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Questions and Answers
What is the most common site for ureteric injury during hysterectomy?
What is the most common site for ureteric injury during hysterectomy?
The vaginal blood supply is directly affected by uterine artery embolization.
The vaginal blood supply is directly affected by uterine artery embolization.
False
What is the role of Sampson's artery?
What is the role of Sampson's artery?
Responsible for menstrual blood supply.
The ___ artery is responsible for supplying blood to the uterus.
The ___ artery is responsible for supplying blood to the uterus.
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Match the following branches of the uterine artery outside to inside:
Match the following branches of the uterine artery outside to inside:
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What is the weight of a non-pregnant uterus?
What is the weight of a non-pregnant uterus?
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The shape of the uterine cavity is slit-like in the sagittal view.
The shape of the uterine cavity is slit-like in the sagittal view.
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What hormone is used as a smooth muscle relaxant to prevent preterm labor?
What hormone is used as a smooth muscle relaxant to prevent preterm labor?
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The primary shape of the uterus is ______.
The primary shape of the uterus is ______.
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Match the following parts of the uterus with their descriptions:
Match the following parts of the uterus with their descriptions:
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What is the angle of anteversion between the cervix and the vagina?
What is the angle of anteversion between the cervix and the vagina?
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An anteverted uterus has its fundus directed towards the sacral promontory.
An anteverted uterus has its fundus directed towards the sacral promontory.
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What is the primary function of the round ligament?
What is the primary function of the round ligament?
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The uterine artery is a branch of the ______.
The uterine artery is a branch of the ______.
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Match the following features with the type of uterus:
Match the following features with the type of uterus:
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Which part of the fallopian tube is the site for fertilization?
Which part of the fallopian tube is the site for fertilization?
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The isthmus is the widest part of the fallopian tube.
The isthmus is the widest part of the fallopian tube.
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What anatomical feature in the fallopian tube acts as the anatomical sphincter?
What anatomical feature in the fallopian tube acts as the anatomical sphincter?
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The __________ is the site of ectopic pregnancy in the fallopian tube.
The __________ is the site of ectopic pregnancy in the fallopian tube.
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Match the following parts of the fallopian tube to their characteristics:
Match the following parts of the fallopian tube to their characteristics:
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What is the size of the ovary?
What is the size of the ovary?
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The ovarian ligament attaches the ovary to the uterine cornu.
The ovarian ligament attaches the ovary to the uterine cornu.
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Which artery supplies the ovary?
Which artery supplies the ovary?
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What causes pain along the medial side of the thigh when there is a large ovarian mass?
What causes pain along the medial side of the thigh when there is a large ovarian mass?
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The cervix receives blood supply primarily from the vaginal artery.
The cervix receives blood supply primarily from the vaginal artery.
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The ______________ connects the ovary to the lateral pelvic wall and contains vessels and nerves.
The ______________ connects the ovary to the lateral pelvic wall and contains vessels and nerves.
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What is the mnemonic used for remembering the lymphatic drainage of the upper 2/3rd of the vagina?
What is the mnemonic used for remembering the lymphatic drainage of the upper 2/3rd of the vagina?
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Match the following anatomical features to their descriptions:
Match the following anatomical features to their descriptions:
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The pudendal nerve supplies the ______ and is involved in the nerve supply to the vulva.
The pudendal nerve supplies the ______ and is involved in the nerve supply to the vulva.
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Match each organ with its corresponding lymphatic drainage:
Match each organ with its corresponding lymphatic drainage:
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Which of the following organs is supplied by the T10-L1 nerve roots?
Which of the following organs is supplied by the T10-L1 nerve roots?
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The left ovarian vein drains into the inferior vena cava (IVC).
The left ovarian vein drains into the inferior vena cava (IVC).
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Name one branch that contributes to the blood supply of the uterus.
Name one branch that contributes to the blood supply of the uterus.
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What is the cervical to corpus ratio during puberty?
What is the cervical to corpus ratio during puberty?
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The zona basalis is shed during menstruation.
The zona basalis is shed during menstruation.
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What is the length of the isthmus during labor?
What is the length of the isthmus during labor?
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The most common cause of failure of female sterilization is the identification of the wrong _____ .
The most common cause of failure of female sterilization is the identification of the wrong _____ .
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Match the layers of the endometrium with their characteristics:
Match the layers of the endometrium with their characteristics:
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What is the karyotype of a typical male?
What is the karyotype of a typical male?
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Females have one Barr body in their karyotype.
Females have one Barr body in their karyotype.
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What does the presence of the Y chromosome indicate?
What does the presence of the Y chromosome indicate?
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In females, the homologous organ to the penis is the ______.
In females, the homologous organ to the penis is the ______.
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Match the following internal genitalia with their corresponding sex:
Match the following internal genitalia with their corresponding sex:
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Which method is considered the best for sex determination?
Which method is considered the best for sex determination?
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Karyotyping is ineffective in cases of ambiguous genitalia.
Karyotyping is ineffective in cases of ambiguous genitalia.
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The ______ is the male homologous structure to the labia majora.
The ______ is the male homologous structure to the labia majora.
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What type of epithelium lines the fallopian tube?
What type of epithelium lines the fallopian tube?
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The most common type of cancer associated with the cervix is squamous cell carcinoma.
The most common type of cancer associated with the cervix is squamous cell carcinoma.
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What is the embryological derivative of the ovary?
What is the embryological derivative of the ovary?
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The lining epithelium of the vagina is primarily __________ epithelium.
The lining epithelium of the vagina is primarily __________ epithelium.
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Match the following organs with their respective most common cancers:
Match the following organs with their respective most common cancers:
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Which follicle stage contains a primary oocyte surrounded by multiple layers of granulosa cells and a fluid-filled antral cavity?
Which follicle stage contains a primary oocyte surrounded by multiple layers of granulosa cells and a fluid-filled antral cavity?
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Hilar cell tumors of the ovary are common and primarily secrete estrogens.
Hilar cell tumors of the ovary are common and primarily secrete estrogens.
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What is the primary characteristic of the secondary follicle?
What is the primary characteristic of the secondary follicle?
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The ______ is located close to the fallopian tube and is a part of the broad ligament.
The ______ is located close to the fallopian tube and is a part of the broad ligament.
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Match the different types of ovarian follicles with their characteristics:
Match the different types of ovarian follicles with their characteristics:
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Study Notes
Uterine Artery and Branches
- The uterine artery supplies the uterus, fallopian tube, round ligament, cervix, and ureter
- Mnemonic: U ARBS - Epithelium, Capillaries, Venous sinus, Endometrial gland, Spiral artery, Basal artery, Radial artery, Arcuate artery, Uterine artery
- The uterine artery crosses the ureter 2 cm lateral to the internal os
- Clamp the uterine artery as close to the uterus as possible during surgery
- Sampson's artery is a branch of the uterine artery that supplies menstrual blood
Blood Supply
- Ovary: Supplied by the ovarian artery (branch of the abdominal aorta at L2)
- Fallopian tube: Medial 2/3rds supplied by the uterine artery; lateral 1/3rd supplied by the ovarian artery
- Uterus: 80% supplied by the uterine artery; 20% supplied by the ovarian artery
- Cervix: Supplied by the descending cervical artery (branch of the uterine artery)
- Vagina: Supplied by the vaginal artery (branch of the internal pudendal artery)
- Vulva: Supplied by the internal pudendal artery and external pudendal artery for the mons pubis
Nerve Supply
- Ovary: T10-L1 via the Ovarian plexus (also supplies the fallopian tube laterally and the broad ligament)
- Uterus: T10-L1 via the Franken Hauser ganglion (uterovaginal plexus)
- Vagina: S2-S4; Upper vagina: S2 - S4; Lower vagina: Pudendal N.
- Vulva: Pudendal nerve + Anterior superior part of: Ilioinguinal nerve; Genito-femoral nerve; Posterior-inferior part of: Posterior cutaneous nerve of thigh; Pudendal nerve
Lymphatic Drainage
- Ovary: Paraaortic lymph nodes
- Uterus: Fundus: Paraaortic lymph nodes; Body: External + Internal iliac lymph nodes
- Vagina: Hypogastric lymph nodes (Internal iliac); Obturator lymph nodes; Paracervical lymph nodes; External iliac lymph nodes.
- Vulva: Superficial inguinal lymph nodes → Deep inguinal lymph nodes (Femoral); Clitoris: Glans: Lymph node of cloquet/Rosenmüller LN (Part of deep inguinal LN); Body; Crura: S.I.L.N → Deep I.L.N
-
Mnemonics:
- HOPE: Hypogastric, Obturator, Paracervical, External iliac (for vagina)
- Upper 2/3rd vagina: HOPE
- Lower 1/3rd vagina: S.I.L.N.
Ovary
- 3 x 2 x 1 cm in size
- Volume: 6-7 cc (≥ 10 cc: PCOS)
- Located in the ovarian fossa of Waldeyer (lateral pelvic wall)
- Ligaments: Ovarian Ligament, Infundibulopelvic Ligament, Mesovarium
-
Relations:
- Superior/Anterior: External iliac artery
- Posterior: Ureter and internal iliac artery
- Lateral: Obturator nerve and infundibulopelvic ligament
- Applied Aspect: Large ovarian mass can cause pain along medial side of the thigh due to pressure on the obturator nerve; Medial pain can be due to the ovarian ligament
- Histological Features: Single layer of cuboidal epithelium (surface epithelium) and the Tunica Albuginea (below surface epithelium).
Angles of the Uterus
- Angle of anteflexion: 120 degrees between the cervix and the uterus
- Angle of anteversion: 90 degrees between the cervix and the vagina
Anteverted vs Retroverted Uterus
- Anteverted: Uterine fundus points towards the pubic symphysis (80% of women); often anteflexed
- Retroverted: Uterine fundus points towards the sacral promontory (20% of women); often retroflexed
Round Ligament
- Attaches the cornua of the uterus to the anterior 1/3rd of the labia majora
- Function: Indirect support of the uterus (keeps it in an anteverted position)
- Blood supply: Sampson's artery (branch of the uterine artery)
Uterine Artery
- Branch of the anterior division of the internal iliac artery
- Supplementary branches from the posterior division supply lower limb muscles
- Supplies the uterus, fallopian tube, round ligament, cervix, and ureter
Cumulus Oophoricus
- AKA discus proligerus
- Cells project into the cavity
- Separates the primary oocyte from the cavity
Uterus
- Pear shaped
- 3 x 2 x 1 inches
- Weight: 60-80g (non-pregnant); 1000g (pregnant)
- Composition: Smooth muscle fibers
- Progesterone (smooth muscle relaxant) is used in the prevention of preterm labor
- Uterine cavity: Potential cavity (Anterior & posterior walls opposed to each other)
- Volume: 10 ml (non-pregnant); SL (pregnant)
- Shape: Triangular (coronal); Slit-like (sagittal)
- Position: Anteverted & anteflexed
- IOC: Hysteroscopy
- Parts: Cornua/angle of uterus, Fundus (dome shaped), Body (corpus), Cervix
- Structures attached at the cornua of the uterus:
- Anterior → Posterior: Round ligament, Fallopian tube, Ovarian ligament
- Superior → Inferior: Round ligament, Fallopian tube, Ovarian ligament
Fallopian Tube
- 10 cm in length
-
Parts (medial to lateral): Interstitium, Isthmus, Ampulla, Infundibulum (fimbrial part).
- Interstitium: Intramural part (inside the uterus); Narrowest part; Anatomical sphincter
- Isthmus: Narrowest part; Physiological sphincter
- Ampulla: Widest and longest part; Site for fertilization; Site for tubal ligation; Site for ectopic pregnancy
- Infundibulum: Fimbrial part of fallopian tube
- Adnexa: Ovary + fallopian tube
- Genital TB: Can affect the fallopian tube (ampulla); Can lead to bilateral cornual block
- Gonococcal infection: Can lead to fimbrial block
- Tubal patency: HSG, Laparoscopic, Hysteroscopic
- Site for tubal ligation: Laparoscopic, Hysteroscopic
Sex Differentiation
- Karyotype: 46(XX) - Female (1 Barr body); 46(XY) - Male (0 Barr body)
- Internal genitalia: Fallopian tube, Uterus, Cervix, Vagina (Female); Seminal vesicle, Epididymus, Ejaculatory duct, Vas deferens (Male)
- External genitalia: Labia majora, Labia minora, Clitoris, Bartholin glands, Paraurethral glands (Female); Scrotum, Penile urethra, Penis, Bulbourethral glands, Prostate (Male)
- Sex Determination: Assessment of external genitalia; Karyotyping is the best method
- Y chromosome → Male; No Y chromosome → Female
General Gynecology
- Cervical fibroid: Extrauterine fibroid
- m/c cause of failure of female sterilization: Identification of the wrong structure
-
Cervix to Corpus ratio:
- Before puberty: 2:1
- At puberty: 1:2
- Reproductive age: 1:3 or 1:4
- Menopause: 1:1
- Isthmus: Anatomical internal os; Histological internal os; 0.5 cm (non-pregnant); 5 cm (pregnant); 10 cm at term
- Body/Corpus: 3 layers: Endometrium, Myometrium, Serosa; Endometrium has 3 layers: Zona compacta, Zona spongiosa, Zona basalis; Functional layers are shed during menstruation.
Lining Epithelium of Female Genitalia
- Ovary: Single layer of Cuboidal epithelium
- Fallopian tube: Ciliated columnar epithelium
- Uterus: Ciliated columnar epithelium (cilia lost at onset of menstruation)
- Cervix: Columnar epithelium → Stratified squamous epithelium
- Endocervix: Non-keratinized stratified squamous epithelium
- Exocervix: Non-keratinized stratified squamous epithelium
- Vagina: Stratified squamous epithelium
- Hymen: Non-keratinized stratified squamous epithelium
- Bartholin gland: Gland: Cuboidal epithelium; Duct: Transitional epithelium; Opening: Squamous epithelium.
Embryological Derivatives
- Ovary: Genital ridge
- Fallopian tube: Mullerian duct / Paramesonephric duct
- Uterus: Mullerian duct
- Cervix: Sinovaginal bulbs of urogenital sinus
- Upper vagina: Mesodermal origin
- Lower vagina: Endodermal origin
- Bartholin's gland: Urogenital sinus
Per Speculum Examination
- Exocervix: Pink
- External os
- Wall of vagina
- Endocervix: Red
Ovarian Cortex
- Contains follicles in various stages
- Active space
- Medulla: Contains blood vessels and Hilar cells
- Homologous to interstitial cells of testes
-
Hilar cell tumor of ovary: Rare
- Secretes androgens
- Masculinizing tumor of ovary
Folliculogenesis
- Primordial follicle: Single layer of flattened cells
- Primary follicle: Single layer of cuboidal cells (granular cells)
- Secondary follicle: Multiple layers of granulosa cells, 1° oocyte, Theca cells, Fluid filled antral cavity.
- Antral follicle: Multiple layer of granulosa cells, I° oocyte, Theca cells, Fluid filled antral cavity.
- Graafian/mature follicle: Ovoid/spherical shape; 18-20mm (17mm); Cavity: Liquor folliculi/antral cavity; Cell layers from outside to inside: Theca externa, Theca interna, Granulosa cells
Parts of the Broad Ligament
- Mesosalpinx: Close to the fallopian tube
- Mesovarium: Close to the ovaries
- Mesometrium: Close to the uterus
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Description
Test your knowledge on the uterine artery and its branches, along with the blood supply to the female reproductive system. This quiz covers essential anatomical details, including the vascular supply to the uterus, ovaries, and more. Enhance your understanding with mnemonics and anatomical relationships.
