Chapter 20 CS female pelvis

These are the four segments of the __________ tubes: interstitial or intramural, isthmus, ampulla, and infundibulum.

Uterine/Fallopian

The geital tract includes:

(Vagina, uterus, and uterine tubes) and ovaries make up the primary reproductive organs of the female. The vagina, uterus, and uterine tubes all have the same basic structure: Cavities or canals enclosed by an inner mucosal lining, a smooth muscle wall, and an outer layer of connective tissue. Together, these communicating cavities are known as the _______ _______.

The endocervical canal extends ___ to ___ cm from its internal Os (or opening). At approx the same level as the isthmus, where it joins the endometrial canal (uterine canal) to its external Os, which projects into the vaginal vault. The endometrial, endocervical, and endovaginal canals form a continuous channel through which the fetus passes at birth.

2,4

Cervical canal measurements

2-4cm length

Premenarchal uterus measurements

2.5 cm length, 2cm width, 1cm thick

Adult ovary measurements

2.5-5.0 cm length, 1.0-3.0 cm width, 0.6-2.2cm thick

Uterine tubes measurements

7-12 cm

Nulliparous uterus measurements

7cm length, 4cm width, 3cm thick

Multiparous uterus measurements

8.5cm length, 5.5 cm width, 4.5 cm thick

Vaginal canal measurements

9cm length

Urinary bladder

A muscular sac that receives and stores urine produced by the kidneys. It consists of four layers of tissue: An inner mucosa, a submucosa layer, the muscularis, and the outer serosa.

Parturition

Act of giving birth

(Segment of the uterine/ Fallopian tube) The isthmus is immediately ___________ to the uterine wall, connected to the interstitial segment. It is a short, straight, narrow portion of the tube. The tube widens laterally, forming the ampullary and infundibular sections.

Adjacent

The ovaries typically lie posterolateral to the uterus within the _________. Ovaries are quite mobile and influenced by the condition of surrounding structures. Even though their position is variable, the ovaries never move anterior to the uterus or broad ligaments.

Adnexa

The longest and most coiled portion of the uterine tube is the _________. Fertilization most often occurs here. The mucosal lining of the ampulla folds into complex matrices, filling much of the tubular lumen.

Ampulla

The spaces within the peritoneal cavity located posterior to the broad ligaments are referred to as the _________. (See fig 20.8)

Andexa

When the bladder is empty, loops of small bowel rest in the ___________ region of the abdominopelvic cavity. A distended urinary bladder pushes the small intestine superiorly, out of the true pelvis.

Anterior

Vesicouterine pouch is another name for what?

Anterior cul-de-sac

The pelvic spades include:

Anterior cul-de-sac, posterior cul-de-sac, space of Retzius.

Pubic/Pubis Symphysis

Anterior fusion of the innominate bones (sacrum and coccyx are the posterior fusion). Palpable external land mark that aids in evaluating the pelvis

When the bladder is empty, the uterus is in an ____________ position, in which the cervix and the vagina form a 90-degree angle, and the body and the fundus are tipped or tilted anteriorly.

Anteverted (anterversion)

Anterior cul-de-sac (vesicouterine pouch)

Area between the uterus and pubic bone

Anterior cul-de-sac

Area between the uterus and pubic bone that is formed by the peritoneum, which expands over the urinary bladder and covers the anterior wall of the uterus. This peritoneal reflection creates a shallow space within the peritoneal cavity, known as the _____________ ____________ or vesicouterine pouch (fig 20.11). This space is usually empty but may contain loops of small bowel.

The tunica albugenia is a fibrous connective tissue capsule found ________ the epithelial layer of the ovary.

Beneath

The _____________ __________ is the most common of the congenital malformations of the female genital tract. It is recognized sonographically by the presence of two endometrial canals that USUALLY COMMUNICATE at the level of the cervix. _____________ ________ is best appreciated in axial or short axis sections (fig 20.13). Note the gestational sac in the right horn of the uterus and myometrium tissue separating the two endometrial canals.

Bicornate uterus

The ovarian stroma, or the _______ of the ovary, consists of the peripheral cortex and the central medulla. The cortex constitutes the bulk of ovarian tissue and is the site of oogenesis, the production of female gametes (egg cells).

Body

Corpus

Body and largest part of the uterus; lies between the uterine fundus and cervix.

Uterine artery

Branch of the internal iliac artery that supplies blood to the reproductive organs of the pelvis (fig 20.20 A). At the level of the cervix, the uterine artery gives rise to the vaginal artery, which courses inferiorly. The uterine artery continues superiorly toward its termination at the fundus of the uterus, giving off small branches of itself and the ovarian and uterine tube arterial branches along the way.

Each __________ ligament originates at uterine cornu and courses within broad ligaments to anterolateral pelvic wall

Broad

Each ovary is located on the posterior surface of each ________ ligament and is anchored in this position by the ovarian and infundibulopelvic ligaments and the _____________.

Broad, mesovarium

The __________ ligaments extend from the upper cervix and isthmus to the obturator fascia at the lateral walls of the pelvis.

Cardinal

The ____________ ligaments and the uterosacral ligaments provide more rigid support for the cervix. These ligaments maintain the normal axis of the cervix, approximately perpendicular to the vaginal canal. The ____________ ligaments extend from the upper cervix and isthmus to the obturator fascia at the lateral walls of the pelvis. (See fig 20.9) The uterosacral ligaments extend from the posterior aspect of the cervix around the lateral walls of the rectum to the sacrum.

Cardinal

What two ligaments provide more rigid support for cervix?

Cardinal ligaments and uterosacral ligaments

Endocervical canal

Cervical canal extending 2 to 4 cm from its internal os, where it joins the endometrial canal to its external os, which projects into the vaginal vault.

The mucosal lining of the vaginal portion of the _________ is identical to the epithelial lining of the vagina.

Cervix

The __________ cells (clia) (of the mucosal lining of uterine/Fallopian tubes) propel a gentle current of secreted fluid, which aids in the transport of the ovum.

Cliated

These muscles are the most posterior muscle pair of pelvic diaphragm These muscles extend from ischial spine to sacrum and coccyx.

Coccygeous muscles

The ____________ muscles are the most posterior of the pelvic diaphragm. These muscles extend from the ischial spine to the sacrum and coccyx. These muscles also make up the levator ani muscle.

Coccygeus

Uterine/ Fallopian tubes

Coiled, muscular bilateral tubes emerging from the cone-shaped cornua of the uterus, which are located at the junction of the superior and lateral uterine margins. They course within the peritoneum along the superior free margin of the broad ligaments, until they reach the ovaries. These tubes conduct a mature ovum (egg cell) from the ovaries to the uterus through gentle peristalsis of their smooth muscle walls. The mucosal lining of the tubes consists of ciliated epithelial cells and secretory cells.

The uterine (Fallopian tubes) join the uterus at the:

Cornua

False Pelvis (Greater or Major Pelvis)

Descriptive area given to the area superior to the pelvic inlet (linea terminalis) and inferior to the iliac crests.

True Pelvis (Lesser or Minor Pelvis)

Descriptive term given to the region deep to the pelvic inlet (linea terminalis).

The vaginal canal also forms the ________ portion of the birth canal.

Distal

Broad ligaments

Double folds of peritoneum that extend from the uterine cornua to the lateral pelvic walls. They are not true ligaments and only provide minimal support for the uterus.

Mesentery

Double layer of visceral peritoneum that wraps around a bowel segment and attaches it to the posterior abdominal wall.

Broad ligaments

Doubly folds of peritoneum extend from uterine cornua to lateral pelvic walls These ligaments are not true ligaments

The ____________ consists of two layers: the superficial (functional) and deep (basal). The superficial layer is referred to as the functional layer or functional zone bc it increases in size during the menstrual cycle and partially sloughs off at the time of menses. The deep or basal layer of the _____________ is composed of dense cellular stroma and mucosal glands; it is not significantly influenced by the menstrual cycle.

Endometrium

The innermost layer of the uterine wall, the _________________, is a mucosal layer that is continuous with vagina epithelium inferiorly and uterine tube mucosa superolaterally. It forms the walls of the endometrial canal, the proximal portion of the birth canal.

Endometrium

uterine walls are composed of three tissue layers:

Endometrium, myometrium, and serosa

The uterine all comprises an inner mucosa, called the _____________; a thick, smooth muscle wall called the myometrium; and an outer ________.

Epithelium

True pelvis (minor or lesser pelvis) location

Extends from the linea terminalis to the pelvic diaphragm inferiorly. It is a bowl shaped cavity aligned poteriorly and inferiorly within the skeletal framework. The urinary bladder, various loops of small bowel, the genital tract, and the ovaries are situated within the ______ _________.

The uterine, or __________ tubes extend laterally from the _________ to the ovaries, within the true pelvis. The tubes course within the peritoneal folds of the ________ ligaments. They are lateral to the uterus, anteromedial to the ovaries, and posterior to the urinary bladder.

Fallopian, uterus, broad

The muscles of the _______ pelvis include: Iliopsoas muscles, rectus abdominis muscles, and transverse abdominis muscles.

False

Parametrium

Fat and cellular connective tissue surrounding the two layers of each broad ligament and the structures they contain. (The Fallopian tube, round ligament, ovarian ligament, and vascular structures of the uterus and ovaries are positioned between the two layers of each broad ligament.)

The peritoneal lining of the abdominopelvic cavity is seen covering the superior aspect of the: urinary bladder, the uterus, and the anterior region of the rectum. The anterior and posterior cul-de-sacs are potential peritoneal spaces covered by _________ is the peritoneum.

Folds

Transverse abdominis muscles

Form anterolateral borders do abdominopelvic cavity This muscle group lies deep to internal and external oblique muscles

Estrogen

Hormone produced by the ovaries that promotes proliferation or preparation of the uterine endothelium for possible implantation by a zygote.

The vagina sits in the _____________ portion of the peritoneal cavity (or midregion of the true pelvis) between the urinary bladder and urethra (anteriorly) and the _________ (posteriorly). It extends superior to inferior, from the external Os of the uterine _________ to the external genitalia.

Hypogastric, rectum, cervix

The nonpregnant uterus is also located in the _____________ portion of the peritoneal cavity, between the urinary bladder (anteriorly) and the rectum (posteriorly). The cervical portion of the uterus enters the vagina and lies at _______ angles to it.

Hypogastric, right

False pelvis muscles

Iliopsoas, rectum abdominis, transverse abdominis

These muscles extend from obturator fascia and ishcial spine anteriorly to coccyx posteriorly. (Also located lateral to pubococcygeus muscles)

Illiococcygeus

Linea terminalis

Imaginary line drawn from the symphysis pubis around to the sacral promontory, marking the dividing plane between the true and false pelves. The circumference of this plane is termed the pelvic inlet.

Iliopsoas muscles

Join iliacus muscles at level of iliac crests to form ilipsoas bundles of the false pelvis. Each of these muscles courses anteriorly along linea terminalis, to travel over the pelvic brim and insert into lesser trochanter of the femur.

At birth, the ovaries are relatively ________ as a result of maternal hormone stimulus. There is little change in ovarian size until 5 or 6, after which age-related growth is seen, associated with an increase in cystic functional changes.

Large

The pubovesical ligaments extend anteriroly from the bladder neck and attach to the pubic bones. The ___________ ligaments extend to fuse with the tendinous arch of the obturator internus muscles.

Lateral

Iliococcygeous muscle (true pelvis, pelvic diaphragm muscle)

Located lateral to the pubococcygeous muscles. This pair extends from the obturator fascia and ischial spine anteriorly to the coccyx posteriorly. Together, the pubococcygeous and ________________ muscles form a hammock across the floor of the true pelvis and are termed the LEVATOR ANI MUSCLES. These muscles provide primary support to the pelvic viscera and aid in the contraction of the vagina and rectum. The coccygeous muscles are the most posterior muscle pair of the pelvic diaphragm. These muscles extend from the ischial spine to the sacrum and coccyx.

Cervix

Lower cylindrical portion of the uterus that projects into the vagina.

The _________ ovarian volumes can be observed during the luteal phase and the _________ volumes during the preovulatory phase.

Lowest, highest

The __________ (of the ovary) contains the ovarian vasculature, lymphatics, and nerves supported by fibrous connective tissue. This highly vascular core communicates with the parametrium of the broad ligament in the ovarian hilum. The hilum is located along the superoanterior aspect of the ovary. The indundibulopelvic and ovarian ligaments support and maintain the relative position of the ovaries in their adnexal location. In most cases the ovaries are situated posterolateral to the broad ligaments; however, they are quite mobile and may be located anywhere within the andexa, except anterior to the uterus or anterior to the broad ligaments.

Medulla

The ____________ is a short, double fold of peritoneum extending from the posterior aspect of the broad ligament to the ovarian hilum.

Mesovarium

Menses/menstration

Monthly sloughing off the endometrial lining of the non pregnant uterus.

Bicornate uterus

Most common of the congenital tract. Recognized sonographically by the presence of two endometrial canals that usually communicate at the level of the cervix.

Rectus abdominis muscles

Much of anterior wall of abdominopelvic cavity is formed by _______ ___________muscles. Extend from 6th rib and xiphoid process down to pubic symphysis. These paired muscles are intersected by transverse tendinous bands and are wrapped in a muscular sheath. Rectus sheath fuses with transversus abdominis muscles to form linea alba.

The _________ folds when the bladder is empty, and it distends and becomes smooth when the bladder is full.

Mucosa

Multiparous

Multiple viable births

The ______________ or muscle layer, forms the bulk of the uterus. It is composed of three distinct layers of different muscle fibers: outer longitudinal fibers, intermediate spiral bands, and inner circular and longitudinal fibers. This combination of fibers is responsible for the _______________ dramatically enlarging during pregnancy and producing the radial muscle contractions necessary to expel the fetus at parturition ( the act of giving birth).

Myometrium

The interstitial or intramural segment of the uterine tube is the ______________ portion (of the uterine tube) and is enclosed within the muscular wall of the uterus.

Narrowest

Nulliparous

No viable births

Parity

Number of viable offspring

This muscle is secured to medial aspect of greater trochanter

Obturator internus muscle

Ovulation

Occurs when the ovarian follicle bursts and releases the mature ovum. Approximately 14 days after follicle formation.

Menarche

Onset of menstruation

The germinal epithelium is a single layer of epithelial cells lining the ________ surface of the ovary. (This name arose from the MISTAKEN belief that the germ cells originated from this tissue layer.)

Outer

The ____________ layer of the bladder, the serosa, is located at the superior portion of the bladder. It is an extension of pelvic peritoneum.

Outermost

Follicles

Ovarian encasement containing an immature ovum. Site of ova maturation.

This ligament lies within the peritoneal folds of the broad ligament

Ovarian ligament

The __________ are the only organ located within the peritoneal cavity that are NOT covered by peritoneum.

Ovaries

What typically lie posterolateral to the uterus (within the adnexa)? They are also quite mobile and influenced by the condition of surrounding structures. They never move anterior to the uterus or broad ligaments.

Ovaries

The germinal epithelium is the outtermost layer of the:

Ovary

The three muscles that form the pelvic diaphragm:

Pubococcygeous, iliococcygeous, and coccygeous muscles

True pelvis muscles

Pubococcygeous, iliococcygeous, coccygeous

Adnexa

Regions of the true pelvis posterior to the broad ligaments

In the __________ state, the vaginal walls collapse together, and the epithelial lining folds into transverse ridges, or rugae.

Relaxed

If the body and fundus are bent at a greater posterior angle until the fundus is pointed inferiorly adjacent to the cervix, the uterine position is described as ___________.

Retroflexed.

The 3 distinctive regions of the pelvis are:

Right iliac, hypogastrium, left iliac

What maintain the forward bend of the uterine fundus?

Round ligaments

Space of Retzuis

Separates the anterior bladder wall from the pubic symphysis; it is filled with extraperitoneal fat. (See fig 20.11).

Graded compression

Slow and steady compression of the bowel between the anterior and posterior abdominal walls.

Space of retzius

Space that separates the anterior bladder wall from the pubic symphysis and is typically filled with extra peritoneal fat.

Ovarian ligament

Supports medial aspect of ovary to uterine cornu.

Broad ligaments

The anterior and posterior peritoneal reflections covering the uterus extend anterolaterally to the walls of the true pelvis. (Figs 20.8 and 20.9) These double folds of peritoneum extend from the uterine cornua to the lateral pelvic walls to form these ligaments. These ligaments are not true ligaments and they provide minimal support for the uterus . The Fallopian tube, round ligament, ovarian ligament, and vascular structures of the uterus and ovaries are positioned between the two layers of each broad ligament. These structures are surrounded by far and cellular connective tissue, called the parametrium.

Linea terminalis

An imaginary acute line drawn along the inner surface of the pelvic bone- from the pubic or pubic symphysis anteriorly to the sacral promontory posteriorly- that marks the plane separating the false from true pelvis.

If the body and fundus are bent at a greater anterior angle until the fundus is pointing inferiorly and resting on the cervix, the uterine position is described as ____________. Inversely, the uterus can also be retroverted and retroflexed. In a ____________ position, the body and fundus are tipped posteriroly and the angle of the cervix and the vagina increases, making them more linearly oriented.

Anteflexed (anteversion), retroverted (retroversion)

The uterine cervix protrudes through the ___________ vaginal wall into the upper potion of the vaginal canal. The space within the vaginal canal encircling the cervix forms the anterior, posterior, and lateral cornices of the __________.(figs 20.14 and 20.15). The walls of the vagina conform the general structure of the genital tract. They are composed of a mucosal lining of epithelial cells, a thin smooth muscle wall. And an outer adventitia. The vagina is highly elastic, permitting gross distention during parturition. (Birth) In the relaxed state, the vaginal walls collapse together, and the epithelial lining folds into transverse ridges, or rugae. (Fig 20.15).

Anterior, vagina

The external urethra orifice of the bladder is located between the labia minora of the external genitalia. The inferolateral surfaces of the bladder meet ____________ and are in contact with the pelvic floor muscles. The superior and posterior walls of the bladder are lined by visceral peritoneum, which is continuous with the peritoneal lining of the abdominopelvic space. The peritoneum covering the bladder walls and extending over the uterine fundus creates a potential space between the bladder and the uterus, known as the anterior cul-de-sac. The space of Retzius seperates the anterior bladder wall from the pubic symphysis and is typically filled with extraperitoneal fat.

Anteriorly

The corpus and fundus of the uterus show considerably more variation in size than the more rigid ________. Before puberty, the cervix accounts for a significantly greater production of the organ than it does during adulthood. During puberty, the dimensions of the uterus and endometrial thickness markedly increase. The corpus and fundus portions enlarge, changing the uterus from tubular to pear shaped.

Cervix

____________ uterine malformations result in an atomic variations of the uterus, cervix, and vagina, resulting from the incomplete fusion of agenesis of the Müllerian ducts.

Congenital

Sacrum and coccyx

Constitute the distal segment of the vertebral spine and form the posterior border of the pelvic cavity.

Isthmus (uterine)

Constricted portion of the uterus where the body or corpus meets or is continuous with the uterine cervix.

Internal iliac artery

Continuation of the common iliac artery. Multiple branches that include the uterine artery.

The _________ is continuous with the uterine cervix at a point marked by a construction of the uterus called the isthmus. During late pregnancy, the isthmus is taken up into the corpus to form the lower uterine segment.

Corpus

False pelvis (major or greater pelvis) location

Defined as the more superior aspect of the pelvic cavity, extending from the iliac crests superiorly, to the linea terminalis inferiorly.

Innominate bones

Encircle most of the pelvic cavity, forming its lateral and anterior margins. Each ____________ ______ is formed by the fusion of 3 ossification centers between the ilium, ischium, and pubis. The __________ _____ join posteriorly at the sacrum and coccyx and fuse anteriorly at the pubis or pubic symphysis.

The infundibulum is the funnel-shaped ______ portion of the uterine tube. The tube terminates at the fimbriated end of the infundibulum and opens into the peritoneal cavity adjacent to the ovary. Specifically, the infundibulum passes through the posterior aspect of the broad ligament to reach the ovary. The uterine tube and the ovary are not intimately connected; thus the genital tract creates a channel between the outside and the peritoneal cavity. The fimbriae of the uterine tube are finger like extensions of the INFUNDIBULUM, which overlie the ovary and direct the released ovum into the tube.

End

The urinary bladder is fixed __________ at its base in the true pelvis, posterior to the pubic symphysis and anterior to the uterus and vagina. It is anchored to the pelvis by pubovesical and lateral ligaments.

Inferiorly

What two paired ligaments support the ovaries and maintain their relative positions in the adnexal regions?

Infundibulopelvic and ovarian ligaments

Endometrium

Innermost, mucosal layer of the uterine wall that is continuous with vaginal epithelium inferiorly and uterine tube mucosa superolaterally.

The innermost ovarian tissue is the ___________, composed of ovarian vessels, nerves, and connective tissue. (Similar to the spermatic cord contents). Follicular development takes place in the ________ of the ovary, which surrounds the medulla. The cortex is enclosed by a fibrous capsule called the tunica ____________. The germinal epithelium is the outermost cellular layer.

Medulla, cortex, ablugenia

Myometrium

Muscle layer that forms the bulk of the uterus. Composed of three layers of different muscle fibers: outer longitudinal fibers, intermediate spiral bands, and inner circular and longitudinal fibers, which are responsible for the dramatic enlargement of the uterus during pregnancy and the radial muscle contractions necessary to expel the fetus at parturition.

The ovaries in ____________ (no births) women lie in a craniocaudal long axis direction on the iliopsoas muscle of the lateral pelvic walls between the external iliac vessels anteriorly and the internal iliac vessels and ureters posteriorly.

Nulliparous

These triangular muscles narrow inferiorly to pass through lesser sciatic notch These muscles also originate along arcuate line of innominate bones and course parallel to lateral walls of true pelvis. They are also secured to medial aspect of greater trochanter Internal surface of this muscle is covered by a tough membranous layer called the obturator fascia.

Obturator internus muscle

The muscles of the true pelvis include:

Obturator internus, piriformis, pelvic diaphragm (pubococcygeus, iliococcygeous, and coccygeous muscles)

External Os

Portion of the endocervical canal that projects into the vaginal vault.

These muscles extend from the pubic bones to coccyx, encircling urethra, vagina, and rectum.

Pubooccygeus muscles

The _________ is situated posterior to the vagina. It is fixed in its position and is largely retroperitoneal.

Rectum

The uterus is located between the urinary bladder (anteriorly) and the _________ (posteriorly). The cervical portion of the uterus enters the vagina and lies at right angles to it.

Rectum

An arbitrary division defined by the _______ promontory and linea terminalis designates the true and false pelvis.

Sacral

The cilia (ciliated cells of the mucosal lining of the uterine tubes) propel a gentle current of __________ fluid, which aids in the transportation of the ovum. Uterine tubes are descriptively divided into

Secreted

The _________ is a thin membrane that covers the myometrium and forms the outer layer of the uterus. The uterus is descriptively divided into four parts: fungus, corpus, isthmus, and cervix.

Serosa

The __________ colon lies within the true pelvis and is somewhat variable in length and position. It is continuous with the descending colon in the left lower quadrant of the abdominopelvic cavity and is loosely secured to the posterior pelvic wall by the ___________. The _____1_____ colon descends toward the rectum in the inferoposterior aspect of the pelvis at the level of the third sacral vertebra.

Sigmoid, mesocolon

Psoas Major Muscles

Somewhat triangular in shape; situated vertically in the body. Prominent paired muscles that originate at the lateral aspects of the lower thoracic vertebrae and course anterolaterally in their descent to the iliac crests.

The _______ within the vaginal canal encircling the cervix forms the anterior, posterior, and lateral fornices of the vagina.

Space

The fundus is the widest and most ____________ segment of the uterus situated between the insertion of the uterine tubes at the level of the uterine cornua. It is continuous with the body and largest part of the uterus, called the corpus.

Superior

The iliac crests of the innominate bones define the most ____________ aspect of the pelvic cavity. The two iliac crests and the pubis symphysis are palpable landmarks that aid in evaluating the pelvis.

Superior

Location of the __________ portion of the bladder is variable depending on the amounts of urine in the bladder. As the bladder fills with urine, the DOME can extend into the false pelvis, displacing moveable pelvic organs and loops of small bowel. Only the _______ is covered by an extension of peritoneum.

Superior, dome

The __________ is the region of the urinary bladder at which the ureters enter and the urethra exists the cavity

Trigone

Pelvic are starts in the hip bones. The pelvis is in that hypogastric and right and left iliac areas. The pelvis actually starts inferior to the belly button (umbilicus) right at the iliac crests. The ________ pelvis is down in the deep, inferior portion of the pelvis, from the linea terminalis. The linea terminalis is where the hip bones come in and don't actually connect (the ischium connects around), so it leaves a huge hole. The superior rim of that hole into the deep pelvis is the linea terminalis, so it is where the hip bones combine and it just creates the ilium (big flat hip bones up here), you have the linea terminalis, and then it will drop into the little bowl (situated posteroinferior), the inferior portion is the true pelvis.

True

What tubes course within the peritoneal folds of the broad ligaments and are lateral to the uterus, anteromedial to the ovaries, and posterior to the urinary bladder?

Uterine tubes (or Fallopian tubes)

The ___________ tubes (Fallopian tubes/ oviducts) are coiled, muscular, bilateral tubes emerging from the cone shaped cornua of the uterus, which are located at the junction of the superior and lateral uterine margins. The ___________ tubes vary in length from 7 to 12 cm as they course within the peritoneum along the superior free margin of the _______ ligaments until they reach the ovaries. These tubes conduct a mature ovum (egg cell) from the ovaries to the uterus through gentle peristalsis of their smooth muscle walls (fig 20.18B). The mucosal lining of the tubes consist of ciliated epithelial cells and secretory cells.

Uterine, broad

The _____________ ligaments extend from the posterior aspect of the cervix around the lateral walls of the rectum to the sacrum.

Uterosacral

The ____________ structure of the pelvis surrounds and protects the lower intestines, the reproductive organs, the urinary bladder, and important components of the nervous and circulatory systems.

ringlike

The external orifice of the vagina is located ___________ to the urethral orifice between the labia minora.

Posterior

The inferior portion of the urinary bladder is composed of a ______________ base (or trigone area) and the neck, which communicate with the ureters and urethra.

Posterior

Retrouterine pouch, or pouch of Douglas are other names for the ?

Posterior cul-de-sac

Psoas major muscles

Prominent paired muscles extending across the posterior wall of the abdominopelvic cavity. These muscles originate at the lateral aspects of the lower thoracic vertebrae and course anterolaterally in their decent to the iliac crests.

The endometrial canal is the the _____________ portion of the birth canal.

Proximal

Endometrial canal

Proximal portion of the birth canal that is formed by the uterine endometrium. It is continuous with the endocervical canal.

Endometrial stripe

The thin, bright, reflective sonographic appearance of the central, linear, opposing surfaces of the endometrium that form the endometrial canal.

Posterior cul-de-sac

This retrouterine reflection of the peritoneum creates a larger potential space between the posterior wall of the uterus (particularly the cervix) and anterior wall of the rectum. This space is known as the ____________ ____________, retrouterine pouch, or pouch of Douglas. The ____________ ____________ is the most dependent space in the abdominopelvic cavity. Any fluid collecting within the peritoneal cavity often drains into this space (fig 20.11).

The muscularis layer of the bladder is composed of ________ layers of smooth muscle, called the detrusor muscle.

Three

Round ligaments

Three paired ligaments provide structural support to the uterus: the __________ _____________, the cardinal ligaments; and the uterosacral ligaments. Each ________ ___________ originates at the uterine cornu and courses with the broad ligaments to the anterolateral pelvic wall. The ________ ___________ passes over the pelvic brim, through the inguinal canal, and is secured at the labia majora. ******* The ________ ___________ maintain the forward bend of the uterine fundus. *******

The urinary bladder, loops of small bowel, the genital tract, and the ovaries are situated within the:

True pelvis

The ________ pelvis extends from linea terminals to pelvic diaphragm inferiorly It is a ______ shaped cavity aligned posteriorly and inferiorly within skeletal framework (Urogenital organs) Urinary bladder, various loops of small bowel, general tract, and ovaries are situated within this pelvis.

True, bowl

__________ blood supply consists of: internal iliac artery, uterine artery, arcuate arteries, radial arteries, straight arteries, spiral arteries.

Uterine

___________ size is directly related to the number of years post menarche.

Uterine

The cardinal ligaments and the uterosacral ligaments provide rigid support for the:

Uterine cervix

Fundus

Widest and most superior segment of the uterus situated between the insertion of the uterine tubes at the level of the uterine cornua; continuous with the body of the uterus.

Posterior Cul De Sac (Rectouterine pouch, Pouch of Douglas)

area between the rectum and the uterus

infundibulopelvic ligament

extends from the infundibulum and the lateral aspect of the ovary to the lateral pelvic wall.

Serosa

thin membrane that covers the myometrium and forms the outer layer of the uterus.

Pelvis

Part of the axial skeleton which links the lower extremities to the rest of the body through the lumbosacral spine

These muscles originate in the most posterior aspect of the true pelvis, along the lower portion of the sacrum, posterior to the uterus. These muscles travel anterolaterally, narrowing to pass through the greater sciatic notch. These muscles are attached to the superior aspect of each greater trochanter.

Piriformis muscle

Internal Os

Portion of endocervical canal that joins or opens into the endometrial canal.

Iliac crests

Portion of innominate bones that define the most superior, bilateral aspect of the pelvic cavity. They are palpable external landmarks that aid in evaluating the pelvis.

Pubococcygeous muscle (true pelvis, pelvic diaphragm muscle)

The most medial and anterior muscle pair of the pelvic diaphragm muscles. These muscles extend from the pubic bones to the coccyx, encircling the urethra, vagina, and rectum.

False pelvis

The most superior aspect of pelvic cavity, extending from iliac crests superiorly to linea terminalis inferiorly.

These muscles make up the levator ani muscle that is the primary support for the pelvic viscera and aid in the contraction of the vagina and rectum.

The pubococcygeus and the iliococcygeus

The wall of the ________ comprises an inner mucosa, a middle smooth muscle layer, and an outer adventitia.

Vagina

Retroflexed uterus

When the bladder is empty and the cervix and vagina are linearly oriented, and the uterine body and fundus are bent at a great posterior angle until the fundus is pointing inferiorly, adjacent to the cervix.

Anteverted uterus

When the bladder is empty and the cervix and vagina form a 90-degree angle, and the uterine body and Fundus are tipped or tilted anteriorly.

Anteflexed uterus

When the bladder is empty and the cervix and vagina form a 90-degree angle, and the uterine body and fundus are bent at a great anterior angle until the fundus is pointing inferiorly and resting on the cervix.

Retroverted uterus

When the bladder is empty and the uterine body and fundus are tipped posteriorly and the angle of the cervix and vagina increases, making them more linearly oriented.