ANATOMY

ANATOMY OF
OF THE
THE
PELVIS
PELVIS
DR TM MAGURE
LECTURER AND CONSULTANT
DEPT OF OBS AND GYN
 INTRODUCTION
• Covered more in pre clinical years
• This is a brief review
• Divided into external and internal organs
• External
– Vulva
• Internal :Reproductive
– Vagina
– Uterus
– Fallopian tubes
– The ovaries
 CTD
• Non –Reproductive
– Bladder
– Urethra
– Ureter
– Rectum
• The pelvic supports
– The pelvic diaphragm
– Urogenital diaphragm
– Pelvic fascia
 VULVA
• Includes
• Mons pubis
• Labia major
• Labia minora
• The vestibule
• The clitoris
• The greater vestibular glands
 THE VAGINA
• Fibromuscular structure
• Lined by stratified squamous epithelium
• Leads from the uterus to the vagina
• About 7cm long
• The vault divided into four fornices: posterior,
anterior and two lateral
• Kept moist by uterine and cervical secretions
and vaginal transudation
 CTD
• Doderlein’s bacillus is a normal
commensal
• Breaks down glycogen to form lactic
acid,
• Producing an acidic pH of around 4.5
• This is protective for the growth of
pathogenic organisms
 THE UTERUS
• Hollow, inverted pear,tapering
inferiourly to the cervix
• Its maximum external dimentions are
approx 7.5cm long,5cm wide and 3cm
thick
• Adult weighs 70g
 CTD
• Consists of
– Fundus
– Cornu
– Isthmus
– Cervix
• Internal os
• External os
• Has three layers
– Outer serous layer
– Middle muscle layer(myometrium)
– Inner endometrium
THE FALLOPIAN TUBES
• Runs from the cornu of the uterus to the ovary
• About 10cm long
• Has four parts
– The intestitial portion
– The isthmus
– The ampulla
– The fimbrial portion
• The epithelium contains 2 functioning cell types
– The ciliatiated( facilitate motion)
– The secretory
 THE OVARIES
• Connected to the cornu of the uterus by
the ovarian ligament and at the hilum to
the broad ligament by the mesoovarium
• Surface covered by a single layer of
cuboidal cells,the germinal epithelium
• Changes with menstrual cycle and age of
patient
 NON REPRODUCTIVE
STRUCTURES
• Important to know relationship to reproductive
structures
• Function may be affected by changes in the
reproductive and may be differentials for genital
pathology
• Includes
– Bladder
– Urethra
– Ureter
– rectum
 THE PELVIC
DIAPHRAGM
• Formed by the levator ani muscles
• Are broad,flat muscle fibres which
pass downwards and inwards
– Pubococcygeus
– Iliococcygeus
• Support pelvic and abdominal
structures,including the bladder
 OTHER PELVIC
SUPPORTS
• Urogenital diaphragm
• The perineal body
• The pelvic peritoneum
• The ovarian ligament
• The pelvic fascia and pelvic cellular tissue
– Parametrium
– Cardinal ligament(transverse cervical ligament)
– Uterosacral ligament
PHYSILOGY
PHYSILOGY OF
OF THE
THE MENSTUAL
MENSTUAL
CYCLE
CYCLE

DR
DR TM
TM MAGURE
MAGURE
 The menstrual cycle
• The female menstrual cycle is determined by a complex
interaction of hormones
• The predominant hormones involved in the menstrual cycle are
– Gonadotropin releasing hormone (GnRH)
– Follicle stimulating hormone (FSH)
– Luteinizing hormone (LH)
– Estrogen and
– Progesterone
• GnRH is secreted by the hypothalamus,
• The gonadotropins FSH and LH are secreted by the anterior
pituitary gland
• Estrogen and progestin are secreted at the level of the ovary.
• GnRH stimulates the release of LH and FSH from the anterior
pituitary, which in turn stimulate release of estrogen and
progestin at the level of the ovary.

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Introduction                  

17
 FOLLICULAR PHASE
• Spans the first day of menstruation until ovulation.
• Aim to develop a viable follicle capable of undergoing
ovulation.
• Initiated by a rise in FSH levels at the first day of the
cycle.
• The rise in FSH levels due to a decrease in progesterone and
estrogen
• FSH stimulates the development of 15-20 follicles each
month
• Also stimulates follicular secretion of estradiol and
expression of FSH receptors by follicles.
• Estradiol levels increase under the influence of FSH,
• Estradiol inhibits the secretion of FSH and FSH levels
decrease.

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 FOLLICULAR
DEVELOPMENT
• One follicle evolves into the dominant follicle
• The remaining follicles undergo atresia.
• Not known how the dominant follicle is selected
• The dominant follicle matures and secretes
increasing amounts of estrogen.
• Estrogen levels peak towards the end of the
follicular phase
• At this critical moment, estrogen exerts
positive feedback on LH,generating a dramatic
preovulatory LH surge.

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Follicular Development

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 LUTEAL PHASE
• Begins at ovulation
• Lasts until the menstrual phase of the next cycle.
• Begins with progesterone induces the
endometrial glands to secrete glycogen, mucus,
and other substances.
• These glands become tortuous and have large
lumens due to increased secretory activity.
• The spiral arteries extend into the superficial
layer of the endometrium.

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 OVULATION
• The LH surge is required for ovulation.
• Under the influence of LH, the primary oocyte
enters the final stage of the first meiotic division
and divides into a secondary oocyte and the first
Barr body.
• The LH surge induces release of proteolytic
enzymes, which degrade the cells at the surface
of the follicle,
• Also stimulates angiogenesis in the follicular wall
and prostaglandin secretion.

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 OVULATION CTD
• These effects of LH cause the follicle to swell
and rupture.
• At ovulation, the oocyte and corona radiata are
expelled into the peritoneal cavity.
• The oocyte adheres to the ovary
• Muscular contractions of the fallopian tube bring
the oocyte into contact with the tubal epithelium
to initiate migration through the oviduct.

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 LUTEAL PHASE CTD
• In the absence of fertilization by day 23 of the
menstrual cycle,
– the corpus luteum begins to degenerate
– ovarian hormone levels decrease.
– As estrogen and progesterone levels decrease, the
endometrium undergoes involution
– Days 25-26 of the menstrual cycle, endothelin and thromboxin
begin to mediate vasoconstriction of the spiral arteries.
– The resulting ischemia may cause some early menstrual cramps.
– By day 28 of the menstrual cycle, intense vasoconstriction and
subsequent ischemia cause mass apoptosis of the functionalis.

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 ENDOMETRIAL
CHANGES
• Cyclical changes in the endometrium prepare for
implantation in the event of fertilization and necessitate
menstruation in the absence of fertilization.
• The endometrium is divided into two portions.
– The functionalis undergoes changes throughout the menstrual
cycle and is shed during menstruation
– The basalis remains constant during the menstrual cycle and
regenerates the functionalis each month.
– The uterine endometrial cycle can be divided into three
phases:
• the follicular or proliferative phase,
• the luteal or secretory phase,
• the menstrual phase.  

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 MENSTRUAL PHASE
• Begins as the spiral arteries rupture
secondary to ischemia, releasing blood into
the uterus
• The apoptosed endometrium is sloughed off
and usually lasts four days.
• The functionalis is completely shed.
• Menstrual flow constists ofArterial and
venous blood, remnants of endometrial
stroma and glands, leukocytes, and red blood

HIV and Pregnancy 26

HIV and Pregnancy 27