Transcript Anatomy of the female reproductive system

Xiu Xiu Jiang
Email: [email protected]
Ai Xia Liu
Email: [email protected]
Telephone (office): 87061501-1839
Women’s Hospital, School of
Medicine, Zhejiang University
Anatomy of the
Female Reproductive System
Jiang Xiu Xiu
Women’s hospital, School of Medicine,
Zhejiang University
Outline
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Bony pelvis
Pelvic floor
External genitalia
Internal genitalia
Vascular, lymphatic and nervous
system
Adjacent organs
Bony Pelvis
Front view
Rear view
Pelvis
A basin-shaped ring Latin word “basin”
To bear the weight of the upper body when
sitting and standing
To contain and protect the pelvic organs
Pelvis
child-bearing and child-birth function in women.
Female
Male
Key factors of bony pelvis
------ related to child-birth
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Size
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Shape
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Joint (movement )
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Ligament (relaxation)
Anatomy of the Bony Pelvis
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Bones
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Joints
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Ligaments
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Three planes of the pelvis
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Types of the female pelvis
Bones
Sacrum (1#) : 5 fused vertebrae
Coxae :
ilium (2#) Ischium (3#) pubis (4#)
Coccyx : 3 fused cartilaginous bones
Bones
sacral promontory
Sacrum : 5 fused vertebrae
sacral promontory
• superiormost portion of the sacrum
• border of the pelvic inlet
• can be touched
• bone marker
Coccyx : 4 fused cartilaginous bones
Bones
Ischium (3#)
Coxae : ilium (2#) pubis (4#)
tuberosity
ischial tuberosity
--- marks the lateral boundary of the pelvic outlet.
Joints
Sacro-iliac joint (SI)
- minimal motion
Sacro-coccygeal joint (SC)
- slightly moveable (forward and backward).
Symphysis pubis
- slightly movable
Joints
Symphysis pubis
Greek word “growing together”
• Absorb shock during walking.
• Delivery of baby.
gap of the symphysis pubis
non-pregnant: 4-5mm
Pregnant: less than 9mm
Joints
Diastasis of the symphysis pubis
result from:
rapid birth; forceps delivery; prenatal;
symptom:
pelvic girdle pain
--- involving 45% of all pregnant women and 25% of all
women postpartum
symphysiotomy
Ligaments
Sacro-iliac joint
Anterior sacroiliac ligament
Interosseous sacroiliac ligament
Posterior sacroiliac ligament
Sacrotuberous ligament
Sacro-coccygeal joint
anterior sacrococcygeal ligament
 posterior sacrococcygeal ligament
lateral sacrococcygeal ligaments
Intercornual sacrococcygeal ligament
Ligaments
Sacrospinous ligament
1. Extend from the lateral border
of the sacrum and coccyx to
the ischial spine
2. A thin, triangular ligament
3. With sacrotuberous ligament,
Closes off the greater sciatic
notch to form the greater
sciatic foramen and closes off
the lesser sciatic notch to form
the lesser sciatic foramen
Ligaments
Sacrospinous ligament
Function
- to prevent posterior rotation of the ilium
with respect to the sacrum
- Fixation site for pelvic organ prolapse
sacrospinous ligament suspension
the vaginal apex is suspended posteriorly and
laterally to the ligament on either side or both
sides
Ligaments
Sacrotuberous ligament
-Extend
from the posterior aspect of the lower 3 sacral vertebrae to the
ischial tuberosity
- It is flat, and triangular in form; narrower in the middle than at the
ends.
Boundary of pelvis
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Border line
posterior
upper border of sacral promontory
lateral
iliopectineal line
anterior
upper border of pubis
Boundary of pelvis
The female bony pelvis is divided into:
False pelvis ( pelvis major )
---above the border line and has no obstetric importance.
True pelvis ( pelvis minor )
---below the border line and related to the child -birth
The bone delivery canal of childbirth
Planes of True Pelvis
• inlet
• outlet
• mid-cavity
Planes of True Pelvis
pelvic inlet is heart-shape,
bounded by
. posteriorly
upper border of sacral promontory
. laterally:
iliopectineal line
. anteriorly:
upper border of pubis
anteroposterior about 11cm.
transverse about 13cm
oblique about 12.75cm
Planes of True Pelvis
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Mid-cavity
It is a segment, the boundaries of which are:
 the roof is the plane of pelvic inlet,
 the floor is the plane of the plane of pelvic outlet,
 anterior - the shorter symphysis pubis,
 posterior - the longer sacrum.
o Interspinous diameter = 10 cm
 between the tips of ischial spines.
Planes of True Pelvis
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Pelvic outlet: 2 triangular planes with 1 base
which is the intertuberous diameter
Anterior sagittal plane:
apex - the lower border of the symphysis pubis.
laterally: the ischiopubic arch
Posterior sagittal plane:
apex - the tip of the coccyx.
Laterally - sacrotuberous ligament
Planes of True Pelvis
Diameters of pelvic outlet
Antero-posterior diameter =11.5cm
from Sacro-coccygeal joint to the lower border of symphysis pubis.
Transverse diameters (Bituberous diameter) = 9 cm
between the inner aspects of the ischial tuberosities.
Anterior sagittal diameter = 6 cm
from the lower border of the symphysis pubis to the centre of the bituberous
diameter.
Posterior sagittal diameter = 8.5 cm
from Sacro-coccygeal joint to the centre of the bituberous diameter.
Caldwell- Moloy Classification
of Pelvic Types (1933)
Four types of female pelves were described. Actually, the majority of pelvis are
mixed types.
Gynaecoid pelvis
1.
2.
3.
4.
5.
6.
It is the normal female type.
Inlet is slightly transverse oval.
Sacrum is wide with average concavity and inclination.
Side walls are straight with blunt ischial spines.
Sacro-sciatic notch is wide.
Subpubic angle is 90-100o.
Ideal shape, best chances for normal vaginal delivery.
Anthropoid pelvis
1.
2.
3.
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5.
6.
7.
It is ape-like type.
All anteroposterior diameters are long.
All transverse diameters are short.
Sacrum is long and narrow.
Sacro-sciatic notch is wide.
Subpubic angle is narrow (<900 )
prominent ischial spines
Android pelvis
1. It is a male type.
2. Inlet is triangular or heart-shaped with
anterior narrow apex.
3. Side walls are converging (funnel pelvis)
4. Projecting ischial spines.
5. Sacro-sciatic notch is narrow.
6. Subpubic angle is narrow <90o
Platypelloid pelvis
1.
2.
3.
4.
5.
It is a flat female type.
All anteroposterior diameters are short.
All transverse diameters are long.
Sacro-sciatic notch is narrow.
Subpubic angle is wide
Pelvic floor
Pelvic floor
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The tissues closing down the pelvic outlet
(muscles and fasciae)
Function
- providing support for pelvic organs, e.g. the bladder,
rectum, the uterus.
- maintenance of continence
Anterior part (urogenital triangle)
urethra and vagina pass through
Posterior part (anal triangle)
rectum pass through
Pelvic floor
Outer layer
Bulbocavernosus muscle (球海绵体肌)
Ischiocavernosus muscle (坐骨海绵体肌)
Superficial transverse perineal muscle (会阴浅横肌)
External anal sphincter (肛门外括约肌)
mid layer
urogenital diaphragm (泌尿生殖膈)
Pelvic floor
Inner layer (pelvic diaphragm 盆膈)
 the main support of the pelvic floor
 formed by the levator ani and coccygenus
muscles and covering fasciae.
 Levator ani: （肛提肌)
pubococcygenus (耻尾肌),
iliococcygenus (髂尾肌),
puborectalis (坐尾肌)
PC
IC
Levator ani
Pubococcygenus (PC )
-a hammock-like muscle
-stretches from the pubic bone to the coccyx (tail bone)
-controls urine flow and position the baby's head during childbirth.
Iliococcygenus (IC)
- arises from the ischial spine, super ramus of the pubis, and is attached to the coccyx
- Help for vaginal contraction
Puborectalis (PR) sphincter ani externus
- arise from the lower part of the symphysis pubis,and the superior fascia of the
urogenital diaphragm , meet with the corresponding fibers of the opposite side
around the lower part of the rectum, and form for it a strong sling.
- Relaxation reduces the angle between rectum and anus, allowing defecation in
conjunction with relaxation of the internal and external sphincters.
Pelvic floor
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Perineum
general conception: the tissues closing down the pelvic outlet
Clinical conception: the tissues between vaginal and anus.
- thickness: 3-4cm
- the outlayer support for pelvic floor
SUMMARY
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Bones
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Joints
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Ligaments
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planes of the pelvis
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Types of the female pelvis
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Pelvice floor
END