Session 5 - Female and Pelvic Anatomy

Question 0

Describe the development of the uterus:

Answer 0

The paramesonephric duct open caudally to the abdomen and connect to the urogential sinus. In the absence of Mullerian Inhibiting Hormone the ducts persist. They then fuse in the midline forming the uterus, Fallopian tubes and the upper third of the vagina.

Question 1

Describe the relationship of the uterus with the peritoneum:

Answer 1

Anterior to the uterus is the uterovesicle patch

Posterior to the uterus is the ‘pouch of Douglas’ or rectouterine pouch

Question 2

Name the ligaments associated with the uterus:

Answer 2

Broad ligament
Suspensory ligament
Ovarian ligament
Round ligament

Question 3

Describe the broad ligament:

Answer 3

Broad sheet made of peritoneum that covers the uterus and spans between the Fallopian tubes, ovaries and their blood supply.
It can be split into the
mesovarium which covers the hilum of the ovary
mesosalpinx - mesentry of the Fallopian tube
mesometrium - largest portion and coves the body of the uterus, also extends to cover the internal iliac artery?

Question 4

Describe the suspensory ligament:

Answer 4

Contains the neurovascular supply to the ovary. E.g. the ovarian artey, vein and the ovarian nerve plexus. Travels from the ovary to the abdominal aorta.

Question 5

Describe the ovarian ligament:

Answer 5

A ligament that joins the ovary to the uterus just below the fallopian tube.

Question 6

Describe the round ligament:

Answer 6

A reflection off of the uterus, runs through the inguinal canal. Embryologically was the gubernaculum. Attaches to the labia majora. Can be a source of pain during pregnancy as the expanding uterus puts presure on the ligament. Also keeps anteflexion of the uterus during pregnancy.

Question 7

What is the normal position of the uterus?

Answer 7

Anteflexed

Anteverted

Question 8

Describe the blood supply no drainage of the ovary:

Answer 8

Ovarian artery - from abdominal aorta
Some anastomoses with the uterine artery from internal iliac

Ovarian vein left side into the left renal vein and right side direct into inferior vena cava.

Question 9

Describe the blood supply to the uterine artery:

Answer 9

Uterine artery from the anterior division of the internal iliac artery.
Also anastomoses with ovarian artery

Question 10

Describe the blood supply to the vagina:

Answer 10

Vaginal arteries - anterior division of the internal iliac arteries.

Question 11

Describe the blood supply to the external genitalia:

Answer 11

Internal pudendal artery - anterior branch of the internal iliac artery

Question 12

Describe the lymphatic drainage of the reproductive system:

Answer 12

Ovary - para-aortic nodes
Uterus
Fundus - aortic nodes
Body - external iliac nodes
Cervix - internal and external iliac nodes
Vagina - internal iliac nodes and superficial inguinal nodes.

Question 13

What does the labia majora enclose?

Answer 13

Pudendal cleft

Question 14

What does the labia minora enclose?

Answer 14

The vestibule

Question 15

What is contained within the vestibule?

Answer 15

Entrance into the vagina
Bulbourethral glands
Entrance into the urethra
Clitoris

Question 16

What is a fornix?

Answer 16

A recess that surrounds the cervix. There are anterior posterior and two lateral fornices.

Question 17

Describe the innervation if the uterus and the vagina:

Answer 17

Inferior 1/5 of vagina is somatically innervated by the pudendal nerve.
Superior 4/5ths and uterus is supplied by the uterovaginal plexus. This supplies both sympathetic and parasympathetic innervation.

Question 18

Describe the innervation of the perineum:

Answer 18

Via the pudendal nerve + ilioinguinal nerve

Pudendal nerve exits via greater sciatic notch and then enters perineal area by lesser sciatic notch.

Question 19

What are the good feature of a pelvis for childbirth?

Answer 19

Round inlet 
Not too prominent ischial spines 
Straight side walls 
Well rounded greater sciatic notch 
Well curved sacrum 
Sub-pubic arch >90 degrees

Question 20

What is the relevance of ligaments in producing a good pelvis for childbirth?

Answer 20

The sacrospinous and sacrotuberous ligaments that for the greater and lesser sciatic foramen can soften under the influence of progesterone which can widen the pelvic outlet.

Question 21

What is the true pelvis?

Answer 21

The lesser pelvis or the area inferior to the linea terminalis. The linea terminalis is the ring of bones which forms the pelvic inlet. It is a bony canal which is solid and immobile. This bony ring consists of the alar of the sacrum, the arcuate line (of the ischium), the pectineal line, and the pubic crest.

Question 22

What are the differences between the gynecoid and android pelvis?

Answer 22

Gynecoid pelvis has a greater pubic angle
Has a more rounded greater sciatic notch
Has a less prominent ischial spine

Question 23

What dimensions are assessed when considering whether a vaginal delivery is suitable?

Answer 23

AP diameter i.e pelvic inlet
Bispinous diameter
Pelvic outlet

Question 24

How is the AP diameter of the pelvis calculated?

Answer 24

Obstetric conjugate - From the mid point of the public symphysis to the sacral promontory

Question 25

How is the AP diameter of the pelvis measured?

Answer 25

From the inferior border of the public symphysis to the sacral promontory