Reproductive System

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Question 16

What is the testis and the epididymus?

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Question 23

The ovaries

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• 4 X 2cm, oval-shaped
• Connected to lateral wall of uterus via the round ligament of the ovary (RLO)
• Lies against lateral wall of pelvis in a depression: ovarian fossa
• Position is variable
• Pregnant: enlarging uterus pulls it into abdominal cavity
• May lie in rectouterine pouch
• Before puberty – Smooth
• After puberty – progressively scarred
• Menopause – small and pitted

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Question 30

Gestation and childbirth: Uterus in pregnancy

Answer 30

During pregnancy, the uterus becomes greatly enlarged as a result of increasing production of oestrogens and progesterone

By 12 weeks, the fundus rises out of the abdomen and by 40 weeks it reaches the level of the xiphoid process

Hypertrophy of smooth muscle fibres and some hyperplasia

Cause of onset of labour is unknown

• Contractility of uterus has been fully developed in response to oestrogen
• Sensitive to oxytocin
• Possibly by sudden withdrawal of progesterone

Presenting part (usually the head) stretches cervix – initiates a reflex response which increases the force of the contractions of the uterine body

Uterine muscular activity is largely independent of extrinsic innervation

Question 31

The anatomy of an emergency caesarean section

Answer 31

Bladder is emptied, catheter inserted and left in position. Allows empty bladder to sink down, away from operating field

Incisions in ant, abdo wall, peritoneum mobilised out of way

Incision in floor of uterovesical pouch to separate bladder from uterine body

Transverse incision in uterus (2.5cm long)

Amniotic cavity opened to release fluid

Uterine incision enlarged

Delivery of foetus

Contracting uterus will expel the placenta

Question 32

Prolapse of the uterus

Answer 32

Tone of levator ani, transverse cervical, pubocervical and sacrocervical ligament

Damage during childbirth, or poor body muscular tone, may result in uterine prolapse (downward displacement of uterus)

In advanced cases, the cervix descends the length of the vagina and may protrude out through the orifice

Because of the attachment of the cervix to the vaginal vault, prolapse of the uterus is generally followed by some prolapse of the vagina