The female pelvis embryonic development
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The Female Pelvis Embryonic Development. Fetal Biometry Workshop Day 1. Expected Learning Outcomes. Describe embryology, anatomy, function of the female pelvis. Describe sonographic techniques applied in the assessment of the female pelvis.

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The Female Pelvis Embryonic Development

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The female pelvis embryonic development

The Female PelvisEmbryonic Development

Fetal Biometry Workshop

Day 1


Expected learning outcomes

Expected Learning Outcomes

  • Describe embryology, anatomy, function of the female pelvis.

  • Describe sonographic techniques applied in the assessment of the female pelvis.

  • Describe congenital abnormalities of the female pelvis.


Detection of genital anomalies

Detection of Genital Anomalies

  • Fetal period

    • Urinary tract abnormalities – 50% of all congenital anomalies

    • Hydrometrocolpos of vagina & uterus most common

    • Hydronephrosis or hydroureter

  • Neonatal period

    • Renal in origin

    • Hydrometrocolpos secondary to an atretic vagina

  • Premenarche to Adulthood

    • Duplicated uterus with one septated vagina


Expression of gender in embryo

Expression of Gender in Embryo

  • Primordial Germ Cells

  • Inducer Germ Cells


Embryonic development

Embryonic Development

  • Genital Ducts

  • Formation of Fallopian Tubes


Embryonic development1

Embryonic Development

  • Formation of the Broad Ligament

  • Formation of the Vagina


Mullerian ducts

Mullerian Ducts

  • Embryological ducts fuse together during organogenesis

  • Form

    • Uterus

    • Upper portion of Vagina

    • Fallopian tubes

  • Ovaries and lower vagina form from primitive YS

  • Anomalies can lead to infertility

  • Delayed onset of menarche

  • Increased Risk of

    • IUGR

    • Preterm labor

    • Retained placenta


Wolffian ducts

Wolffian Ducts

  • Embryologically sits along side with the Mullerian ducts

  • Male becomes the vas deferens

  • Develops into the trigone of the urinary bladder and ureters

  • In absence of testosterone these regress

  • Known remnant is Gartner’s duct cyst


Embryonic development2

Embryonic Development

  • Formation of the Vagina


Review embryonic development

Review – embryonic development


Pelvic skeleton

Ring of 4 bones

Sacrum

Coccyx

2 large innominate or hip bones

Principle functions:

Weight-bearing bridge between spinal column and bones of lower limbs

Directs the pathway of fetal head during childbirth [parturition]

Protects the reproductive organs

Pelvic Skeleton


Pelvic skeleton1

Pelvic Skeleton


Pelvic spaces

True Pelvis

False Pelvis

Pelvic Spaces


Pelvic muscles

Pelvic Muscles


Pelvis muscles

Pelvis Muscles


True pelvis muscles

True Pelvis Muscles


Pelvic organs

Pelvic Organs

  • Urinary Bladder & urethra

  • Uterus

  • Fallopian tubes

  • Vagina

  • Ovaries

  • Pelvic colon

  • Rectum


Urinary bladder urethra

Urinary Bladder & urethra

  • Urinary Bladder

    • Thick-walled

    • Highly distensible muscular sac

    • Lies between symphysis pubis & vagina


The vagina

The Vagina


Uterine ligaments

Uterine Ligaments

  • Cardinal

  • Round

  • Broad


The uterus

The Uterus


Uterus size shape

Uterus Size & Shape

  • Newborns

    • “adult” contour due to maternal estrogen

  • Infant

    • Small, high in pelvis, cylindrical, lies along same axis as vagina

  • Young girls

    • Nearly cylindrical, body more globular

  • Puberty

    • Characteristic inverted pear shape

  • Pregnancy

    • Corpus and fundus grow thicker, increasing globularity

  • Menopause

    • Corpus and fundus shrink and regress to prepubertal state

    • Elderly women – little more than a cap above the cervix


Variants of uterine position

Variants of Uterine Position

  • Anteflexed

    • forward

  • Retroflexion

    • backward

  • Anteverted

    • anterior incline

  • Retroverted

    • posterior incline


Retroflexed uterus

Retroflexed Uterus


Anteflexed uterus

Anteflexed Uterus


Retroverted uterus

Retroverted Uterus


Anteverted uterus

Anteverted Uterus


Uterine malformation

Uterine Malformation

  • Mullerian agenesis

  • Bicornuate

  • Unicornuate

  • Didelphys

  • Septated

  • Arcuate

  • DES exposure

  • High incidence of uterine malformations and renal abnormalities

    • Abnormalities are always on the same side


Mullerian agenesis

Mullerian agenesis

  • No uterus

  • What would be a symptom

  • Where else should we look


Unicornuate

Unicornuate

  • Only one side of the mullerian duct forms

  • Takes on a penis shape

  • Difficult to tell by US


Bicornuate

Bicornuate


Didelphys

Didelphys

  • Both mullerian ducts fail to fuse

  • Double uterus, cervix, and vagina

  • Endometrial cavities are widely separated

  • Partial

    • Uterus Bicornis Bicollis

      • One vagina

      • 2 cervices

      • 2 uterine horns

      • 1 side has not outlet for menstrual flow

        • Causes hematometrocolpos

    • Uterus Bicornis Unicollis

      • One vagina

      • Once cervix

      • 2 uterine horns


Septated uterus

Septated Uterus


Arcuate uterus

Arcuate Uterus


Des exposure

Diethylstilbestrol

Synthetic estrogen

Used in 40’s-70’s

Small, irregular T shaped uterus is the most common malformation related to drug

DES Exposure


The fallopian tubes

The Fallopian Tubes


The ovaries

The Ovaries


Follicular development

Follicular Development


Ovary location

Ovary Location

  • Bladder empty – ovarian fossa

    • Posterolateral pelvic wall beneath the brim of pelvis

  • Filling bladder – ovarian fossa at the sides of uterine fundus

  • Distended bladder – increasing pressure forces downward in the adnexal space


The pelvic bowel

The Pelvic Bowel


Pelvic spaces1

Pelvic Spaces


Adnexa

Area that is adjacent to uterus

Includes ovaries and fallopian tubes

Adnexa


Arterial system of pelvis

Arterial System of Pelvis

  • Aorta

    • Common iliac arteries

      • External and internal or hypogastric artery

        • Internal courses down into pelvic cavity

          • Superior gluteal artery is branch

          • Oburator artery

          • Umbilical artery

          • Uterine-vaginal artery

          • Superior vesical artery

          • Internal pudendal and inferior gluteal arteries


Venous system of the pelvis

Venous System of the Pelvis

  • Inferior vena cava

    • Common iliac veins

      • External iliac veins – legs

      • Internal iliac veins – pelvic organs and muscles


Ureter

Ureter

  • Courses lateral pelvic wall posterior to the ovary

  • Enter pelvis at point just caudad to bifurcation of common iliac vessels.

  • Most anterior and lateral of the 3 tubular structures seen deep to the ovary


Review

Review


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