Session 5

Question 1

Describe the anatomical and neurovascular supply of the fallopian tube

Answer 1

Ciliated columnar cells, peg (secretory) cells
Lateral –> medial: fimbrae, infundibulum, ampulla, isthmus
Arterial supply - ovarian and uterine arteries
Venous drainage - ovarian and uterine veins
Lymphatics - iliac, sacral, aortic nodes

Question 2

Describe the anatomical and neurovascular supply of the uterus

Answer 2

Paramesonephric ducts develop (persist in absence of MIH)
Anteverted, anteflexed
Opens to peritoneal cavity via ostium of the uterine tubes
Cervix - internal os, endocervical canal, external os
Neurovascular pouches - uterovesical, rectouterine (pouch of Douglas)
Arterial supply - uterine artery
Venous drainage - uterine vein
Lymphatics - iliac, sacral, aortic, inguinal
Innervation - sympathetic –> uterovaginal/inferior hypogastric plexus (T10-T12, L1), parasympathetic –> pelvic splanchnic nerves (S2-4)

Question 3

Describe the anatomical and neurovascular supply of the vaginal

Answer 3

Bartholin glands (can lead to bartholinitis, cysts)
Fornices - recesses of vagina around cervix (culdocentesis = drain pouch of Douglas)
Arterial supply - uterine and vaginal arteries
Venous drainage - vaginal venous plexus –> uterine vein –> internal iliac vein
Lymphatic drainage - iliac, superficial inguinal nodes
Innervation - superior 4/5 –> uterovaginal plexus, inferior 1/5 –> pudendal nerve, perineum –> pudendal nerve, ilioinguinal nerve

Question 4

Define the terms ‘broad ligament’, ‘round ligament’, ‘ovarian ligament’, ‘suspensory ligament’, ‘transverse cervical ligament’, ‘uterosacral ligament’

Answer 4

Broad ligament - peritoneal fold, mesentery of uterus (mesometrium), tube (mesovarium), ovary (mesosalpinx)
Round ligament - remnant of gubernaculum, ovary –> labia (via inguinal canal)
Ovarian ligament - ovary –> uterus
Suspensory ligament - ovary –> abdominal wall
Transverse cervical ligament - lateral stability of cervix
Uterosacral ligament - maintains anteversion

Question 5

Describe the differences between the female and male pelvis

Answer 5

Female (gynecoid):
Round inlet
Straight side walls
Ischial spines not prominent
Well rounded greater sciatic notch 
Well curved sacrum
Sub pubic arch >90 degrees
Male (android):
Heard shaped pelvic inlet
Prominent projecting promontory and ischial
Spines
Sub pubic arch 50-60 degrees

Question 6

Describe the clinical assessment of the pelvis

Answer 6

Pelvic inlet - anteroposterior diameter (capacity of birth canal)
Mid-pelvis - check for straight side walls (likely success of vaginal delivery)
Pelvic outlet - infrapubic angle, distance between ischial tuberosities (affected by progesterone)

Question 7

Describe the pelvic conjugates

Answer 7

Obstetric conjugate - sacral promontory –> midpoint of pubic symphysis (not measurable by physical examination)
Diagonal conjugate - sacral promontory –> inferior border of pubic symphysis

Question 8

Describe the bony structures of the pelvis in the female and male

Answer 8

Innominate bones (x2) - iliac crest, ischial spine, ischial tuberosity
Sacrum - promontory (S1)
Coccyx - projects into pelvic canal

Question 9

Name the ligaments located in the pelvis

Answer 9

Sacrospinous

Sacrotuberous

Question 10

Differentiate between the greater and lesser pelvis

Answer 10

Greater = 'false' pelvis - superior to linea terminalis no obstetric relevance 
Lesser = 'true' pelvis - inferior to linea terminalis, bony canal (solid and immobile)

Question 11

What is the linea terminalis?

Answer 11

Pubic crest
Pecten pubis (pectineal line)
Arcuate line

Question 12

Describe the anatomical and neurovascular supply of the ovary

Answer 12

Develops in mesonephric ridge, suspended by mesovarium, broad ligament contains ovarian ligament, suspensory ligament of the ovary
Arterial supply - ovarian artery (from AA)
Venous drainage - right ovarian vein –> IVC, uleft ovarian vein –> L renal vein –> IVC
Lymph drainage - para aortic nodes
Innervation - sympathetic –> ovarian plexus, parasympathetic –> uterine plexus