Blood supply to the internal genital organs carried out mainly from the aorta (system of the common and internal iliac arteries). Basics blood supply to the uterus provided uterine artery (a uterina), which arises from the internal iliac (hypogastric) artery (a iliaca interna). In about half of the cases, the uterine artery arises independently from the internal iliac artery, but it can also arise from the umbilical, internal pudendal and superficial cystic arteries
Uterine artery goes down to the lateral pelvic wall, then passes forward and medially, located above the ureter, to which it can give an independent branch. At the base of the broad uterine ligament, it turns medially towards the cervix. In the parametrium, the artery connects with the accompanying veins, nerves, ureter and cardinal ligament. The uterine artery approaches the cervix and supplies it with the help of several tortuous penetrating branches. The uterine artery then divides into one large, very tortuous ascending branch and one or more small descending branches supplying blood. top part vagina and adjacent part bladder. The main ascending branch runs upward along the lateral edge of the uterus, sending arcuate branches to its body. These arcuate arteries surround the uterus under the serous layer. At certain intervals, radial branches depart from them, which penetrate into the intertwining muscle fibers of the myometrium. After childbirth, the muscle fibers contract and, acting as ligatures, compress the radial branches. The arcuate arteries quickly decrease in size along the midline, therefore, with midline incisions of the uterus, less bleeding is observed than with lateral ones. The ascending branch of the uterine artery approaches the fallopian tube, turning laterally at its upper part, and divides into tubal and ovarian branches. The tubal branch runs laterally in the mesentery fallopian tube(mesosalpinx). The ovarian branch goes to the mesentery of the ovary (mesovarium), where it anastomoses with the ovarian artery, which arises directly from the aorta
The ovaries are supplied with blood from ovarian artery (a.ovarica), originating from the abdominal aorta on the left, sometimes from the renal artery (a.renalis). Descending together with the ureter, the ovarian artery passes through the ligament that suspends the ovary to the upper part of the broad uterine ligament, giving off a branch to the ovary and tube; the terminal section of the ovarian artery anastomoses with the terminal section of the uterine artery.
IN blood supply to the vagina In addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries also participate. The arteries of the genital organs are accompanied by corresponding veins. The venous system of the genital organs is very developed; the total length of the venous vessels significantly exceeds the length of the arteries due to the presence of venous plexuses that widely anastomose with each other. Venous plexuses are located in the clitoris, at the edges of the vestibule bulbs, around the bladder, between the uterus and ovaries. IN innervation of the female genital organs the sympathetic and parasympathetic parts of the autonomic system are involved nervous system, as well as spinal nerves.
The fibers of the sympathetic part of the autonomic nervous system, innervating the genital organs, originate from the aortic and celiac ("solar") plexuses, are directed downwards and at level V lumbar vertebra form superior hypogastric plexus (plexus hypogastrics superior). Fibers extend from it, forming right and left lower hypogastric plexuses (plexus hypogastrics sinister et dexter inferior). Nerve fibers from these plexuses go to the powerful uterovaginal, or pelvic, plexus (plexus uterovaginal, s.pelvicus).
Uterovaginal plexuses located in the parametrial tissue lateral and posterior to the uterus at the level internal pharynx and cervical canal. Branches approach this plexus pelvic nerve (n.pelvicus), relating to the parasympathetic part of the autonomic nervous system. Sympathetic and parasympathetic fibers extending from the uterovaginal plexus innervate the vagina, uterus, internal parts of the fallopian tubes, and bladder. The ovaries are innervated sympathetic and parasympathetic nerves from the ovarian plexus (plexus ovaricus).
Blood supply to the internal genital organs carried out mainly from the aorta (system of the common and internal iliac arteries). Basics blood supply to the uterus provided uterine artery (a uterina), which arises from the internal iliac (hypogastric) artery (a iliaca interna). In about half of the cases, the uterine artery arises independently from the internal iliac artery, but it can also arise from the umbilical, internal pudendal and superficial cystic arteries
Uterine artery goes down to the lateral pelvic wall, then passes forward and medially, located above the ureter, to which it can give an independent branch. At the base of the broad uterine ligament, it turns medially towards the cervix. In the parametrium, the artery connects with the accompanying veins, nerves, ureter and cardinal ligament. The uterine artery approaches the cervix and supplies it with the help of several tortuous penetrating branches. The uterine artery then divides into one large, very tortuous ascending branch and one or more small descending branches supplying the upper part of the vagina and adjacent part of the bladder. The main ascending branch runs upward along the lateral edge of the uterus, sending arcuate branches to its body. These arcuate arteries surround the uterus under the serous layer. At certain intervals, radial branches depart from them, which penetrate into the intertwining muscle fibers of the myometrium. After childbirth, the muscle fibers contract and, acting as ligatures, compress the radial branches. The arcuate arteries quickly decrease in size along the midline, therefore, with midline incisions of the uterus, less bleeding is observed than with lateral ones. The ascending branch of the uterine artery approaches the fallopian tube, turning laterally in its upper part, and divides into tubal and ovarian branches. The tubal branch runs laterally in the mesentery of the fallopian tube (mesosalpinx). The ovarian branch goes to the mesentery of the ovary (mesovarium), where it anastomoses with the ovarian artery, which arises directly from the aorta
The ovaries are supplied with blood from ovarian artery (a.ovarica), originating from the abdominal aorta on the left, sometimes from the renal artery (a.renalis). Descending together with the ureter, the ovarian artery passes through the ligament that suspends the ovary to the upper part of the broad uterine ligament, giving off a branch to the ovary and tube; the terminal section of the ovarian artery anastomoses with the terminal section of the uterine artery.
IN blood supply to the vagina In addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries also participate. The arteries of the genital organs are accompanied by corresponding veins. The venous system of the genital organs is very developed; the total length of the venous vessels significantly exceeds the length of the arteries due to the presence of venous plexuses that widely anastomose with each other. Venous plexuses are located in the clitoris, at the edges of the vestibule bulbs, around the bladder, between the uterus and ovaries. IN innervation of the female genital organs The sympathetic and parasympathetic parts of the autonomic nervous system, as well as the spinal nerves, are involved.
The fibers of the sympathetic part of the autonomic nervous system, innervating the genital organs, originate from the aortic and celiac ("solar") plexuses, go down and form at the level of the V lumbar vertebra superior hypogastric plexus (plexus hypogastrics superior). Fibers extend from it, forming right and left lower hypogastric plexuses (plexus hypogastrics sinister et dexter inferior). Nerve fibers from these plexuses go to the powerful uterovaginal, or pelvic, plexus (plexus uterovaginal, s.pelvicus).
Uterovaginal plexuses located in the parametrial tissue lateral and posterior to the uterus at the level of the internal os and cervical canal. Branches approach this plexus pelvic nerve (n.pelvicus), relating to the parasympathetic part of the autonomic nervous system. Sympathetic and parasympathetic fibers extending from the uterovaginal plexus innervate the vagina, uterus, internal parts of the fallopian tubes, and bladder. The ovaries are innervated sympathetic and parasympathetic nerves from the ovarian plexus (plexus ovaricus).
The female genital organs are divided into external (vulva) and internal. The internal genital organs ensure conception, the external genital organs are involved in sexual intercourse and are responsible for sexual sensations.
The internal genital organs include the vagina, uterus, fallopian tubes and ovaries. To the external - the pubis, labia majora and minora, clitoris, vestibule of the vagina, large glands of the vestibule of the vagina (Bartholin's glands). The boundary between the external and internal genital organs is the hymen, and after the onset of sexual activity - its remains.
External genitalia
Pubis(venus tubercle, lunar mound) - the lowest part of a woman’s anterior abdominal wall, slightly elevated due to a well-developed subcutaneous fat layer. The pubic area has a pronounced hairline, which is usually darker than on the head, and in appearance it is a triangle with a sharply defined upper horizontal border and a downward-pointing apex. The labia (labia pudendum) are folds of skin located on both sides of the genital slit and the vestibule of the vagina. Distinguish between labia majora and labia minora
Labia majora– folds of skin, in the thickness of which there is fat-rich fiber. The skin of the labia majora has many sebaceous and sweat glands and during puberty the outside is covered with hair. The Bartholin glands are located in the lower parts of the labia majora. In the absence of sexual stimulation, the labia majora are usually closed at the midline, providing mechanical protection for the urethra and vaginal opening.
Labia minora located between the labia majora in the form of two thin, delicate pink folds of skin that limit the vestibule of the vagina. They have large number sebaceous glands, blood vessels and nerve endings, which allows us to consider them an organ of sexual sensation. The labia minora meet over the clitoris to form a fold of skin called foreskin clitoris. During sexual arousal, the labia minora become saturated with blood and turn into elastic ridges, narrowing the entrance to the vagina, which increases the intensity of sexual sensations when the penis is inserted.
Clitoris- the female external genital organ located at the upper ends of the labia minora. This is a unique organ whose sole function is to concentrate and accumulate sexual sensations. Magnitude and appearance clitoris have individual differences. The length is about 4-5 mm, but in some women it reaches 1 cm or more. When sexually aroused, the clitoris increases in size.
Vaginal vestibule- a slit-like space, limited on the sides by the labia minora, in front by the clitoris, and behind by the posterior commissure of the labia. From above, the vestibule of the vagina is covered with the hymen or its remains. At the vestibule of the vagina, the external opening of the urethra opens, located between the clitoris and the entrance to the vagina. The vestibule of the vagina is sensitive to touch and at the moment of sexual arousal it is filled with blood, forming an elastic elastic “cuff”, which is moistened by the secretion of the large and small glands (vaginal lubrication) and opens the entrance to the vagina.
Bartholin's glands(large glands of the vestibule of the vagina) are located in the thickness of the labia majora at their base. The size of one gland is about 1.5-2 cm. During sexual arousal and intercourse, the glands secrete a viscous grayish protein-rich fluid (vaginal fluid, lubricant)
Internal genital organs
Vagina (vagina)- the internal genital organ of a woman, which is involved in the process of sexual intercourse, and during childbirth is part of the birth canal. The length of the vagina in women is, on average, 8 cm. But in some it can be longer (up to 10-12 cm) or shorter (up to 6 cm). The inside of the vagina is lined with mucous membrane a large number folds, which allows it to stretch during childbirth.
Ovaries- female gonads, from the moment of birth they contain more than a million immature eggs. The ovaries also produce the hormones estrogen and progesterone. Due to the constant cyclical changes in the content of these hormones in the body, as well as the release of hormones by the pituitary gland, the maturation of eggs and their subsequent release from the ovaries occur. This process is repeated approximately every 28 days. The release of the egg is called ovulation. In close proximity to each ovary is a fallopian tube.
Fallopian tubes(fallopian tubes) - two hollow tubes with holes that run from the ovaries to the uterus and open at the top of it. There are villi at the ends of the tubes near the ovaries. When the egg leaves the ovary, the villi, with their continuous movements, try to capture it and drive it into the tube so that it can continue its journey to the uterus.
Uterus- a hollow organ shaped like a pear. It is located in the pelvic cavity. During pregnancy, the uterus enlarges as the fetus grows. The walls of the uterus are made up of layers of muscle. With the onset of contractions and during childbirth, the muscles of the uterus contract, the cervix stretches and dilates, and the fetus is pushed into the birth canal.
Cervix represents its lower part with a passage connecting the uterine cavity and vagina. During childbirth, the walls of the cervix become thinner, the os of the cervix expands and takes the form of a round hole with a diameter of approximately 10 centimeters, due to this it becomes possible for the fetus to exit the uterus into the vagina.
Hymen (hymen)- a thin fold of the mucous membrane in virgins, located at the entrance to the vagina between the internal and external genitalia. Each girl has an individual, just for her inherent features hymen. The hymen has one or more holes of various sizes and shapes through which blood is released during menstruation. During the first sexual intercourse, the hymen ruptures (defloration), usually with the release of a small amount of blood, sometimes with a feeling of pain.
Blood supply to the external genitalia mainly carried out by the internal pudendal artery and only partially by branches of the femoral artery. The internal pudendal artery (a.pudenda interna) is the main artery of the perineum. It is one of the branches of the internal iliac artery (a.iliac interna) and supplies blood to the skin and muscles around anus. The perineal branch supplies the structures of the superficial part of the perineum and continues in the form of posterior branches going to the labia majora and minora. The internal pudendal artery supplies blood to the bulb of the vestibule of the vagina, the large gland of the vestibule and the urethra.
External (superficial) pudendal artery(r.pudenda externa, s.superficialis) originates from the medial side of the femoral artery (a.femoralis) and supplies the anterior part of the labia majora.
Blood supply to the internal genital organs carried out mainly from the aorta (system of the common and internal iliac arteries).
Main blood supply to the uterus is provided by the uterine artery (a uterina), which arises from the internal iliac (hypogastric) artery (a iliaca interna).
The ovaries are supplied with blood from the ovarian artery (a.ovarica), extending from the abdominal aorta on the left, sometimes from the renal artery (a.renalis).
In the blood supply of the vagina In addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries also participate.
Blood supply to the external genitalia
are supplied with blood from such arteries: internal genital (a. pudenda interna), which arises from the internal iliac artery (a. iliaca interna) external genital (a. pudenda externa), which begins with the stegnevoi artery and rises up medially from the outer ring of the axillary canal; zatulnoi (a. obturatoria), emanating from the internal iliac artery; external spermatic (a. spermatica externa) - branches of the external iliac artery (a. iliaca externa). Veins of the same name run parallel to the arteries.
Blood supply to the internal genital organs carried out mainly by the uterine arteries, which arise from the internal iliac arteries, and the ovarian arteries, which arise from the aorta.
The uterine arteries approach the uterus at the level of the internal os, are divided into descending branches (supplying blood to the cervix and upper part of the vagina) and ascending branches, which rise along the ribs of the uterus, giving off transverse additional branches for the myometrium, branches for the broad and round ligaments, fallopian tube and ovary.
The ovarian arteries provide blood supply to the ovaries, fallopian tubes and upper parts of the uterus (anastamoses are developed between the uterine and ovarian arteries).
The blood supply to the fallopian tubes is carried out by branches of the uterine and ovarian arteries, which correspond to similar veins. Venous plexuses are located in the area of mesosalpings and round uterine ligament.
The upper part of the vagina receives nutrition from the branches of the uterine arteries and vaginal arteries. The middle part of the vagina is supplied with blood by the branches of the internal iliac arteries (inferior cystic arteries, middle rectal artery). Bottom part The vagina also receives blood supply from the middle rectal artery and from the internal pudendal arteries.
Venous outflow is carried out through veins of the same name, forming plexuses in the thickness of the broad ligaments between the uterus and ovaries and between bladder and vagina.
Lymphatic drainage from the lower part of the vagina goes to the inguinal nodes. From the upper parts of the vagina, cervix and lower segment of the uterus, lymph goes to the sacral, obturator, external and internal iliac nodes, parametrial and pararectal lymph nodes. From the upper part of the uterine body, lymph collects in the para-aortic and pararenal lymph nodes. The outflow of lymph from the fallopian tubes and ovaries occurs in the periovarian and para-aortic lymph nodes.
Innervation of the internal genital organs comes from nerve plexuses located in abdominal cavity and the small pelvis: upper hypogastric, lower hypogastric (pelvic), vaginal, ovarian. The body of the uterus receives predominantly sympathetic fibers, the cervix and vagina - parasympathetic. The innervation of the fallopian tubes is carried out by parasympathetic and sympathetic departments the autonomic nervous system from the uterovaginal, ovarian plexuses and fibers of the external spermatic nerve.
Pregnancy-induced edema and proteinuria without hypertension. Clinic, diagnosis, treatment, prevention.
Indications for early amniotomy. Execution technique.
Amniotomy.
This is the opening of the amniotic sac. Produced using jaws from bullet forceps.
Effects:
Reducing the volume of the uterine cavity and increasing labor activity.
Violation of the integrity of the fetal bladder leads to the release of PG and increased labor.
Removal of anterior waters in order to enhance labor.
PGs have an antispasmodic effect, which leads to a decrease in blood pressure.
Mechanical compression of the lower pole of the low-lying placenta.
Reduction of intrauterine volume with PONRP.
Indications for early amniotomy:
Hypertension
Preeclampsia of any degree
Weakness of labor
Flat amniotic sac (anterior water column less than 2 cm)
Low placentation
PONRP, as an aid before a CS, to prevent Cuveler's uterus
Age-related primiparas
Polyhydramnios
Multiple pregnancy prevention of uterine overstretching
Large fruit
Low water
Extragenital pathology
5. Ligamentous apparatus. Hanging apparatus. Round ligaments of the uterus. Broad ligaments of the uterus. Own ovarian ligaments.
6. Anchoring apparatus of the uterus. Supportive apparatus of the uterus.
7. Female crotch. Female genitourinary area. Superficial and deep perineum.
8. Anal (anal) area in women.
10. Ligamentous apparatus. Hanging apparatus. Round ligaments of the uterus. Broad ligaments of the uterus. Own ovarian ligaments.
Blood supply, lymphatic drainage and innervation of the genital organs. Blood supply to the external genitalia mainly carried out by the internal pudendal artery and only partially by branches of the femoral artery.
The internal pudendal artery (a.pudenda interna) is the main artery of the perineum. It is one of the branches of the internal iliac artery (a.iliac interna). Leaving the pelvic cavity, it passes in the lower part of the greater sciatic foramen, then goes around the ischial spine and runs along the side wall of the ischiorectal fossa, transversely crossing the lesser sciatic foramen. Its first branch is the inferior rectal artery (a.rectalis inferior). Passing through the ischiorectal fossa, it supplies blood to the skin and muscles around the anus. The perineal branch supplies the structures of the superficial part of the perineum and continues in the form of posterior branches going to the labia majora and minora. The internal genital artery, entering the deep perineal section, branches into several fragments and supplies the bulb of the vestibule of the vagina, the large gland of the vestibule and the urethra. When it ends, it divides into the deep and dorsal arteries of the clitoris, which approach it near the pubic symphysis.
External (superficial) pudendal artery (r.pudenda externa, s.superficialis) originates from the medial side of the femoral artery (a.femoralis) and supplies the anterior part of the labia majora. The external (deep) pudendal artery (r.pudenda externa, s.profunda) also departs from the femoral artery, but deeper and more distally. After passing through the fascia lata on the medial side of the thigh, it enters the lateral part of the labia majora. Its branches pass into the anterior and posterior labial arteries.
Veins passing through the perineum, are mainly branches of the internal iliac vein. For the most part they accompany the arteries. An exception is the deep dorsal clitoral vein, which drains blood from the erectile tissue of the clitoris through a fissure below the pubic symphysis into the venous plexus around the bladder neck. The external genital veins drain blood from the labia majora, passing laterally to enter the great saphenous vein of the leg.
Blood supply to the internal genital organs carried out mainly from the aorta (system of the common and internal iliac arteries).
Basics blood supply to the uterus provided uterine artery (a uterina), which arises from the internal iliac (hypogastric) artery (a iliaca interna). In about half of the cases, the uterine artery arises independently from the internal iliac artery, but it can also arise from the umbilical, internal pudendal and superficial cystic arteries
Uterine artery goes down to the lateral pelvic wall, then passes forward and medially, located above the ureter, to which it can give an independent branch. At the base of the broad uterine ligament, it turns medially towards the cervix. In its parametrium, the artery connects with the accompanying veins, nerves, ureter and cardinal ligament. The uterine artery approaches the cervix and supplies it with the help of several tortuous penetrating branches. The uterine artery then divides into one large, very tortuous ascending branch and one or more small descending branches supplying the upper part of the vagina and adjacent part of the bladder. The main ascending branch runs upward along the lateral edge of the uterus, sending arcuate branches to its body. These arcuate arteries surround the uterus under the serous layer. At certain intervals, radial branches depart from them, which penetrate into the intertwining muscle fibers of the myometrium. After childbirth, the muscle fibers contract and, acting as ligatures, compress the radial branches. The arcuate arteries quickly decrease in size along the midline, therefore, with midline incisions of the uterus, less bleeding is observed than with lateral ones. The ascending branch of the uterine artery approaches the fallopian tube, turning laterally at its upper part, and divides into tubal and ovarian branches. The tubal branch runs laterally in the mesentery of the fallopian tube (mesosalpinx). The ovarian branch goes to the mesentery of the ovary (mesovarium), where it anastomoses with the ovarian artery, which arises directly from the aorta
The ovaries are supplied with blood from ovarian artery (a.ovarica), originating from the abdominal aorta on the left, sometimes from the renal artery (a.renalis). Descending together with the ureter, the ovarian artery passes through the ligament that suspends the ovary to the upper part of the broad uterine ligament, giving off a branch to the ovary and tube; the terminal section of the ovarian artery anastomoses with the terminal section of the uterine artery.
IN blood supply to the vagina In addition to the uterine and genital arteries, the branches of the inferior vesical and middle rectal arteries also participate. The arteries of the genital organs are accompanied by corresponding veins. The venous system of the genital organs is very developed; the total length of the venous vessels significantly exceeds the length of the arteries due to the presence of venous plexuses that widely anastomose with each other. Venous plexuses are located in the clitoris, at the edges of the vestibule bulbs, around the bladder, between the uterus and ovaries.