to uterus
Hard to see
Piriformis
Posterior walls of pelvis
Posterior to cervix
Levator ani
Most inferior
Like a hammock with coccygeus for pelvic floor
Coccygeus
Posterior floor of pelvis
Perineum
Space between the thighs Urethra Vagina Rectum Coccygeus muscle Levator ani muscle \+pubococcygeus \+ iliococcygeus
Potential spaces
Intraperitoneal
-posterior cul de sac
\+ recto uterine pouch
\+ pouch of Douglas
-most posterior and inferior
-anterior cul de sac
\+ vesico uterine pouch
Extraperitoneal
-vaginal fornices
-space of retziusUrinary bladder
Variable states of distension can cause uterus to fold
Ureters
Travel inferior to ovaries and enter bladder posteriorly st trigone
Urethra
Makes up third point of trigone
Anterior to vagina
Trigone
Only area that does not expand or contract
Does not have specialized tissue
