BOOK REVIEWS. Atlas of Pelvic Anatomy and. Gynecologic Surgery, 2nd Edition. Editors: Baggish, Michael S, MD; Karram, Mickey M,. MD. Bibliographic Data. Atlas of Pelvic Anatomy and Gynecologic Surgery and Gynaecologic Surgery from professors in obstetrics and gynaecology from the USA. Atlas of Pelvic Anatomy and Gynecologic. Surgery. Authors Michael S Baggish, Mickey M Karram. In the preface to this excellent book the authors remind us that .
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Copyright - all rights reserved / Clifford R. Wheeless, Jr., M.D. and Marcella L. Roenneburg, M.D.. All contents of this web site are copywrite protected. Atlas of Pelvic Anatomy and Gynecologic Surgery E-Book (eBook, PDF). Atlas of . Early Development of the Human Pelvic Diaphragm (eBook, PDF). 98, The updated edition of Atlas of Pelvic Anatomy and Gynecologic Surgery richly illustrates pelvic anatomy and surgical operations through full-color anatomic.
The role of transvaginal ultrasound or endometrial biopsy in the evaluation of the menopausal endometrium. Baggish M, Karram M. Trophoblastic disease. Atlas of Pelvic Anatomy and Gynecologic Surgery. Philadelphia, PA: Elsevier Saunders; Rock J, Jones H. Normal and abnormal bleeding. Upon further questioning, she reports possible passage of tissue with the blood clots. She had been seen in the same ER 1 week earlier and diagnosed with an embryonic demise. She was discharged with expectant management of the miscarriage.
She appears ill. Minimal bleeding is noted from the cervix. SlideShare Explore Search You. Submit Search. Successfully reported this slideshow. We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime. Upcoming SlideShare.
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Be the first to like this. The middle muscular layer myometrium is relatively thick and can be subdivided into three groups of alternating longitudinal and oblique smooth muscle groups.
The outer most muscular layer is contiguous with the vagina and the fallopian tubes. The third uterine layer endometrium ranges from a few millimeters to over a centimeter in thickness, depending on the hormonal status. It can be divided into the stratum basale and the stratum functionale.
Only the stratum functionale is hormonally responsive. The uterine axis is important to note when invasive transcervical uterine procedures are performed to prevent inadvertent perforation and subsequent injury to adjacent vital structures or viscera.
The vagina obliquely attaches around the middle of the cervix, dividing it into the supravaginal section and the portio vaginalis. The endocervical canal is approximately 3 cm in length and leads into the uterine cavity.
They generally are less than 1 cm in external diameter, but can become markedly swollen if the tubes become blocked, leading to a condition known as a hydrosalpinx. The intramural segment travels from the cornua of the uterine cavity through the myometrium for 1 cm to 2 cm to connect to the isthmic portion. The isthmus is relatively narrow, with an internal diameter of only 1 mm, therefore making it the preferred site for tubal sterilization procedures.
Traveling distally, the inner diameter begins to enlarge in the ampulla to approximately 6 mm.
Fertilization usually occurs in this segment and the ampulla is also the site of most ectopic pregnancies. The most distal portion of the fallopian tube is called the infundibulum. The highest concentration of ciliated epithelium is also found here, which assist in oocyte transport to the uterine cavity.
Several ligamentous structures emanate from the uterus see Fig. They extend laterally, cross the external iliac vessels, enter the internal inguinal ring, and insert into the labia majora. Neither the round ligament nor the broad ligament provides much support to the uterus.
Occasionally the round ligament is attached to the anterior abdominal fascia to correct symptomatic retroverted uteri. Found within the peritoneal leaves at the base of the broad ligament, the cardinal ligament provides the main support for the uterus and cervix. The uterosacral ligaments provide minor cervical support. The course of the uterosacral ligaments can be highlighted by placing the uterus on traction. Uterine and pelvic support will be discussed more later in this article.
They rest in an indentation of the peritoneum called the ovarian fossa, immediately adjacent to the iliac vessels and ureters. Around the sixth week of gestation, primordial germ cells migrate from the yolk sac to the genital ridges. Failure to complete migration can lead to extra-ovarian teratomas, most commonly found in the retroperitoneum . At birth, 1 to 2 million oocytes are present.
The number of oocytes steadily declines thereafter, so that at the onset of puberty only , are present. In a reproductive span of 35 to 40 years, multiple follicles can be found at any given time in varying stages of development, but only to oocytes will be selected to ovulate .
Stroma cells are tightly packed around developing follicles and secrete hormones. The outer cortex of the ovary is composed of a single layer of cuboidal epithelium, derived from coelomic mesothelium, and is essentially the same as other peritoneal surfaces within the abdomen. The urinary system and rectum Thorough understanding of the urinary system and its anatomy is critical for safe gynecologic procedures. The bladder can be found anterior to the uterus.
It is a distendable hollow organ with three sections: the mucosa, detrusor muscles, and serosa. The serosa is only present on the superior surface. The base of the bladder is adjacent to the endopelvic fascia and anterior vagina.
This region lacks mucosal folds and is slightly raised when compared with the remainder of the bladder. The urachus, a remnant of the allantois, extends from the bladder dome to the umbilicus. Occasionally its proximal portion is still patent, therefore secure ligation is necessary when dividing it to prevent urinomas from developing.
The ureters are paired retroperitoneal muscular tubes approximately 34 cm in length, originating from the renal calyxes, which insert into the inferior bladder at the trigone.