OBGYN Lecture 1 & 2 Female Pelvis

Normal AP & Sonographic Appearance of Female Pelvis

What are the functions of the female pelvis?

- provides a weight-bearing bridge b/w spine & lower limbs bones

- directs the pathway of fetal head during child birth

- protects reproductive & other pelvic organs

What are the pelvic bones?

1 sacrum, 1 coccyx, 2 innominate

The two innominate bones are bilaterally formed by the fusion of the:

ilium, ischium, pubis

Pelvic bones define two distinct spaces called

the true pelvis (or lesser) and, the false pelvis (ir major)

What separates the true pelvis from the false pelvis?

linea terminalis (an imaginary line)

The linea terminalis extends from the \_____________ down to the \______________

sacral prominence (promontory) along the inner surface of the innominate bone; symphysis pubis anteriorly

The true pelvis contains

urinary bladder, small bowel, sigmoid colon, rectum, ovaries, fallopian tubes, and uterus.

The nongravid uterus lies within the _____ of the pelvis between the _______ and the ____

midline; urinary bladder; rectum

The superior aspect of the pelvic cavity is open to the \_____________

abdominal cavity

The inferior aspect of the pelvis cavity is comprised of

membranes, ligaments and muscles of the pelvic floor

The sacrum and coccyx form the

posterior wall of the pelvis

Pelvic ligaments

Cardinal
Uterosacral
Broad
Round
Ovarian
Suspensory

(CU BROS)

broad ligament

is a flat sheet of peritoneum

The broad ligament is associated with the

uterus, fallopian tubes and ovaries.

The broad ligament extends from the \____________ on both sides and folds over the \______________, covering their surface anteriorly and posteriorly

lateral pelvic wall; internal female genitalia

The free border of the broad ligaments contains the \_______________.

fallopian tubes

The portion of the broad ligament containing the fallopian tube is referred to as the \______________

mesosalpinx

The ovary is attached to the posterior layer of the broad ligament by?

mesovarium (folds of peritoneum)

The largest part of the broad ligament is the

mesometrium

What surrounds the uterus and runs laterally to cover the external iliac vessels and the proximal part of the round ligament of the uterus?

mesometrium

The ________ originate from the uterine cornua and extend across the pelvic space from posterior to anterior

round ligaments

What ligament pulls the uterus towards and over the bladder

round

________ ligaments loosely tether the uterine fundus and tilt it forward in the pelvis, aiding in the normal anteflexion of the uterus at the isthmus

Round

The \_____________ forms the lateral boundaries of the rectouterine pouch

uterosacral ligaments

The \________________ are situated along the inferior border of the broad ligament

cardinal ligaments

Cardinal ligaments house the

uterine artery & uterine veins

Cardinal ligaments provides

an extensive attachment on the lateral wall

The \____________ connects the ovary to the side of the uterus

ovarian ligament

Structurally, the ovarian ligament is a \_________________ that lies within the \___________________

fibrous band of tissue; broad ligament

The ovarian ligament joins the \___________ just below the origin of the \_________________

uterus; fallopian tubes

The \_________________ of the ovary extends outwards from the ovary to the lateral abdominal wall

suspensory ligament

What is the function of the suspensory ligament

to contain the ovarian vessels and nerves

False Pelvis Muscles include?

* Psoas major (pelvic sidewall)
* Iliacus (pelvic sidewall)

true pelvis muscles

* Piriformis: posterolateral wall
* Obturator internus: anterolateral wall
* Muscles of the pelvic diaphragm (levator ani and coccygeus)

Pelvic floor is formed by

levator ani muscles and small coccygeus muscles and their covering fasciae

The \_____________ is incomplete anteriorly both in males and females to allow passage of urethra

pelvic floor

Coccygeus muscle is a \_____________ muscle that arises from the \_________

small triangular; ischium

The coccygeus muscle is inserted into the \_______________ and into \______________

lower end of sacrum; coccyx

Both the levator ani and coccygeus assist in supporting ?

pelvic viscera (organs)

The \_____________ is a broad sheet of muscles.

levator ani

The levator ani is composed of three separate paired muscles called

Pubococcygeus, Puborectalis , liococcygeus

The area posterior to the pelvic floor is the

perineum

The \__________ is the area b/w the vaginal canal and anus

perineum

Sonographically pelvis muscles appear as ______ structures with ______ in a ______ axis

hypoechoic; linear echogenic striations; long

If pelvic muscles and/or ligaments weaken, a condition known as \__________ may occur

uterine prolapse

uterine prolapse

The uterus drops down and can possible protrude outside of the vaginal canal

\___________ spaces are potential spaces where fluid tend to collect

pelvic

In anatomy, a potential space is a space that

can occur b/w 2 adjacent structures that are normally pressed together

The vesicouterine pouch is also known as the

anterior cul-de-sac

Where is the vesicouterine pouch located?

anterior to uterus & posterior to urinary bladder (b/w uterus & bladder)

The rectouterine pouch is also known as

posterior cul-de-sac, pouch of douglas

Where is the rectouterine pouch (pouch of Douglas) located

posterior to uterus & anterior to rectum (b/w uterus and rectum)

The retropubic space is also known as the

space of retzius

The retropubic space (space of retzius) is located between

urinary bladder & symphysis pubis

The common iliac arteries (the bifurcation of the aorta) course \__________ to the \__________ muscles

anterior & medial; psoas

The common iliac arteries supply the

pelvic cavity & lower extremities

Each common iliac artery (left and right) bifurcate into the

external and internal iliac arteries

The \___________ becomes the common femoral artery in the lower extremities (legs)

external iliac

The \_______________ supply the organs in the pelvic cavity including: bladder, uterus, vagina, and rectum

internal iliac

Blood supply to the uterus is via the

paired uterine arteries (right & left)

The uterine arteries branches off of the

internal iliac arteries

Uterine Arteries supplies the

serosal layer of uterus (outer layer)

Arcuate Arteries supplies the

myometrial layer of uterus (muscle layer)

Radial Arteries supplies the

deeper layer of myometrium

Straight arteries are also known as

Basal arteries

Straight arteries supply

basal layer of endometrium

Spiral Arteries supply

functional layer of endometrium

Which arteries slough off during the menstrual cycle?

spiral arteries

The uterine artery has a branch that runs \_________ to the ovary and connects (anastomoses) with the \____________

lateral; ovarian artery

Other branches of the uterus supply the

fallopian tube and cervix

Uterine Arteries supply blood to the _______ arteries

ovarian

The ovarian arteries branch of the ____ and the uterine arteries branches of the _____

aorta; internal iliac arteries

All veins match their arteries and eventually drain into the

_____; EXCEPT the ______vein which drains into the __________________ vein

IVC; left ovarian; left renal

The urinary bladder is most anterior in the \____________ and posterior to \_________________

pelvic cavity; pubic symphysis

The urinary bladder is \__________ shaped when empty

pyramid

The urinary bladder is \__________ shaped when full

dome

The urinary bladder remains in \_________ pelvis when empty

true

The urinary bladder rises upwards to \____________ pelvis as it fills

false

The bladder wall consists of 4 layers

From inner to outer:
Mucosa
Submucosa
Muscular
Serosa

What controls urinary bladder contractions?

detrusor muscle

What is the function of the bladder?

collect and store urine

There are three openings in the bladder (aka) the

Trigone of bladder

What are the 3 openings in the bladder?

* 2 openings on the posterior aspect of the bladder where the ureters drain into the bladder
* 1 opening in the inferior aspect of the bladder where the urethra drains the U.B.

Normal bladder wall thickness fully distended is

~ 1.6 - 4 mm

Ureters extends from the \__________ and drain into the \__________________ aspect of the urinary bladder

kidney hilum; posterior

Ureters runs \_________ to internal iliac artery and \_________ to the ovary

anterior; posterior

Are ureters normally seen sonographically?

No, unless it's obstructed

Ureteral jets may be visualized by

color doppler as the empty urine into the bladder

Urethra

Muscular tube that extends from the U.B. to the genitals

What is the urethra responsible for?

releasing urine from body

What are two sphincters of the urethra?

internal & external sphincter

internal sphincter

a continuation of the Detrusor Muscle.

Internal sphincter is under \______________ control

involuntary

What is the primary muscle for prohibiting the release of urine?

internal sphincter

External sphincter

a secondary sphincter to control the flow of urine

External sphincter is under \___________ control

voluntary

Uterus

Pear-shaped, hollow organ

The primary function of the uterus is to

provide a place for products of conception to implant and develop

What affect uterine size?

age and parity

What are the parts of the uterus?

fundus, body, isthmus