Female Pelvis

female pelvis contents

-bladder

-ureters

-sigmoid

-rectum

-ileum

-uterus

-ovaries

-fallopian tubes

-vagina

communication w/ female pelvis

w/ the abdominal cavity via the fallopian tubes

vaginal canal leads to

the lowest part of the uterus

portions of vaginal canal surrounding cervix is...

fornix

-anterior & posterior

female pelvis divided into ___ sections by the __________

2

uterus

anterior section of female pelvis

ureterovesicle space (UV space)

posterior section of female pelvis

rectouterine space

posterior fornix is covered in

peritoneum (behind uterus)

above posterior fornix is

rectouterine pouch (aka pouch of douglas)

rectouterine pouch is aka

pouch of douglas

where is the pouch of douglas

posterior to the lower uterine segment & the rectosigmoid

where is the UV space?

anterior to uterus & posterior to the bladder

cervix protrudes into the ...

upper most vaginal vault

cervix shape

somewhat rounded w/ central opening

parts of cervix

-external os: external opening

-internal os: internal opening

what enlarges to allow fetus to pass from uterine cavity to vaginal canal?

cervix & cervical canal

mid portion of uterus

uterine body

upper portion of uterus

fundus

what is at the lateral portions of the fundus of uterus?

cornuae (right & left)

-this is where fallopian tubes attach

uterus consists of ___ layers

3

-serosa

-myometrium

-endometrium

which layer of the uterus has sublayers

endometrium

-functional layer

-deep basal layer

outer covering of uterus

serosa

-very thin

thick mid portion layer of uterus

myometrium

-made of smooth muscle

inner layer of uterus

endometrium

-consists of the functional layer & deep basal layer

what is the layer that sluffs off during a period?

functional layer of endometrium

size & echogenicity of endometrium

vary on time of cycle

uterus adjacent to under surface of

parietal peritoneum

pre puberty uterine size

-3 cm long

-2 cm wide

-1 cm ant/post

nulliparous uterine size (adult)

adult w/o children

-8 cm long

-4 cm wide

-2-3 cm ant/post

post menopausal (~40yo+) uterine size

-3.5-5.5 cm long

-1-2 cm wide

multiparity (adult w/ multiple children) uterine size

increases in size, varies

endometrium echogenicity

slightly more echogenic than uterine wall

-can vary

endometrium measurements vary based on...

menstrual cycle

early proliferative phase

day 5-9

early proliferative phase endometrium measurement

4-8 mm

late proliferative stage

days 10-14

late proliferative stage endometrium measurement

6-10 mm

which stage does the endometrium have a multilayer appearance?

late proliferative phase

early secretory stage

days 15+

early secretory stage endometrium measurement

7-14 mm

postmenopausal endometrium measurement

less than 8 mm **********

fallopian tubes size

-approx 12 cm long

-1-4 mm in diameter

are the fallopian tubes easy to visualize on US?

NO

unless there is a problem

parts of fallopian tubes

-interstitial portion

-isthmus

-ampulla

-infundibulum

-fimbrae

what is the interstitial portion?

area where the tube pierces the uterine wall

where is the isthmus

just lateral to the uterus

what is the widest part of the fallopian tube

AMPULLA

where does fertilization occur?

ampulla ******

of fallopian tube

what/where is the infundibulum?

it is the funnel like projection

above the broad ligament that overlies the ovary

what is at the ends of the infundibulum?

fimbriae

where is the fimbriae?

at ends of infundibulum

this area is adjacent to the ovary, but is intraperitoneal

uterine variants

-normal

-didelphys

-bicornuate (bicollis, unicollis)

-subseptus

-unicornuate

-cervix: nabothian cysts

normal uterus shape

pear shape

or upside down triangle

didelphys variant

-2 uterine cavities, heart shape

-2 vaginal canals

-2 cervix

bicornuate bicollis type variant

-2 uterine cavities

-2 cervix

-1 vagina

bicornuate unicollis type variant

-split uterine cavity

-1 cervix

-1 vagina

subseptus variant

-partially split uterine cavity

unicornuate variant

-1 uterine cavity

-1 fallopian tube

normal uterine position

usually midline might have slight tilt right or left

most common uterine position

anteverted: tilts anterior from cervix

anteverted: degree of diversion depends on what?

bladder distension

anteverted: the cervix & vagina form _____ angle to the uterus

90*

anteflexed uterus

rare

-uterus is tipped forward at miduterus

retroflexed uterus

common

-curved backwards or posterior

retroverted

very rare

-entire uterus is flipped backward at the point of the cervix

flexed

is in relation to uterus

verted

is in relation to cervix

ovary shape

almond

ovaries positioned where?

-lie on posterior surface of broad ligament

-next to fibriated end of fallopian tube

-adjacent to cornuae of uterus

ovaries size at birth

-relatively large

-due to maternal hormonal stimulation

ovaries size in reproductive years

-2.5-5 cm long

-1.5-3 cm wide

-0.6-2.2 cm ant/post

ovaries volume

LxWxthickness x 0.523

-normal volume: 6.8 cc

why do you need to know normal volume of ovaries?

bc if torsion, blood flow cuts off & gets super big

area around will be super echogenic

ovaries location

along side wall of pelvis

ovaries are medial to

external iliac vessels

ovaries are anterior to

ureter

ovaries position

variable

-especially after pregnancy, can be typically seen in ovarian fossa

ovarian fossa

shallow depression on lateral wall of female pelvis

posterior support structure

uterosacral ligament (aka cardinal ligament)

what does the uterosacral ligament (cardinal ligament) do?

provides rigid support to the cervix

extends from posterior aspect of the cervix around lateral walls of the rectum to the sacrum

uterosacral ligament (cardinal ligament) attaches posteriorly to

sacrum at S3/S4 level

uterosacral ligament (cardinal ligament) attaches anteriorly to

junction of cervix & uterus

mid portion support structures

-broad ligaments

which one is NOT a true ligament?

broad ligament ****

broad ligament is what?

double fold of peritoneum

broad ligament attaches to

lateral walls of pelvis

broad ligament surrounds what 5 things?

-fallopian tubes

-round ligaments

-ovaries

-blood vessels

-nerves

what does the broad ligament do?

provides minimal support to the uterus

what is the mesosalpinx?

part of the lining of the abdominal cavity & higher vertebrae

-specifically the portion of the broad ligament that stretches from the ovary to the level of the fallopian tube

anterior support structure

-round ligaments

what does the round ligaments do?

maintain the forward bend of the uterine fundus

round ligaments are contained within

broad ligament

round ligament arises from where?

superior aspect of uterus

round ligament goes...

upward & lateral to inguinal canal

ovarian ligaments

-ovarian ligament

-suspensory ligament

-mesovarium

what does the ovarian ligament do?

connects the ovary to the uterus

suspensory ligament is aka

Infundibulopelvic ligament

what does the mesovarium do?

attaches the ovary to the broad ligament

what does the suspensory ligament do?

attaches the lateral pelvic wall to the ovary

uterus vascular supply is from

-internal iliac artery via uterine artery

-uterine vein into internal iliac vein