Female Pelvic Anatomy 08/03/21

Vagina

7-10cm, long muscular tube that extends from the cervix of the uterus to the external genitalia. Lies between the urinary bladder and the rectum. Wall is composed mainly of smooth muscle, and is lined with a mucous membrane.

Hymen

A membrane that partially covers the entrance of the vagina. The size of this opening increases with age.

Uterus

A small, hollow, pear shaped muscular structure suspended in the mid - pelvis. It is partly covered by the peritoneum.

Menopause

After ________: the uterus atrophies. Women more than 5 years post "this" uterus measures: length: 3.5 - 7.5 cm width: 2-4 cm AP diameter: 2-3 cm

Perineum

Area between vaginal opening and the anus.

Labia majora

Elongated folds composed mainly of fat and numerous glands. They are covered with pigmented skin, hair on the outer surface, and smooth inner surface. "Large lips"

Menopause

Following _______, the ovary atrophies and follicles disappear. Any persistent cyst in the post-menopausal ovary must be regarded with suspicion. May be difficult to visualize on a sonogram. Following a hysterectomy, ovaries are difficult to visualize due to loss of anatomical landmark.

Cervix

Function of ______: provides an alkaline secretion favorable to to sperm penetration. During delivery, must help with the expulsion of the fetus by effacing and dilating.

Uterus

Function of ________ is reproductive: receives fertilized egg, nourish the developing conceptus, ultimately to expel the fetus.

They produce a moderately hypoechoic pattern typical of smooth muscle

How do the muscular walls of the vagina appear sonographically?

(L x w x h) /2 = v^3

How is ovarian volume calculated?

Endocervical canal

In pregnancy, the mucosa of the ______ undergoes hypertrophy and produces a dense, sticky mucous plug that effectively plugs the uterus to impede upper migration of bacteria from vagina.

Distended

In regards to sonographic appearance, the walls of the bladder become stretched and thin when the bladder is ______.

Empty

In regards to sonographic appearance, walls are thick and easily demonstrated when the bladder is ____.

Endometrium

Inner layer of the uterine wall composed of mucosa that varies in thickness and composition through the menstrual cycle.

Myometrium

Muscular, middle layer of the uterus. Smooth muscle dense and firm. Forms the bulk of the uterine wall. Sonographically appears homogenous with low to moderate echogenicity.

Fimbriae - infundibulum - ampulla - isthmus - interstitial (intramural)

Name the regions of the Fallopian tube starting with the most lateral portion

Ovaries

Normal echo pattern for ______: • background of low amplitude echoes with scattered bright reflectors and anechoic spaces of the developing follicles.

Not greater than 9.8 cm ^3

Normal ovarian volume during menstruating years

5.8 cm ^3

Normal ovarian volume during post- menopause

3.0 cm^3

Normal ovarian volume range for pre-menarchal

Internal os

Opening of cervix into the uterine body

External os

Opening of cervix into the vagina

Serosa (perimetrium)

Outermost layer of the uterus, it is thin and not visible on sonography.

Ovaries

Paired almond shaped organs lying on the posterior segment of the broad ligament. Surface not covered by peritoneum but by a single layer of epithelium. Position varies but typically lie posterolateral to uterus within the adnexa.

Fallopian tubes ( salpines - plural, salpinx- singular)

Paired, coiled muscular tubes that extend from the cornua of the uterus into the peritoneal cavity. function: transport the ovum (egg) from the ovary to the uterus.

Trigone region

Posterior wall of the bladder is composed mainly of the _____region, which is defined by the orifices of the two ureters and the urethra.

Isthmus

Short, straight narrow portion of the Fallopian tube.

Heterotropic pregnancy

Simultaneous intrauterine and extrauterine implantation: rare, but increasing number due to increase in infertility treatments.

Urethral opening

Situated between the clitoris above, and the vaginal opening.

Uterus

Size of _______ varies with age and pregnancies. • prepuberty - small •reproductive years - full size • pregnancy increases overall size • post-menopause - atrophies (shrinks)

2.5 - 5.0 cm in length 1.5 - 3.0 cm in width 0.6 - 2.2cm in AP

Size of ovaries during menstruating years

Multiparous women

Size of uterus of ________: length: 8-10.5 cm width: 4-6 cm AP diameter: 3-5 cm

Nulliparous women of reproductive age

Size of uterus of _____________: length: 6-8.5 cm width of corpus: 3-5 cm anteroposterior (AP) diameter: 2-4 cm

Mons pubis

Skin covered mound of adipose tissue that cushions the pubic symphysis.

Fundus

Superior potion of the uterus cavity that is rounded or dome shaped.

Cilia

The fallopian tubes' lining is covered with _____, which are essential to the movement of the egg through the tube into the uterus. If damaged, the egg may not get pushed along normally.

1mm, 6mm

The interstitial portion of the Fallopian tube is the narrowest at ~ _____, and widens to _____ at the ampulla.

Corpus (body)

The largest uterine region and houses the uterine cavity. Narrows as it approaches the isthmus.

Cornual ends

The lateral borders of the fundus to which the tubes are connected are called _____.

Ampulla

The longest, most tortuous portion of the Fallopian tube. Terminates in the trumped shaped infundibulum.

Infundibulum

The most lateral portion of the Fallopian tube, with a funnel shaped opening. Has numerous finger like projections called fimbriae. The tube terminates at the fimbriated end of this, and opens into the peritoneal cavity; adjacent to the ovary.

Echogenic

The mucosa of the vagina is highly _____.

Interstitial (intramural)

The narrowest portion of the Fallopian tube that is enclosed within the uterine wall.

Fornix

The posterior wall of the vagina is longer than the anterior wall. This attachment creates a ring shaped, blind pocket called the _____ between the outer wall of the cervix and inner surface of the vaginal wall.

Fallopian tubes

The sono appearance of ______: • rarely recognized except when filled with fluid (hydrosalpinx) • difficult to delineate from surrounding structures.

Dome

The superior wall of the bladder is referred to as the ______, and is usually in contact with the anterior wall of the uterus, which folds forward to rest on the bladder.

Fallopian tubes

The total length of this structure in adults is 7-14cm.

Posterior, anterior

The uterus lies ____ to the urinary bladder, and _____ to the rectum.

Outer epithelial layer

There are 3 walls of the urinary bladder. 1) outer epithelial layer 2) middle muscular layer (gives bladder contractibility) 3) inner layer mucosa (very echogenic) which layer is not visible on ultrasound?

Urinary bladder

Thick walled highly distendible sac that lies between the symphysis pubis and the vagina.

Labia minora

Two thin folds located within the labia majora. "Small lips"

Full

You can tell the bladder is adequately __________ for transabdominal pelvic sonography when the dome of the bladder extends above the fundus of the uterus.

Prepubertal uterus

_______ measures: length: 1-3 cm width and height: 0.5-1.0 cm

Uterine growth

________ begins at approximately 7-8 years of age and accelerates during puberty and continues to grow until approximately 20 years old.

Vulva

external female genitalia

Cervix

Cylindrically shaped, most caudal portion of the uterus. Composer of 90% collagenous tissue which gives it strength. Size: 2.5-4cm in length.

Urethra

Carry urine from the bladder to the urethral orifice

Ureters

Carry urine from the kidneys to the bladder

Medulla

Central portion of the ovary containing loose connective tissue, vessels and nerves.

Ectopic pregnancy

Clinical signs of ______: • pain, bleeding, pelvic mass

Isthmus

Constricted, narrow portion of the uterus that marks the transition from the corpus to the cervix.

Outer surface

Layer of ovary that consists of simple epithelium.

Tunics albuginea

Layer of ovary that consists of tough, white fibrous connective tissue. Not seen sonographically.

Cortex

Layer of ovary which consists of dense connective tissue and OVARIAN FOLLICLES.

clitoris

Located at the anterior end of the labia minora, composed of erectile tissue.

1) outer serosal layer 2) middle muscular layer 3) inner mucosa layer (this layer has cilia)

What 3 layers does the wall of the Fallopian tube consist of?

1) outer layer 2) middle layer 3) inner layer

What 3 layers is the myometrium subdivided into?

1) interstitial (intramural) 2) isthmus 3) ampulla 4) infundibulum

What 4 parts is the Fallopian tube divided into?

Medulla, cortex, tunica albuginea, outer surface

What are the four layers of the ovary?

Fundus, corpus, isthmus, cervix

What are the four regions of the uterus?

Serosa, myometrium, endometrium

What are the layers of the uterus?

Basal layer (stratum basalis) and functional layer (stratum functionalis)

What are the two layers of the endometrium?

10-16%

What percentage of people have repeat ectopics due to tubal scarring? (Increases up to 30% after 2 ectopics) PID also causes scarring

Interstitial (intramural)

What region of the Fallopian tube inserts into the uterine wall?

Nabothian cysts

What type of cysts could you find in the uterus?

Gartner's duct cyst

What type of cysts could you find in the vaginal canal?

Ectopic pregnancy

When the fertilized ovum implants in any area outside the endometrial cavity.

Fallopian tubes (93% ampullary, 4% isthmus, 2.5% interstitial within the uterine cornua)

Where do ectopic gestations most commonly occur at 97%?

Ampulla

Where does fertilization take place in the Fallopian tubes?

Functional layer (stratum functionalis)

Which layer of the endometrium sheds during menstruation?

Outer layer

Which layer of the myometrium involves longitudinal muscle fibers?

Inner layer

Which layer of the myometrium involves muscle fibers arraigned both longitudinally and oblique? (This layer is seen as a hypoechoic thin region surrounding the echogenic endometrium)

Middle layer

Which layer of the myometrium is richly vascular?

Isthmus

Which region of the uterus is the point at which the uterus is the most flexible?

Cornual pregnancy

Which type of ectopic pregnancy is the most dangerous because it goes undetected due to being surrounded by the myometrium which allows for greater growth vs. thin walls, and also because maternal veins lie adjacent to these and may cause massive hemorrhaging from late ectopic rupture?

Episiotomy

surgical incision of the perineum that helps prevent tearing during childbirth.