Female Reproductive

System

1. To know the different parts of the female reproductive system, as compared to the male counterpart2. To understand the relations of these organs to neighboring structures4. To enumerate the common clinical conditions of these organs as to its embryology, anatomy and histology5. To know the recent technology used in its study

OBJECTIVES

Broad Ligament

• Fold of peritoneum that encloses uterus

• Extends from side of uterus to lateral pelvic wall and floor

• Uterine tubes found in free edge

Ovaries• Ovarian surface• Ovarian fossa

– Boundaries: iliac vessels

• 1.5 x 0.75 “

• Ligaments

- Broad (mesovarium)

- suspensory

- round

Superiorend

Inferiorend

Blood supply:•Arteries – Ovarian (L2)•Veins – Ovarian (IVC & Renal)Lymph drainage:•para-aortic nodes (L1)Nerve supply:*aortic plexus

Clinical Notes:1.Position2.Cysts

- benign- malignant

Technology: 1.Ultrasound2.Laparoscopy3.In vitro fertilization

* Genital ridge

Uterine Tubes

• 10-12 cm long• Functions

– carry oocytes from ovaries

– carry sperms from uterus to ampulla

– conveys dividing zygote to uterus

Uterine Tube

• Infundibulum– abdominal ostium– 20 to 30 fimbriae

• Ampulla– widest & longest

• Isthmus– narrowest part

• Intramural - interstitial

Blood supply:•Arteries – Ovarian

Uterine•Veins – Lymph drainage: - internal iliac / para-aorticNerve supply: - Autonomics of the inferior hypogastric plexus

Clinical Notes:1.PID2. Ectopic pregnancy

Technology:1.Tubal ligation2.In vitro fertilization3.Laparoscopy – chromotubation

* Paramesonephric ducts

Eccyesis

Uterus

• Located between bladder and rectum

• Anterior – bladder• Posterior – rectum• Lateral – adnexae

Vesicouterinepouch

Rectouterinepouch

Uterus

• Two main portions– body - superior two

thirds– cervix - inferior third

• Isthmus– junction between the

body and cervix

• Fundus• Cornua

- Functions: reception, retention, nutrition

- pear-shaped- 3 x 2 x 1”- triangular cavity - thick muscular wall

- Arteries & Veins: uterine- Lymph drainage: * Fundus – para-aortic nodes * Body & cervix – int & ext. iliac; superficial inguinal nodes * Nerve supply – as the tubes

Uterine positions

Vesicouterinepouch

Rectouterinepouch

Uterine Ligaments

Ovarian ligament

Suspensory ligament

Round ligament

Uterine Support

• Pelvic Diaphragm– levator ani muscles– coccygeus

• Urogenital diaphragm• Cardinal ligament• Uterosacral ligament• Pubocervical ligament

LEVATORANI

UG DIAPH

FASCIA

< OBT. INT.

< PERINEAL BODY

Vestigial Structures

Clinical Correlations:1.Uterus at different ages 2.Pregnancy & labor

Cesarean section3. Pelvic examination4. Conditions:

* Prolapse / Procidentia* Leiomyoma* Malignancy * Embryological

Blood Supply of Female Reproductive Tract

• Vagina– vaginal artery– internal pudendal a.

• Uterus– uterine artery– ovarian artery

• Ovary– ovarian artery

• Uterine tubes– uterine & ovarian a.

Vaginal a.

Internal pudendal a.

Uterine a.

Ovarian a.

Blood Supply to FemaleReproductive Organs

• Anastomoses of venous plexuses– vaginal– uterine– rectal– pampiniform

• Venous drainage– internal iliac veins– ovarian vein

• right - inferior vena cava• left- left renal vein

Lymphatic Drainage

• External iliac nodes– 8-10 in number– drain bladder, male internal

organs, uterus

• Internal iliac nodes– from all pelvic viscera– deep part of perineum

• Sacral lymph nodes– from posterior pelvic wall,

rectum, prostate/cervixExternaliliac nodes

Internaliliac nodes

Commoniliac nodes

Lumbarnodes

Sacral nodes

Cisterna chyli

Lumbar trunk

Lymphatic Drainage

• Common iliac nodes– lateral group

• common iliac vessels• lymph from external &

internal nodes– median group

• angle between vessels• lymph directly from

pelvic viscera

• Lumbar aortic nodes– along abdominal aorta– lymph from common iliac

nodes , fundus of uterus, ovary & tubes

Externaliliac nodes

Internaliliac nodes

Commoniliac nodes

Lumbarnodes

Sacral nodes

Cisterna chyli

Lumbar trunk

Lymphatic Drainage

Externaliliac nodes

Internaliliac nodes

Commoniliac nodes

Lumbarnodes

Sacral nodes

Cisterna chyli

Lumbar trunk

Lumbar aortic nodes

Lumbar trunk

Cisterna Chyli

Thoracic duct

Pelvic Autonomic System

• Superior hypogastric plexus– anterior to bifurcation of

aorta– inferior prolongation of

intermesenteric plexus

• R&L hypogastric nerves– mingle with pelvic

splanchnic ncerves

Pelvic Autonomic System

• Inferior hypogastric plexus– superior hypogastric

plexus and pelvic splanchnic nerves

– surrounds internal iliac artery

• Pelvic plexus

Pelvic Plexus

• Middle rectal plexus– innervates rectum

• Vesical plexus– innervates urinary

bladder

• Prostatic plexus– innervates male

internal reproductive organs

• Uterovaginal plexus

Dissection• Identify structures that enter and leave

the pelvis (ureter, internal iliac artery & branches)

• Examine the peritoneal relationships in both male and female pelves– Note the formation of the pouches

• rectovesical• rectouterine• vesicouterine

Vesico-uterinepouch

Recto-uterinepouch

Rectovesicalpouch

Dissection

– Identify all the different ligaments of each individual pelvis that can be visualized

• posterior surface of anterior abdominal wall• females

– uterosacral and cardinal ligaments– broad , round, suspensory ligament

Dissection

• Remove the peritoneum from the pelvic cavity and inspect the pelvic viscera – Pull the apex of the bladder upward and backward to easily

detach the bladder from the pelvic wall exposing the retropubic space

• With a bone saw cut through the symphysis pubis and retract it laterally

• Cut through the midline of the bladder (Sagittal section) Inspect bladder wall