Obstetric Anatomy & Examination Flashcards
Brief descriptions of what organs must be examined and what to look for.
Describe the vulva
The vulva comprises the entrances to the vagina and urethra, the structures which surround them (clitoris, labia minora, and fourchette), and the encircling labia majora and perineum. The hymen, when broken (by tampons or intercourse) leaves tags at the mouth of the vagina (carunculae myrtiformes).
What are you looking for on examination of the vulva?
Rashes; atrophy; ulcers; lumps; deficient perineum (you can see the back wall of the vagina); incontinence.
Describe the vagina.
The vagina is a potential space with distensible folded muscular walls. The contents of the rectum, which runs behind the posterior wall, are palpable through the vagina. The cervix projects into the vault at the top which forms a moat around it, deepest posteriorly, conventionally divided into anterior, posterior, and 2 lateral fornices. From puberty until the menopause lactobacilli in the vagina keep it acidic (pH 3.8-4.4), discouraging infection.
What are you looking for on examination of the vagina?
Inflammation; discharge; prolapse.
Describe the cervix.
The cervix is mostly connective tissue. It feels firm, and has a dent in the centre (the opening, or os, of the cervical canal). Mucin-secreting glands of the endocervix lubricate the vagina. The os is circular in nulliparous women, but is a slit in the parous.
What are you looking for on examination of the cervix?
Pain on moving the cervix (excitation); ectopy; cervicitis and discharge; polyps, carcinoma.
Describe the uterus.
The uterus has a thick muscular-walled body lined internally with columnar epithelium (the endometrium) connected to the cervix or neck. It is supported by the uterosacral ligaments. The peritoneum is draped over the uterus. The valley so formed between it and the rectum is the rectovaginal pouch (of Douglas), and the fold of peritoneum in which the Fallopian tubes lie is known as the broad ligament. The size of the uterus is by convention described by comparison with its size at different stages of pregnancy. Since that is variable, estimates are approximate, but the following is a guide: non-pregnant—plum-sized; 6 weeks—egg; 8 weeks—small orange; 10 weeks—large orange; 14 weeks—fills pelvis.
In most women the uterus is anteverted, ie its long axis is directed forward and the cervix points backwards. The body then flops forwards on the cervix—anteflexed. An anteverted uterus can be palpated between the hands on bimanual examination (unless she is obese, or tense, or the bladder is full).
In 20% it is retroverted and retroflexed.
What are you looking for on examination of the uterus?
Position (important to know for practical procedures); mobility (especially if retroverted); size; tenderness.
Describe the adnexae
The adnexae are the Fallopian tubes, ovaries, and associated connective tissue (parametria). They are palpated bimanually in the lateral fornices, and if normal may not be felt. The ovaries are the size of a large grape and may lie in the rectovaginal pouch.
What are you looking for on examination of the adnexae?
Masses & tenderness.
