Female Pelvis SG

Uterine positions

anteversion, anteflexion, anteversion/anteflexion, retroversion, retroflexion, retroflexed/retroverted, dextroversion, levoversion

Uterine Version =

vagina-cervix angle

Uterine Flexion =

cervix-body angle

Uterus is usually positioned:

Anteverted and anteflexed

anteversion

the cervix forms a 90 degree or smaller anterior angle with the vaginal canal

anteflexion

body and fundus only angle anteriorly

retroversion

the cervix forms an posterior angle of greater than 90 degrees to the vaginal canal

retroflexion

fundus and body bent posteriorly

retroflexed/retroverted

entire uterus is angled posteriorly

dextroversion

normal variant to the right in absence of pelvic masses

levoversion

normal variant to the left in absence of pelvic masses

Postmenopausal patients who are not on HRT (hormone replacement therapy) should have endometrial thickness of _____.

<5 mm

Postmenopausal patients on HRT or taking tamoxifen may demonstrate normal endometrial thicknesses up to _______.

8 mm

Postmenopausal patients with an endometrial thickness grater than 8mm, would be consider ____________.

hyperplasia

Echogenicity of ovaries

ovoid medium-level

What is LMP?

last menstrual period

What does the pituitary gland secrete?

Luteinizing Hormone (LH)

When does progesterone levels decline?

9-11 days after ovulation

What is GPA?

Gravida/para/abortus

Gravida in GPA is defined as:

the total number of times the patient has been pregnant

Para in GPA is defined as:

the number of live births (viable children) that the patient has had

Abortus in GPA is defined as:

the total number of miscarriages or elective abortions

What does the hypothalamus release?

gonadotropin-releasing hormone (GnRH)

Estrogen is secreted by

follicles

Progesterone secreted by

corpus luteum

Ovulation normally occurs on day ___

14

What triggers ovulation?

LH surge, accompanied by smaller FSH surge

Process of ovulation regulated by _________________ within the brain.

hypothalamus

What are the different stages of ovulation?

Follicular Phase (Preparation), Ovulatory Phase (Release), Luteal Phase (Post-Ovulation)

Follicular Phase

ovarian follicles grow, they fill with fluid (antrum) and secrete increasing amounts of estrogen

Ovulation Phase

ovum/egg released once a month from a ruptured Graafian follicle from one of two ovaries

Luteal Phase

cells in lining of ruptured ovarian follicle begin to multiply and create the corpus luteum, or yellow body

Luteinizing hormone level will typically increase rapidly ________hours before ovulation in process known as LH surge.

24 to 36

Mittelschmerz

lower pelvic pain during ovulation

Muscles of the pelvis major (false)

psoas major and iliacus muscles

Muscles of the pelvis minor (true)

piriformis muscles and obturator internus muscles

When is FSH released?

days 1 - 14

What does FSH do?

stimulates development of the follicle in the ovaries

Pelvic vasculature in descending order in size:

uterine, arcuate, radial, basal, spiral

The bony pelvis consists of four bones:

Right and Left Coxal, Sacrum, Coccyx

Where is the pelvis major (false pelvis) located?

superior to the iliopectineal line

Where is the pelvis minor (true pelvis) located?

inferior to caudal portion of parietal peritoneum

Uterus is derived from

embryonic mullerian ducts

What shaped does the uterus have?

pear shaped, hollow

Uterus is divided into

fundus, body, and cervix

Largest to smallest segments of the fallopian tube:

ampulla, isthmus, interstitial portion

What are the uterine ligaments?

broad, round, cardinal, uterosacral, suspensory, and ovarian

Broad ligament divides into:

Mesosalpinx, Mesovarium, and Mesometrium

mesosalpinx of broad ligament

upper fold of broad ligament; encloses fallopian tube

mesovarium of broad ligament

posterior fold of broad ligament; encloses ovary

mesometrium of broad ligament

between mesovarium and mesosalpinx

Round Ligament

Fundus to anterior pelvic sidewalls; holds uterus forward

Cardinal ligament

Extend across pelvic floor laterally; firmly supports cervix

Uterosacral ligament

Extend from uterine isthmus posteriorly, alongside rectum to sacrum; firmly supports cervix

Suspensory ligament

Extends from lateral aspect of ovary to pelvic sidewall

What are the three pouches?

vesicouterine pouch, rectouterine pouch, retropubic space

Where is the vesicouterine pouch located?

anterior to fundus, between uterus and bladder

Where is the rectouterine pouch located?

posterior to uterine, between uterus and rectum

Where is the retropubic space located?

space of retzius, between bladder and symphysis pubis

Menstrual status divided into 4:

premenarche, menarche, menstrual cycle, and menopause

Premenarche

prepuberty

Menarche

onset of menses

Menstrual cycle

menstruating approximately every 28 days

Menopause

cessation of menses

What is the name for endometrial regeneration?

proliferative phase

Graafian follicle

mature follicle

Corpus luteum

enlarged ovarian follicle that secretes progesterone after release of the egg cell

Layers of the uterus

perimetrium, myometrium, endometrium

Perimetrium

serous outer layer (serosa)

Myometrium

muscular middle layer

Endometrium

inner mucous (mucosal) membrane, glandular portion of uterine body

What are the 2 zones of the endometrium?

zona functionalis and zona basalis

Zona Functionalis

superficial layer of glands and stromas (shedding)

Zona Basalis

deep layer of endometrial glands (regenerates)

How should the bladder be for a transvaginal ultrasound?

empty bladder

How should the bladder be for a transabdominal ultrasound?

distended bladder