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Anatomy of the Female Reproductive System Ob & Gy Department, First hospital, Xi’an Jiao Tong University WANG SHU 2017/5/24 1 Anatomy of the Bony Pelvis • Bones • Joints • False pelvis and true pelvis • Three planes of the true pelvis • Types of the female pelvis 2017/5/24 2 bone joints F&T 3 plane I. BONES ilium Two coxae Pelvi pubis Sacrum Coccyx 2017/5/24 Ischium 5 fused vertebrae 5 fused cartilaginous 4 II. JOINTS Two sacro-iliac joints joints Sacro-coccygeal joint Symphysis pubis 2017/5/24 5 III. False Pelvis & True Pelvis • The lines of demarcation between false pelvis and true pelvis ------ border line . posterior : upper border of sacral promontory . lateral: ilio-pectineal boundary . anterior: upper border of pubis • False pelvis • True pelvis 2017/5/24 6 IV. Three Planes of True Pelvis • Inlet: the pelvic inlet to the pelvis minor is bounded by . posteriorly: the promontory of the sacrum; . laterally:the linea terminal; . anteriorly:the upper border of the pubis, ending at the symphysis. • Mid-cavity • Outlet: very irregular ,it is bounded by . anteriorly: the arcuate ligament of the pubis , . laterally: the ischiopubic arch, the ischial tuberosity, . Posteriorly: the sacrotuberous ligament, the coccyx. 2017/5/24 7 V. Types of the Female Pelvis • Gynaecoid • Anthrocoid • Platypelloid • Android 2017/5/24 8 a b c d A. Gynecoid Pelvic Inlet: The gynecoid pelvis provides a rounded ,slightly oviod , or elliptical inlet with a well-rounded forepelvis. Posterior segment: This type of pelvis has a well-rounded, spacious posterior segment, an adequate sacrosciatic notch, a hollow sacrum with a somewhat backward sacral inclination,and a Norman-type arch of the pubic rami. Side walls: 2017/5/24 This type of pelvis has straight side walls and wide interspinous and intertuberous diameters.the bones are primarily of medium weight and structure. 10 B. Anthropoid Pelvic Inlet: This type of pelvis is characterized by a long, narrow, oval inlet with an extended and narrow anterior. Posterior segment: This type of pelvis has a posterior segment, a wide sacrosciatic notch, and a long, narrow sacrum. Side walls: 2017/5/24 Straight side walls are characteristic of the anthropoid pelvis, whose interspinous and intertuberous diameters are less than those of the average gynecoid pelvis. A medium bone structure is usual. 11 C. Platypelloid Pelvic Inlet: This type of pelvis has a distinct oval inlet with a very wide, rounded retro pubic angle Posterior segment: This type of pelvis has a a wider, flat posterior segment. The sacrosciatic notch is narrow and has a normal sacral inclination, although it is often short. The subpubic arch is very wide and Side walls: The side walls are straight,with wide interspinous and intertuberous diameters. 2017/5/24 12 D. Android Pelvic Inlet: The android pelvis has a wedge-shaped inlet, a narrow forepelvis. Posterior segment: This type of pelvis has a flat posterior segment, and a narrow sacrosciatic notch,with the sacrum inclining forward. . Side walls: The side walls converge and the bones are medium to heavy in structure.. 2017/5/24 13 Pelvic floor Outer layers: bulbocavernosus muscle ischiocavernosus muscle superficial transverse perineal muscle external sphincter muscle of anus Mid-layers: urogenital diaphragm Inter layers: pelvic diaphragm Perineum: 2017/5/24 perineal body 14 External genital organs • • • • • 2017/5/24 Mons pubis Labia majus Labia minus Clitoris Vaginal vestibule Urethral orifice Major vestibular gland Vestibular bulb Vaginal orifice and hymen 17 Internal genital organs I. VAGINA • Fornices Because the cervix of the uterus projects into the upper portion,the anterior wall of the vagina is shorter than the posterior wall.the circular cul-de-sac formed around the cervix is known as the fornix and is divided into 4 regions;the anterior fornix,the posterior fornix,and 2 lateral fornices. • Mucous membrane The mucous of the vagina is lined throughout by stratified squamous epithelium.Even though the vagina has no true glands,there is a secretion present.it consists of cervical mucus, desquamated epithelium,and a direct transudate. 2017/5/24 19 II. UTERUS • Bulk of uterus The uterus is a pear-shaped,thick-walled,muscular organ.it is approximately 7~8cm long and 4~5cm at its widest point.In the prepubertal period,it is considerably smaller.In women who have borne children, it is larger. • Isthmus of uterus The communi-cation of the cavity below with the cavity of the cervix corresponds in position to the isthmus and forms the internal orifice(internal osuteri). At the extremty of the vaginal portion is the opening leading to the vagina, the external orifice (external os uteri), which is round or oval before parturition but takes the form of a transverse slit in women who have borne children. 2017/5/24 22 II. UTERUS • The normal position of the uterus: Normally ,the uterus forms a sharp angle with the vagina,so that its anterior surface lies on the upper surface of the bladder and the body is in a horizontal plane when the woman is standing erect.there is a bend in the area of the isthmus, at which the cervix then faces downward.this position is the normal anteversion, it may be placed backward (retroversion). • Tissue structure . Endometrium: it is soft and spongy,composed of tissue resembling embryonic connective tissue. . Myometrium: the muscular layer is extremely thick. . Perimetrium: it is simply the peritoneal covering.it is thin and firmly adherent over the fundus and most of the body. 2017/5/24 23 II. UTERUS • Cervix . supra-vaginal portion . vaginal portion • Ligaments . round ligaments . broad ligaments . utro-sacral ligaments . transverse cervical ligaments • Arteries: The blood supply to the uterus is from the uterine and ovarian arteries. The uterine artery runs downward and medially to cross the ureter near the cervix. 2017/5/24 26 III. Fallopian Tube • Position: the fallopian tubes serve to convey the ova to the uterus. They extend from the superior angles of the uterus to the region of the ovaries,running in the superior border of the broad ligament.Each tube is 714cm long. • Four portions: . Interstitial: it has a rather long intramural course, and its opening into the uterus. . Isthmus: it is very narrow ,1mm in diameter. . Ampulla: it is wider,more tortuous,it terminates in the infundibulum. . Infundibulum: it is attached to the ovary. 2017/5/24 29 IV. Ovaries • Tissue structure: The ovary is covered by low columnar epithelium and consists of a cortex and a medulla. The medulla is made up of connective tissue fibers and supporting tissue;the definitive ova (oocytes) lies in the cortex. • Position: The ovaries are paired organs situated close to the wall on either side of the pelvis minor. It is suspended by means of the mesovarium,the suspensory ligament of the ovary,and the ovarian ligament. • Arteries: The ovarian arteries may originate as branches of the abdominal aorta,the left frequently originates from the left renal artery;the right less frequently. 2017/5/24 31