Female Pelvis

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FEMALE PELVIS Peritoneal Covering Recto-uterine pouch (cul-de-sac of Douglas) Vesiculo-uterine pouch Broad ligament

Covers/Relations Fundus, uterus (posterior surface of body), upper 1/3 rectum

Parametrium Mesosalphinx Mesovarium True ovarian ligament False suspensory lig.

Fold inserted between upper 1/3 uterus & superior surface of bladder Below FT, sides of uterus and cervix Fixed by infundibulo-pelvic ligament to sacro-iliac joint Supports uterine vessels and nerves and distal ends of ureters Covers fallopian tubes Enfolds ovaries; includes true ovarian ligament Supero-lateral angle of uterus below utero-tubal jxn  tubal pole Tubal pole  lateral pelvic wall at sacro-iliac joint; ovarian vsls.

Infundibulo-pelvic lig. Cardinal (Mckenrodt’s) lig. Utero-Sacral ligament

Thickening at sacro-iliac joint; encloses ovarian vessels Thickennings at sides of cervix, extended to lateral pelvic walls Uterine arteries along its superior border Back of cervix  recto-uterine fold and last segments of sacrum

Round ligament

Superior angles of uterus anterior to utero-tubal jxn  inguinal canal  fibrous tissue beneath labia majora From pelvic surface of symphysis pubis to neck of bladder

Pubo-vesical ligament

Others Covering also used as serosa of these organs

Double layered fold Encloses parametrium Abundant endopelvic fascia

Blends with infundibulopelvic ligament Maintains cervix and uterus in place Prevents forward displacement of cervis Remnants of Wolffian ducts Normal position of uterus

Organ Ovaries

Definition Size of almond seed  age,  scarring (corpora lutea and albicans) Mesovarium – covering of ovaries

Fallopian Tubes Intramural segment Isthmus Ampulla Infundibulum

Muscular tubes in lateral pelvic wall Vicinity of sacro-iliac joint Shortest, narrowest, most fixed part Opening: 1 mm in diameter 2.5 cms Gradual widening; longest part Expanded end with finger-like extensions (fimbriae) Abdominal opening (ostium abdominale) – potential but direct communication with ext env’t via utero-tubal and vaginal passages Ovarian fimbria – longer fimbria; facilitates entry of ovum through ostium into ampulla Hollow muscular organ Diameter: 7-8 cm (0-1 pregnancy), 9-10 (multi), 3-4 (menopause) Slightly arching superior border anove utero-tubal junctions Directed forwards towards symphysis pubis Main part; Broadened below fundus Narrows inferiorly (isthmus) Invaginated into upper end of vaginal Intravaginal portion – enclosed by vaginal fornices canal Ant. fornix – nicest area to palpate for tumor; shallowest Internal os – in isthmus of cervix Lateral fornices – BV External os – rounded or narrow slit Post. fornix – largest and deepest; receptaculum seminis Supravaginal portion – upper segment - rises above pelvic diaphragm into pelvic cavity  contact with cul-de-sac of Douglas Triangular; lined by endometrium Intrauterine openings – at superior angles of cavity Plica palmatae – characteristic palm-leaf-like folds After deliver: involution; 8-12 weeks to recover Upper end – distended for lower half of cervix Lower 1/3 of vaginal canal – surrounded by: Fornices – pouches produced by walls at upper end Pubo-coccygeus (of levator ani) Anterior vaginal wall – shorter, rough (due to rugae) Sphincter urethra and deep TP muscles - related to neck of bladder and urethra Bulbo-cvernoss and superficial TP muscles Posterior wall – longer , smoother; from rectal wall by Musculo-membranous tube; 7-8 cms long thin fascial septum Opens into vestibule of perineum

Uterus Fundus Body (corpus) Cervix

Cavity Vagina

NVS Uterine a.

Ovarian a.

Vaginal a. Veins Lymphatic Sym nerves PS nerves

Fossa ovarica of Waldeyer – where it lodges; below bifurcation of ext and int iliac vessels Superior or tubal pole – directed postero-laterally Inferior or uterine pole – antero-medially Below bifurcation of common iliac vessels 10-12 cms long, enveloped by mesosalphinx Embedded in uterus at superior lateral angle of uterus From uterine wall and extended laterally Dilated ends curved downwards near tubal pole

Origin Internal iliac

Course End Down, forwards, medially to lateral border of isthmus Anastomose with tubal Enveloped by cardinal ligament branch of ovarian artery Side of isthmus: Gives off vaginal branch Ascends on lateral border of uterus  utero-tubal jxn Abdominal Anastomose with uterine Oblique course down  crossing over the ureter aorta artery Pelvic brim: enters fold of infundibulo-pelvic ligament Below origins Mesovarian border  hilus of ovary of renal a. Gives tubal branch  mesosalphinx  utero-tubal jxn Int. iliac Gives branches to lowest part of bladder and rectum Anastomose to form median Vaginal wall: gives off anterior and posterior branches longitudinal azygos artery Vaginal plexuses along sides of vagina  uterine plexuses  other pelvic plexuses Sides of uterus and vagina + urethral, ovarian, and tubal channels  nodules along vein  int & ext iliac vsls Efferent vsls  lumbar, aortic, and other nodes; some into femoral nodes Sacral Joins perivascular plexus (hemorrhoidal arteries, branches Innervate smooth muscles ganglia from inf hypogastric plexus) and glands (uterus & oviducts) S2, 3, 4 Conveyed by pelvic splancnic nerve + above plexuses

2006