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Semester 4 > Repro Session 5 > Flashcards

Repro Session 5 Flashcards

1
Q

What are the bony landmarks that are palpable O/E of the pelvis?

A

Iliac crest, linea terminalis, ischial spine and ischial tuberosity

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2
Q

What is the promontory?

A

Anterior superior edge of the 1st sacral vertebra

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3
Q

What is the false pelvis?

A

Above linea terminalis where a foetus of any size can be accommodated

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4
Q

What is the true pelvis?

A

Bony canal below linea terminalis that is solid and immobile

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5
Q

What allows a small amount of laxity in the true pelvis during pregnancy?

A

Hormones acting on the pubic symphysis

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6
Q

What are the two ligaments of the pelvis?

A

Sacrospinous and sacrotuberous

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7
Q

What is the pelvic inlet?

A

Boundary between the greater and lesser pelvis determining the size and shape of the birth canal

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8
Q

What are the alternative names of the pelvic inlet?

A

Linea terminalis and iliopectineal line

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9
Q

Where is the plane of greatest diameter in the pelvis?

A

From mid pubic symphysis to IV disc of S2/3

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10
Q

Where is the plane of least diameter found in the pelvis?

A

Inferior pubic symphysis to between S5 and coccyx (obstetric conjugate)

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11
Q

Where is the pelvic outlet found?

A

At the end of the lesser pelvis at the beginning of the pelvic wall

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12
Q

How is the pelvic outlet increased in pregnancy?

A

Hormones increase laxity of sacrotuberous and allow movement of the coccyx

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13
Q

What is assessed in the midpelvis on clinical examination?

A

Straight side walls and bispinous diameter (between ischial spines)

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14
Q

What is assessed at the pelvic outlet on clinical assessment of the pelvis?

A

Infrapubic angle and distance between ischial tuberosities

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15
Q

What is the obstetric conjugate?

A

Sacral promontory to midpoint of pubic symphysis

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16
Q

What is the diagonal conjugate?

A

Sacral promontory to inferior pubic symphysis

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17
Q

Which conjugate is used clinically to assess AP diameter of the pelvis and why?

A

Diagonal as the inferior pubic symphysis can be palpated

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18
Q

What are the differences between a gynecoid and android pelvis?

A

Gynecoid has wider ilium, flared alar, larger and more circular pelvic inlet, small ischial spines, straight side walls, larger sub-pubic angle, well curved sacrum and larger sciatic notch

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19
Q

What makes up the lateral border of the pelvic inlet?

A

Iliopectineal line

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20
Q

What forms the anterior border of the pelvic inlet?

A

Public symphysis

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21
Q

What forms the posterior border of the pelvic inlet?

A

Sacral promontory

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22
Q

What forms the anterior border of the pelvic outlet?

A

Pubic arch (inferior border of ischiopubic rami)

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23
Q

What forms the lateral border of the pelvic outlet?

.

A

Ischial tuberosity and sacrotuberous ligament

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24
Q

What forms the posterior border of the pelvic outlet?

A

Tip of coccyx

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25
Q

What are the 4 bones that form the pelvis?

A

2 inominate bones, sacrum and coccyx

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26
Q

What are the components of the broad ligament of the uterus?

A

Mesosalpinx, mesovarium and mesometrium

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27
Q

What are the components of the uterine tube?

A

Infundibulum, ampulla, isthmus and uterine part

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28
Q

Where do the ovaries develop?

A

Within the mesonephric ridge

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29
Q

What is the function of the mesovarium?

A

Attach ovary to posterior surface of broad ligament of the uterus

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30
Q

What type of mesothelium is found in the ovaries before puberty?

A

Simple cuboidal

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31
Q

What happens to the ovarian mesothelium with each ovulation?

A

Becomes scarred

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32
Q

What contains the ovarian vessels, lymph and nerves?

A

Suspensory ligament of the ovary

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33
Q

What is the ligament of ovary, found in the mesovarium, a remnant of?

A

Gubernaculum

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34
Q

What tethers the ovary to the uterus?

A

Ligament of ovary

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35
Q

What does the ligament of ovary continue as after attaching to the ovary?

A

Round ligament of uterus

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36
Q

Where are the ovaries typically found?

A

Laterally between uterus and lateral pelvic wall

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37
Q

What provides arterial supply to the ovaries?

A

Ovarian arteries, direct branches of AA

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38
Q

Where does the venous drainage of the ovaries empty?

A

L ovarian vein to L renal vein, R ovarian vein to IVC

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39
Q

Where does lymph from the ovaries drain?

A

Paraaortic nodes

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40
Q

What gives innervation to the ovaries?

A

Sympathetic from ovarian plexus, parasympathetic from uterine plexus

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41
Q

Approximately how long are the uterine tubes?

A

10 cm

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42
Q

Describe the position of the uterine tubes.

A

Lie in the mesosalpinx to form the free anterosuperior edge of broad ligament. Extend posterolaterally to lateral pelvic walls then arch anterior and superior to ovaries

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43
Q

Are the uterine tubes always symmetrical?

A

No, often asymmetrical

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44
Q

Describe the infundibulum of the uterine tubes.

A

One large ovarian fimbria attaches to the superior pole of the ovary and the rest spread over the medial surface

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45
Q

Which part of the uterine tube is the widest and longest and therefore best for fertilisation?

A

Ampulla

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46
Q

What is the connection of the uterine tube to the uterine horn called?

A

Isthmus

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47
Q

Describe the uterine part of the uterine tube.

A

Short intra-mural segment opening via the uterine ostium into the uterine cavity

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48
Q

Why is implantation in the uterine tube potentially catastrophic?

A

Lining is specialised for conduction and has a rich blood supply so gives huge risk of haemorrhage

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49
Q

What gives arterial supply to the uterine tubes?

A

Uterine and ovarian arteries

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50
Q

What gives venous drainage to the uterine tubes?

A

Uterine and ovarian veins

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51
Q

Where does lymph from the uterine tubes drain?

A

Iliac, sacral and aortic nodes

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52
Q

What gives innervation to the uterine tubes?

A

Ovarian and uterine plexuses and sensory afferents from T11-L1

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53
Q

What happens in ectopic tubal pregnancy?

A

Pyosalpinx causes formation of an adhesion so the blastocyst cannot pass to the uterus

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54
Q

What happens to oocytes following ligation of the uterine tubes?

A

Degenerate and are absorbed

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55
Q

What can develop in the Gartner (Wolffian) duct if it does not degenerate fully?

A

Cyst

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56
Q

How is bimanual examination of the uterus performed?

A

2 gloved fingers of R hand inserted into vagina whilst L hand is pressed inferoposteriorly on public region of anterior abdominal wall

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57
Q

What is Hegar sign?

A

Softening of isthmus indicates pregnancy (feels like cervix is away from body of uterus)

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58
Q

What is the clinical relevance of the recto uterine pouch?

A

Can drain pelvic abscess or aspirate accumulated peritoneal cavity fluid by culdocentesis

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59
Q

What does the exact position of the uterus depend on?

A

Distension of the bladder

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60
Q

What is the usual position of the uterus?

A

Anteverted w.r.t. vagina, anteflexed w.r.t.cervix so immediately posterosuperior to bladder and anterior to rectum

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61
Q

Which uterine positions increase the risk of uterine prolapse?

A

Anteflexed and retroverted. Retroflexed and retroverted

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62
Q

What are the components of the uterus?

A

Fundus, body and cervix

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63
Q

Where is the usual site of implantation of the blastocyst?

A

Body of uterus

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64
Q

What does the uterus develop as a result of?

A

Persistence of paramesonephric ducts due to absence of MIH

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65
Q

What happens to form the mesentery of the uterus, uterine tube and ovary?

A

Fusion of the uterus in the midline creates a broad transversus fold draped by peritoneum

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66
Q

How is the uterus supported in the pelvic cavity?

A

Dynamically by pelvic diaphragm and passive by its position

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67
Q

What happens to the uterus when intra-abdominal pressure increases?

A

It presses in the bladder

68
Q

What are the anterior relations of the uterus?

A

Uterovesicle pouch and superior surface of bladder

69
Q

What are the posterior relations of the uterus?

A

Rectouterine pouch containing loops of small intestine and anterior rectal surface

70
Q

What is the lateral relation of the uterus?

A

Peritoneal broad ligament

71
Q

Why can contiguous spread of cervical cancer to the bladder arise?

A

Close anterior relation of uterus and bladder

72
Q

What gives arterial supply to the uterus?

A

Uterine people artery from anterior internal iliac

73
Q

What gives venous drainage to the uterus?

A

Plexus in broad ligament that empties into the uterine and then internal iliac veins

74
Q

Describe the lymphatic drainage of the uterus.

A

Fundus: aortic and inguinal nodes. Body: external iliac nodes. Cervix: external and internal iliac nodes and sacral nodes

75
Q

What gives innervation to the uterus?

A

Uterovaginal plexus

76
Q

What is the internal os?

A

Junction between uterine cavity and endocervical canal

77
Q

What epithelium lines the endocervical canal?

A

Mucus-secreting simple columnar

78
Q

What is the external os?

A

Junction between the endocervical canal and ectocervix

79
Q

What epithelium lines the ectocervix?

A

Stratified squamous non-keratinised

80
Q

What forms the cardinal and utero sacral ligaments of the cervix?

A

Condensations of endopelvic fascia

81
Q

Where is the cardinal ligament of the uterus found?

A

Base of broad ligament extending from cervix to lateral pelvic walls

82
Q

What does the cardinal ligament of the cervix contain?

A

Uterine artery and vein

83
Q

What is the function of the cardinal ligament of the cervix?

A

Lateral stability

84
Q

What is the function of the uterosacral ligament of the cervix?

A

Maintain anteversion

85
Q

Where does the uterosacral ligament extend from and to?

A

From cervix to sacrum

86
Q

What gives arterial supply to the cervix?

A

Uterine artery

87
Q

What gives venous drainage to the cervix?

A

Uterine veins via uterine plexus

88
Q

What is the vagina?

A

Distensible musculomembranous tube 7-9 cm long from the middle cervix to the vaginal orifice

89
Q

Is the vagina usually collapsed or open?

A

Collapsed so lateral walls are in contact

90
Q

What is the vaginal fornix?

A

Recess around fornix with anterior, posterior and lateral parts

91
Q

Which part of the vaginal fornix is deepest and is related to the rectouterine pouch?

A

Posterior

92
Q

What is the glans of clitoris formed from?

A

Corpora cavernosa

93
Q

What does the vestibule of the vagina contain to secrete mucus?

A

Ducts of vestibular/Bartholin glands

94
Q

What are the Bartholin glands homologous to in the male?

A

Bulbourethral glands except these are in deep perineal pouch (Bartholin in superficial)

95
Q

What can be used as a landmark for anaesthesia of the pudendal, inferior cluneal, obturator, genitofemoral and ilioinguinal nerves?

A

Ischial spine

96
Q

What types of fistula can obstetric trauma lead to?

A

Vesicovaginal, urethrovaginal or rectovaginal

97
Q

What are the anterior relations of the vagina?

A

Fundus of urinary bladder and urethra

98
Q

What are the lateral relations of the vagina?

A

Levator ani, visceral pelvic fascia and ureters

99
Q

What are the posterior relations of the vagina from inferior to superior?

A

Anal canal, rectum and rectouterine pouch

100
Q

What are the 4 muscles that compress the vagina, acting as sphincters?

A

Pubovaginalis, EUS, urethrovaginal sphincter and bulbospongiosus

101
Q

What gives arterial supply to the vagina?

A

Uterine and vaginal arteries (internal iliac)

102
Q

What gives venous drainage to the vagina?

A

Vaginal venous plexus draining to uterine vein and internal iliac veins

103
Q

Where does lymph from the vagina drain?

A

Iliac and superficial inguinal nodes

104
Q

What gives innervation to the superior 4/5 of the vagina?

A

Uterovaginal plexus

105
Q

What gives somatic innervation to the inferior 1/5 of the vagina?

A

Deep perineal nerve from pudendal

106
Q

What gives arterial supply to the vulva?

A

Parked pudendal arteries (internal branch mainly)

107
Q

What gives venous drainage to the vulva?

A

Pudendal veins and smaller labial veins

108
Q

What happens in sexual activity to increase the size of the clitoris?

A

Veins of vulva engorge

109
Q

Where does lymph from the vulva drain to?

A

Superficial inguinal nodes

110
Q

What gives sensory innervation to the vulva?

A

Anterior from ilioinguinal nerve and genital branch of genitofemoral. Posterior from pudendal and posterior cutaneous nerve of thigh

111
Q

What gives parasympathetic innervation to the clitoris and vestibule?

A

Cavernous nerves from uterovaginal plexus

112
Q

Describe the structure of innervation above the pelvic pain line.

A

Visceral afferents from intraperitoneal uterine fundus and body follow sympathetic innervation to inferior thoracic and superior lumbar thoracic ganglia

113
Q

Describe the organisation of innervation below the pelvic pain line.

A

Afferent fibres from subperitoneal uterine cervix and vagina follow parasympathetic fibres through plexuses to S2-4 spinal ganglia

114
Q

What are the pros and cons of general anaesthesia for childbirth?

A

A: emergencies and mothers preference. D: needs maternal respiratory and maternal and foetal cardiac function monitoring

115
Q

What allows childbirth under general anaesthetic to be passive?

A

Hormones and obstetrician

116
Q

Where is spinal anaesthetic for childbirth administered?

A

Subarachnoid space of L3-L4

117
Q

What sensation is lost in spinal anaesthesia for childbirth?

A

Perineum, pelvic floor, birth canal, lower limbs and uterine contractions

118
Q

Why is electrical monitoring of uterine contractions needed in spinal anaesthesia for childbirth?

A

They cannot be felt by the mother

119
Q

What sensation is lost in pudendal anaesthesia for childbirth?

A

S2-4 dermatomes and inferior 1/4 of vagina

120
Q

What is the advantage of using pudendal anaesthesia for childbirth?

A

Uterine contractions are maintained

121
Q

How is a caudal epidural given in childbirth?

A

In-dwelling catheter placed in sacral canal between S2-4 in advance

122
Q

How is laparoscopic examination of the pelvic viscera performed?

A

Laparoscope into peritoneal cavity below umbilicus, insufflation of inert gas, elevate pelvis so gravity pulls intestines into abdomen and external manipulation of uterus as necessary

123
Q

What can laparoscopic examination be used for in the female reproductive tract?

A

Ovarian cysts, tumours, endometriosis and ectopic pregnancies

124
Q

What is the pelvic floor?

A

Muscular and fibrous tissue diaphragm that fills the lower pelvic canal, closes the abdominal cavity, defines the upper border of the perineum and supports the pelvic organs

125
Q

What is the function of the pelvic floor?

A

Continence, rotation of baby in childbirth, truncal stability (with abdominal muscles)

126
Q

What forms the lateral wall of the pelvic cavity?

A

R and L hip bones, obturator membrane and obturator internus

127
Q

What forms the antero-inferior pelvic wall?

A

Pubic bodies, rami and symphysis

128
Q

What forms the floor of the pelvic cavity?

A

Muscle and fascia of coccygeus and levator ani

129
Q

What forms the posterolateral wall of the pelvic cavity?

A

Sacrum, coccyx, anterior sacroiliac, sacrospinous and sacrotuberous ligaments

130
Q

What are the two holes in the pelvic floor for?

A

Anterior urogenital hiatus for urethra and vagina. Central rectal hiatus for anal canal

131
Q

Describe the arterial supply to all pelvic organs.

A

Internal iliac artery –> posterior trunk –> pudendal, vaginal and inferior rectal arteries

132
Q

Why is puborectalis a major component of anal continence?

A

Sling action gives 80 degree anorectal flexure

133
Q

What happens if the pudendal nerve is stretched during childbirth?

A

Neurapraxia-transient innervation loss and weakness of muscles causing anorectal incontinence

134
Q

What gives innervation to levator ani?

A

Pudendal nerve

135
Q

What are the spinal roots of the pudendal nerve?

A

S2-4

136
Q

What are the anatomical borders of the perineum?

A

Anterior: pubic symphysis. Posterior: tip of coccyx. Lateral: inferior public rami, inferior ischial rami and sacrotuberous ligament. Roof: pelvic floor. Base: skin and fascia

137
Q

What are the surface borders of the perineum?

A

Anterior: mons pubis/penis base. Lateral: medial surface of thighs. Posterior: superior end of intergluteal cleft

138
Q

What are the contents of the urogenital triangle form deep to superficial?

A

Deep perineal pouch, perineal membrane, superficial perineal pouch, deep perineal fascia, superficial perineal fascia and skin

139
Q

What is the deep perineal pouch?

A

Potential space between pelvic floor and perineal membrane

140
Q

What are the contents on the deep perineal pouch?

A

Urethra, EUS, bulbourethral glands and deep transverse perineal muscles

141
Q

Which muscles does the perineal membrane provide attachment for?

A

Superficial external genitalia muscles

142
Q

What is the perineal membrane perforated by?

A

Urethra and vagina

143
Q

What is the superficial perineal pouch?

A

Potential space between perineal membrane and fascia

144
Q

What are the contents of the superficial perineal pouch?

A

Erectile tissue, ischiocavernosus, bulbospongiosus, superficial transverse perineal muscles and bartholins glands

145
Q

What is the seep perineal fascia?

A

Fascia covering the superficial perineal muscles

146
Q

What is the superficial perineal fascia continuous with?

A

Fascia of abdominal wall

147
Q

What forms the labia majora and mons pubis?

A

Superficial fatty layer of superficial perineal fascia

148
Q

What is found in the anal triangle?

A

Anal aperture, external anal sphincter and 2 ischioanal fossae

149
Q

Where are the 2 ischioanal fossae located in the anal triangle?

A

Lateral to anus, continuous with ischioanal fat

150
Q

What are the pros and cons of a midline tear/episiotomy in childbirth?

A

Easier to repair due to fewer structures involved but endangers the anal sphincter

151
Q

What are the pros and cons of a mediolateral tear/episiotomy during childbirth?

A

Anal sphincter is protected but is harder to repair as more structures involved

152
Q

What is the perineal body?

A

Irregular fibromuscular mass in the centre of the perineum between the anterior and posterior triangles

153
Q

Which muscles attach to the perineal body?

A

Levator ani, bulbospongiosus, superficial and deep transverse perineal muscles, external anal sphincter muscles and EUS fibres

154
Q

Why is the endopelvic fascia divided into 3 levels of support in uterine prolapse?

A

Each gives a different level of support that needs to be identified so that treatment an be most effective

155
Q

What forms level 1 of endopelvic fascial support?

A

Uterosacral and cardinal ligament complex

156
Q

What forms level 2 of endopelvic fascia support?

A

Arcus tendinosus, fascia pelvis and rectovaginalis

157
Q

What forms level 3 of endopelvic fascia support?

A

Perineal body

158
Q

How can prolapse and incontinence arise from pelvic floor damage?

A

Stretch and damage to pelvic floor muscles and supporting ligaments causes muscle weakness and ineffective muscle action

159
Q

What are risk factors for developing prolapse of incontinence following pelvic floor damage?

A

Age, obesity, menopause due to low oestrogen, chronic cough and smoking causing CT laxity

160
Q

What is the treatment plan for prolapse due to pelvic floor damage?

A

Remove prolapsed organs, restore CT supports and maintain function

161
Q

What are possible S/E associated with prolapse treatment?

A

Recurrence, new incontinence or dyspareunia

162
Q

What proportion of females >40 y.o. are affected by in continence?

A

50%

163
Q

How do pelvic floor exercises treat incontinence due to pelvic floor damage?

A

Rapid and long contractions of slow and fast twitch fibres cures 50-75% of pts and prevents progression

164
Q

How does surgery treat incontinence due to pelvic floor damage?

A

Increases support to sphincter mechanism and bladder neck by colposuspension or tension free vaginal tape

165
Q

What are the possible S/E associated with surgical treatment of incontinence following pelvic floor damage?

A

Voiding difficulty, retention, overactive bladder due to partial obstruction

Semester 4 (33 decks)

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