OB Broad Perspective and Anatomy of Female Repro Flashcards
Leading cause of women’s death worldwide as of 2013
Cardiovascular disease
Leading cause of maternal death in the Philippines
Pregnancy related complications
An average of _ among <20 y/o population has already been pregnant at least once
22%
No. of times pregnant, regardless of the duration or outcome (how many times have you been pregnant?)
Gravida
Delivered before 37 weeks
Preterm birth
Number of abortion that took place in the Philippines (2008)
500,000
Number of women who sought treatment for complications after abortion
90,000
Maternal causes of death in the Philippines
Complications related to pregnancy thru labor, delivery, & puerperium (38.4%)
Hypertension (35.2%)
Postpartum hemorrhage/uterine atony (17.3%)
Abortive outcome (9.1%)
Deals with child birth and treatment of the mother before and after childbirth
Deals with pregnancy, labor, & puerperium (6 weeks after childbirth, mother recovers to non pregnant state)
Obstetrics
Maternal mortality rate in the Philippines
162 deaths per 100,000 live births
Infant mortality rate in the Philippines
19.34 deaths per 1,000 live births
External generative tract
Mons pubis Labia majora and minora Clitoris Hymen Vestibule Vagina Perineum Bartholin's Para urethral glands Uretha
Internal generative tract
Uterus
Cervix
Oviducts/Fallopian tubes
Ovaries
Also known as mons veneris
A fat filled cushion
Forming the escutcheon
Contains many nerve endings
Mons pubis
Mons pubis
Function: padding during coitus
Embryo: from fusion of labioscrotal swellings
Histo: stratified squamous keratinized epithelium
Blood supply: inferior epigastric artery & deep external pudendal artery
Lymphatics: superficial inguinal lymph nodes
Innervation: ilioinguinal & genitofemoral nerves
Innervation of mons pubis
Ilioinguinal and genitofemoral nerves
Has rich venous plexus that may develop varicosities during pregnancy due to increased venous pressure by the enlarged uterus
Labia majora
Continuos with the mons pubis superiorly
Posteriorly, merge over the perineal body to form the posterior commisure
Round ligaments terminate at its upper border
Labia majora
Highly sensitive (coitus)
Homologous with male scrotum
From labioscrotal swellings
Labia majora
Blood supply of Labia majora
Internal pudendal artery
Venous plexus
Innervation of Labia majora
Ilioinguinal & genitofemoral nerves
Posterior labial nerves
Histology of labia majora
Keratinized stratified squamous
Apocrine, eccrine, & sebaceous glands
Dense CT with elastic fibers and adipose
Length: 7-8cm
Depth: 2-3cm
Thickness: 1-1.5cm
Labia majora
Paired, thin, hairless tissue fold medial to the labia majora
Length: 2-10cm
Width: 1-5cm
Labia minora
2 lamellae of the Labia minora
Upper: fuse to form prepuce (hood) of clitoris
Lower: frenulum of the clitoris
Fuse in midline as low ridges of tissue called FOURCHETTE
Highly sensitive (coitus)
Labia minora
Derived from urethral (urogenital) folds
Homologous to ventral shaft of penis
Labia minora
Histology of labia minora
Outer: thinly keratinized stratified squamous
Inner: lateral portion same as outer.
Medial to Hart line: non keratinized
Dermis: CT with elastic fibers, sm, and sebaceous glands
Lacks hair follicles, eccrine, and apocrine glands
Blood supply of labia minora
Internal pudendal artery and dorsal artery of the clitoris
Lymphatics and Innervation of Labia minora
Lymphatics: deep inguinal nodes
Innervation: dorsal nerve of clitoris and post. labial nerve (perineal nerve)
Beneath prepuce & above the frenulum and urethra
Projects downward and inward towards vaginal opening
Length: 2cm
Clitoris
Clitoris is composed of
Glans (stratified squamous), corpus, and 2 crura
Principal female erogenous organ
Clitoris
Derived from genital tubercle
Erectile homologue of the penis
Clitoris
Histology of Clitoris
Keratinized stratified squamous without dermal appendages
Abundant in erectile tissues
Blood supply of clitoris
Deep artery of clitoris (branch of internal pudendal artery) -body of clitoris
Dorsal artery of clitoris - glans and prepuce
Lymphatics of clitoris
Deep inguinal nodes
Internal iliac nodes
Innervation of clitoris
Inferior hypogastric plexus
Dorsal nerve of the clitoris (from pudendal nerve)
An almond shaped area. Functionally mature female structure
Vestibule
Vestibule
Laterally: Hart line
Medially: external hymen
Anteriorly: frenulum of clitoris
Posteriorly: fourchette
Posterior portion of vestibule is called
Fossa navicularis
- posterior portion between fourchette and vaginal opening
- seen only in nulliparas
Six opening of vestibule
Urethra
Vagina
2 bartholins
2 skenes
Vestibule is derived from
Urogenital membrane
Histology of vestibule
Non keratinized stratified squamous
Minor vestibular glands (acini) -mucinous columnar epi
Also known as greater vestibular glands
Major glands measure 0.5-1cm
Bartholin glands
Measure 1.5-2cm and open distal to the hymenal ring (at 5 & 7 o’clock position on the vestibule)
Bartholin glands
May swell & obstruct to form cyst or abscess (following trauma or infection)
Bartholin glands
Lie inferior to vestibular bulbs & deep to inferior end of the bulbocavernousus muscle
Bartholin glands
Also known as skene’s glands
Obstruction & inflammation may lead to urethral diverticulum
Paraurethral glands
Lower 2/3 lie immediately above vaginal canal
Urethra
Length: 2-3cm
Too short that makes female more prone to UTI
Upper portion of vagina is separated from the rectum by
Cul-de-sac or pouch of Douglas
Vagina is anteriorly separated from the bladder and rectum by
Vesicovaginal septum
Vagina is posteriorly separated from the rectum by
Rectovaginal septum
Anterior wall: 6-8cm
Posterior wall: 7-10cm
Vagina
Transport of sperm, serves as birth canal, physiologic changes during arousal (vasocongestion & lubrication)
Vagina
Embryology of vagina
Upper 1/3: Müllerian duct (paramesonephric)
Lower 2/3: urogenital sinus
Histology of vagina
Epithelial layer: non keratinized stratified squamous
(Premenopausal, lining becomes thin with folds - rugae)
Muscular layer: sm, collagen, & elastin
Adventitial layer: collagen & elastin
No glands
Blood supply of Vagina
Proximal: cervical branch of uterine artery & vaginal artery
Posterior: middle rectal artery
Distal: internal pudendal artery
Venous plexus
Lymphatics of vagina
Upper 3rd: external, internal, and common iliac nodes
Middle 3rd: internal iliac nodes
Lower 3rd: inguinal lymph nodes
Innervation of upper vagina
Uterovaginal plexus
Innervation of lower vagina
Pudendal nerve
Surrounds vaginal orifice
Hymen
Diamond shaped area with boundaries that mirror those of the bony pelvic outlet
Perineum
Boundaries of the perineum
Anterior: pubic symphysis
Anterolateral: ischiopubis rami & ischial tuberosities
Posterolateral: sacrotuberous ligaments
Posterior: coccyx
Fibromuscular mass found in the midline at the the junction between the anterior and posterior triangle of the perineum
Perineal body or central tendon of the perineum
Provides perineal support
Homologous with male’s corpora spongiosa
Vestibular bulbs
Contents of superficial space of anterior triangle
Bartholin glands Vestibular bulbs Clitoral body and crura Pudendal vessels and nerves Ischiocavernosus Bulbocavernosus Superficial transverse perineal muscles Superficial space bounded by Colles fascia and perineal membrane
Helps maintain clitoral erection by compressing the crus of clitoris by obstructing venous drainage
Ischiocavernosus muscles
Constrict vaginal lumen and aid release of secretion from bartholin glands
Contributes to clitoral erection by compressing the deep dorsal vein of the clitoris
Bulbocavernosus muscles
Contents of deep space of anterior triangle
Urethra and vagina
Internal pudendal artery
Urethrae and urethrovaginal sphincter muscles
Deep space is continuous with the pelvic cavity
Happens when veins in vestibular bulbs lacerate or even rupture due to child birth
Vulvar hematoma
Size of uterus in multiparous women
9-10 cm
6-8cm in nulliparous
Functions of the uterus
Implantation
Pregnancy support
Labor and delivery
Menstruation
Uterus is derived from
Paramesonephric (Mullerian) ducts
Histological parts of the uterus
Myometrium: sm bundles with elastic fibers and blood vessels
Endomentrium: basalis and functionalis
Blood supply of uterus
Uterine artery (from int Iliac artery)
Ovarian artery (from aorta)
Venous drainage of Uterus
Arcuate veins Uterine vein Int Iliac vein Common iliac Veins in pampiniform plexus Ovarian vein Rt ovarian vein Inf vena cava Left ovarian vein Left renal vein
Lymphatics of uterus
Internal iliac nodes and para aortic nodes
Innervation of uteus
Autonomic - pelvic viscera
Sympa - presacral nerve/ superior hypogastric plexus (T10-12)
Para- anterior rami of S2-4 / pelvic splachnic nerves
Components of Inferior Hypogastric Plexus (Pelvic Plexus)
2 hypogastric nerves (sympa) + 2 pelvic splachnic nerves (para)
3 divisions of inferior hypogastric plexus
Vesical - bladder
Middle rectal - rectum
Uterovaginal - uterus, proximal fallopian tubes, and upper vagina
Upper cervical segment that lies above the vagina’s attachment to the cervix
Portio supravaginalis
Cervical segment that protrudes into the vagina
Portia vaginalis
Fusiform in shape
Cervix
Serves as opening of the uterus (sperm transport/ barrier & chilbirth)
Attaches the uterus to vagina
Cervix
Epithelium of endocervix
Columnar mucin-secreting epithelium
Epithelium of ectocervix
Non-keratinized stratified squamous
Where squamous and columnar epithelium of the cervix meets
Squamo-columnar junction
Blood supply of cervix
Cervicovaginal artery (from uterine artery)
Lymphatics of cervix
Internal iliac nodes
Innervations of cervix
Uterovaginal plexus
Sensory afferent: pelvic splanchnic n. (S2-S4)
Oval organs located in the upper pelvic cavity
Rests on ovarian fossa of Waldeyer
Ovary
The female gonad
Supported by uteroovarian ligament
Ovary
Produces mature germ cells (ova)
Source of female hormones
Ovary
Develops from mesothelial layer of the epithelium (coelomic epithelium)
Ovary
Epithelium of Ovary
Epithelium: simple cuboidal (germinal layer of Waldeyer)
Cortex: oocytes & developing follicles
Medulla: loose CT, arteries and veins, & smooth muscle fibers
Blood supply of ovary
Ovarian artery (from abdominal aorta)
Ovarian branch of uterine artery
Ovarian vein
Lymphatics of ovary
Lateral aortic nodes
Innervation of ovary
Ovarian plexus (sympa) Hypogastric and aortic plexus Vagus nerve (parasympa) Sensory afferents (T10)
Also called oviducts
Fallopian tubes
Tubular structures arising from the uterine cornua
Length: 8-14cm
Fallopian tubes
Where fertilization and ectopic pregnancy usually occurs
Ampulla
Covered by mesosalpinx at the superior margin of the broad ligament
Isthmus, ampulla, & infundibulum
Conduit of sperm and site of fertilization
Fallopian tubes / oviducts
Important in ovum transport
Tubal peristalsis created by the cilia and muscular layer contractions (endosalpinx of fallopian tubes)
Provides support to the uterus and other pelvic structures
Ligaments
4 major ligaments
Round ligament
Broad ligament
Cardinal ligament
Uterosacral ligament
RBCU
Corresponds embryologically to the male gubernuculum testes
Round ligament
Passes thru inguinal canal and terminates at upper portion of labia majora
Round ligament
Branch of uterine artery that runs within the round ligament
Sampson artery
Two winglike structures from lateral uterine margins to the pelvic sidewalls
Broad ligament
Divides the pelvic cavity into anterior and posterior compartments
Broad ligament
Also known as transverse cervical ligament or Mackenrodt ligament
Cardinal ligament
Originates at the supravaginal portion of the cervix and inserts into the fascia over sacrum
Uterosacral ligament
Aids in fallopian tube identification during puerperal sterilization
Round ligament
Male homologous for scrotum
Labia majora
Male ventral shaft
Labia minora
Glans penis
Clitoris
For protection
Mon pubis
For sperm transport
Vagina
Episiotomy: surgical repair
Midline: easy
Mediolateral: more difficult
Episiotomy: blood loss
Midline - less
Mediolateral - more
Leading cause of maternal death worldwide as of 2014
Pre-existing maternal conditions (cardiovascular disease, renal disease, etc)