Women's Health Anatomy & Physiology Flashcards
What is the name of the anterior surface of the 1st sacral vertebra
sacral promontory
What is the name of the separation between the true pelvis and the false pelvis
linea terminalis
List the 3 conjugates and how they are measured
- true conjugate: US
- obstetric conjugate: US
- diagonal conjugate: per vaginal
List the 4 types of pelvis shapes
- gynecoid (favorable for vaginal delivery)
- android
- anthropoid
- platypelloid
Which type of pelvis is this
Gynecoid
Which type of pelvis is this
Android
Which type of pelvis is this
Anthropoid
Which type of pelvis is this
Platypelloid
Name the 4 parts of the fallopian tube, distally to proximally
Name the 3 components of the broad ligament
Which structure delivers ovarian blood vessels
suspensory ligament
Which structure delivers uterine blood vessels
Mesometrium of the broad ligament
List the 3 components of the wall of the uterus, superficial to deep
- perimetrium
- myometrium
- endometrium
Which structure is generally the culprit of low back pain during menstruation
the uterosacral ligament
Which structure anchors the ovary medially to the uterus
ovarian ligament
Which structure anchors the ovary laterally to the pelvic wall
suspensory ligament
Which structure suspends the ovary
mesoovarium of the broad ligament
What are the 2 major regions of the ovary
cortex: ovarian follicles
medulla: large blood vessels & nerves
Describe the 5 stages of a follicle
- primordial: single layer of squamous cells around oocyte
- primary: single layer of cuboidal cells around oocyte
- secondary: several layers of granulosa cells around oocyte
- late secondary: same as secondary but now with a few fluid cavities
- vesicular/Graafian: one large fluid filled cavity
Which cell type is a common nidus for tumors to arise
granulosa cells of a follicle
List the 4 major components of the uterus, superior to inferior
- fundus
- body
- isthmus
- cervix
Which suspensory ligament of the uterus does the uterine artery pass through
Transverse cervical ligament (aka Mackenrodt’s, aka Cardinal)
Which ligament of the uterus is commonly affected by endometriosis
uterosacral ligament
Describe blood flow to the uterus
Aorta - common iliac - internal iliac - uterine artery - spiral/radial/arcuate arteries
Describe the layers of the endomerium
- Stratum basalis: replaces functionalis
- Stratum functionalis (spongiosum & compactum): sheds every menstrual cycle
Describe the histology of the cervix
- Endocervix: single layer of columnar cells
- Ectocervix: several layers of squamous cells
- Squamocolumnar junction: most likely area for dysplasia (important to sample in pap)
Locate the peritoneal pouches and fornices
Where are the Skene’s glands located
Two directly inferiolaterally to the urethra
Where are the Bartholin’s glands located
Two laterally to the vaginal opening
- susceptible to Bartholin Cysts: painful, palpable enlargement d/t blockage
Describe the boundaries of the perineum
Diamond shaped area below the levator ani muscles
- pubic arch
- ischial tuberosities
- sacrotuberous ligaments
- coccyx
Describe the divisions of the perineal triangles and the central point
Urogenital and Anal triangles, centered at the perineal body where all perineal muscles insert
What is located within the anal triangle of the perineum that can result in rectal prolapse
Ischiorectal fossa containing fat - can atrophy and prolapse in severe malnutrition/diarrhea/etc.
What is done to prevent a perineal tear in vaginal childbirth
Episiotomy
- mediolateral preferred
- midline avoided d/t risk of perineal body injury despite less blood vessels
Describe the 4 degrees of perineal tear
- 1st: limited to fourchette & superficial perineal skin
- 2nd: extends to perineal muscle & fascia
- 3rd: extends to anal sphincter
- 4th: extends to rectal mucosa
Describe the structure of a mammary gland
Modified sweat glands consisting of 15-25 pyramidal lobes
- extends from 2nd to 6th rib
- tail of spence/axillary tail extends into axilla
What are tubercles of montgomery
modified sebaceous glands that enlarge during pregnancy/lactation
What are suspensory ligaments of cooper
attach the breast to underlying muscle & contain lymphatics
- may be involved in malignancy & contract to produce peau d’orange
Describe the flow of milk in lactation
Alveoli of lobule - lactiferous duct - lactiferous sinus - opening to nipple
Describe how estrogen, progesterone, and placental hormones act on mammary glands
- estrogen: stimulates growth & branching of the ducts
- progesterone: stimulates alveolar formation
- placental: forms true secretory alveoli during pregnancy
Where does most of the lymphatic drainage of the breast go
75% drains to axillary nodes
Describe the bloodflow of the mammary glands
Arterial supply & venous drainage from axillary & internal thoracic & intercostals
Intercostal nerves T4-6
What is the role of GnRH
pulsatile release from the hypothalamus that stimulates pituitary to release FSH & LH
Describe the role of prolactin-inhibitory hormone
decreases pituitary prolactin release (dopamine)
What is the role of FSH
early & late follicle maturation
What is the role of LH
- late follicle maturation
- causes estrogen spike midcycle which triggers ovulation & corpus luteum formation
- stimulates progesterone release
What is the role of PRL
- breast milk secretion after primed by estrogen & progesterone
- prevents ovulation during lactation
What is the role of estrogen
Ovarian hormone
- synthesized by cholesterol & androgens stimulated by FSH & LH
- Estradiol>Estrone>Estriol
What is the effect of estrogen on cervical mucus
causes it to be thin and water making it easy for sperm to traverse
What is the role of progesterone
Ovarian hormone
- synthesized from cholesterol stimulated by LH in the corpus luteum & placenta
- increases basal body temp with timing of ovulation
What is the effect on cervical mucus from progesterone
causes it to become thick, seals off uterus from further entry of sperm or bacteria
Describe what happens during the follicular phase
(appx day 1-14)
- FSH secretion slightly elevated causing proliferation of granulosa cells & estrogen secretion
- single follicle secretes more estradiol & dominates
- remaining follicles synthesize androgens & become atretic
Describe what happens in ovulation
(appx day 14)
- rupture & liberation of Graafian follicle
- dramatic rise in circulating estrogen which can no longer inhibit release of LH & FSH, this surge induces ovulation
Describe what happens during the ovarian luteal phase
- Mittelschmerz
- FERTILIZATION: corpus luteum sticks around and produces progesterone
- NO FERTILIZATION: ovum passes, corpus luteum sheds on day 24/4 days prior to next menstruation
Describe what is happening during the uterine proliferative phase
- under the influence of estrogen from maturing follicles
- repair & growth of endometrium from previous menstruation
Describe what happens during the uterine secretory phase
- influenced by progesterone & estrogen of corpus luteum
- endometrial glands coil & secrete fluid
- FERTILIZATION: corpus luteum secrets progesterone & ripens/maintains endometrium
- NO FERTILIZATION: corpus luteum regresses, less estro & progesterone, endometrial thinning, necrosis, vasospasm, menstruation
______ is a passive process d/t lack kof gonadal sex steroids
menstruation
Describe the difference between the fetal & maternal surfaces of the placenta
Which hormone is tested in a pregnancy test
hCG
Describe the types of placenta previa
Describe the types/degrees of placental adhesion
Describe placental abruption
- placental prematurely separates from the uterus
- MC pathologic cause of late pregnancy bleeding
- usually after 20 weeks & before delivery
