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This is the complete lecture note for OBG501 General Gynaecology. You can read it online below, open it in the full viewer, or download the PDF for offline study. It pairs with the course's video lectures, so you can read and watch together.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Course code: OBG 501 Course title: General Gynaecology Course credit load: 3 Units Series 1: Anatomy and Clinical Evaluation • Part 1.1: Bony Pelvis and Pelvic Floor o Sub Part 1.1.1: Bony pelvis and pelvic types o Sub Part 1.1.2: Pelvic floor and perineum o Sub Part 1.1.3: Pelvic ligaments and support structures • Part 1.2: Anatomy of the Female Genital Tract o Sub Part 1.2.1: Vulva and vagina o Sub Part 1.2.2: Uterus and cervix o Sub Part 1.2.3: Fallopian tubes and ovaries • Part 1.3: Blood Supply, Lymphatic Drainage, and Innervation of the Pelvis o Sub Part 1.3.1: Arterial supply of the pelvis and genital tract o Sub Part 1.3.2: Venous drainage and lymphatic drainage o Sub Part 1.3.3: Innervation of the pelvis and perineum • Part 1.4: Laboratory and Imaging Evaluation in Gynaecology o Sub Part 1.4.1: Common laboratory tests in gynaecology o Sub Part 1.4.2: Imaging techniques in gynaecology o Sub Part 1.4.3: Cervical and endometrial sampling • Part 1.5: Surgical Evaluation in Gynaecology o Sub Part 1.5.1: Diagnostic laparoscopy and hysteroscopy o Sub Part 1.5.2: Principles of preoperative gynaecological assessment o Sub Part 1.5.3: Common gynaecological surgical procedures overview Introduction
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Picture a final-year student standing in for the first time in a gynaecology clinic, faced with a patient describing pelvic pain and irregular bleeding. Without a firm grasp of pelvic anatomy and the tools available to evaluate a gynaecological patient, even a straightforward presentation can feel overwhelming. This Series lays that essential foundation: the anatomy of the bony pelvis, pelvic floor, and female genital tract, together with the laboratory, imaging, and surgical methods used to evaluate the gynaecological patient, the groundwork upon which every subsequent Series in this course will build. The aim of this Series is to equip you with a sound understanding of pelvic and genital tract anatomy and the principal methods used to evaluate a gynaecological patient. We shall commence this Series by examining the bony pelvis and pelvic floor, before moving to the detailed anatomy of the female genital tract from the vulva to the ovaries. Next, we will consider the blood supply, lymphatic drainage, and innervation of the pelvis. Following that, our attention turns to laboratory and imaging evaluation in gynaecology. Finally, we will conclude by examining surgical evaluation, including diagnostic laparoscopy, hysteroscopy, and the principles of preoperative assessment. Series Learning Outcomes Upon completing this Series, you should be able to: • SLO 1.1: describe the anatomy of the bony pelvis and pelvic floor, • SLO 1.2: describe the gross anatomy of the female genital tract, • SLO 1.3: describe the blood supply, lymphatic drainage, and innervation of the pelvis, • SLO 1.4: describe the common laboratory tests used in gynaecological evaluation, • SLO 1.5: describe the imaging techniques and sampling methods used in gynaecological evaluation, and • SLO 1.6: describe the principles of surgical evaluation in gynaecology. 1.1 Bony Pelvis and Pelvic Floor 1.1.1 Bony pelvis and pelvic types The bony pelvis is formed by the two innominate (hip) bones, the sacrum, and the coccyx, joined anteriorly at the pubic symphysis and posteriorly at the sacroiliac joints, and is functionally divided into the false pelvis (above the pelvic brim, supporting the abdominal viscera) and the true pelvis (below the brim, through which the fetus must pass during labour), making its dimensions of direct clinical importance in obstetric practice.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Caldwell-Moloy classification describes four basic pelvic shapes, gynaecoid (the classical, most favourable shape for vaginal delivery, round with a wide transverse diameter), android (heart-shaped, narrower and less favourable), anthropoid (oval, with a longer anteroposterior diameter), and platypelloid (flattened, with a short anteroposterior diameter), and while few women have a pure pelvic type, recognising the dominant pattern helps anticipate the likely course and difficulty of labour. Fill in the blank: The pelvis is divided into the false pelvis and the ________ pelvis by the pelvic brim. The pelvic shape most favourable for vaginal delivery is the ________ type. 1.1.2 Pelvic floor and perineum The pelvic floor is a muscular diaphragm formed principally by the levator ani (comprising the pubococcygeus, puborectalis, and iliococcygeus muscles) and the coccygeus muscle, spanning the pelvic outlet and supporting the pelvic organs against intra-abdominal pressure, with the puborectalis playing a particularly important role in maintaining the anorectal angle central to faecal continence. The perineum is divided by an imaginary line between the ischial tuberosities into the anterior urogenital triangle (containing the external genitalia and, in women, the vaginal and urethral openings) and the posterior anal triangle (containing the anal canal), and understanding this division and the underlying muscular layers is essential when assessing and repairing perineal trauma sustained during childbirth. Fill in the blank: The pelvic floor is formed principally by the ________ ani muscle group. The perineum is divided into the urogenital triangle and the ________ triangle. 1.1.3 Pelvic ligaments and support structures The uterus and adjacent pelvic organs are supported by a combination of ligaments, fascial condensations, and the pelvic floor musculature, with the cardinal (transverse cervical) ligaments and uterosacral ligaments, both condensations of endopelvic fascia rather than true ligaments in the strict anatomical sense, providing the principal horizontal support to the cervix and upper vagina at the level of the pelvic floor. The broad ligament is a double fold of peritoneum draping over the uterus, fallopian tubes, and ovarian ligaments, providing a degree of lateral stability while also carrying the uterine vessels, ureter, and round ligament within its layers, and understanding this relationship is of direct surgical relevance, as the ureter's proximity to the uterine artery within the broad ligament is a recognised site of iatrogenic ureteric injury during hysterectomy. Fill in the blank: The principal horizontal support to the cervix and upper vagina comes from the cardinal and ________ ligaments. Within the broad ligament, the ureter passes close to the ________ artery, a recognised site of surgical injury.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS Figure 1.1: The four Caldwell-Moloy pelvic types and the muscular anatomy of the pelvic floor. Pilot questions 1.1 1. Describe the bones that form the bony pelvis and how they articulate. (Linked to SLO 1.1) 2. Describe the four Caldwell-Moloy pelvic types and their clinical relevance to labour. (Linked to SLO 1.1) 3. Describe the muscles that form the pelvic floor. (Linked to SLO 1.1) 4. Describe the division of the perineum into the urogenital and anal triangles. (Linked to SLO 1.1) 5. Describe the ligamentous and fascial support of the uterus and cervix. (Linked to SLO 1.1) 1.2 Anatomy of the Female Genital Tract 1.2.1 Vulva and vagina The vulva comprises the external female genitalia, including the mons pubis, labia majora and minora, clitoris, vestibule (into which the urethra and vagina open), and the Bartholin's and Skene's glands, which provide lubrication during sexual arousal and are a recognised site of cystic and abscess formation when their ducts become obstructed or infected.
la-NET | ONLINE LEARNING VIDEO PLATFORM FOR POST-SECONDARY & HIGHER INSTITUTION STUDENTS The vagina is a fibromuscular canal extending from the vulva to the cervix, lined by non-keratinised stratified squamous epithelium that is hormonally responsive, undergoing cyclical change under oestrogen influence, and surrounding the cervix to form the anterior, posterior, and lateral fornices, the posterior fornix being of particular clinical importance as it lies in close proximity to the pouch of Douglas, allowing transvaginal access for procedures such as culdocentesis. Fill in the blank: The glands responsible for vaginal lubrication that can become obstructed and form a cyst or abscess are the ________ glands. The posterior vaginal fornix lies close to the pouch of ________. 1.2.2 Uterus and cervix The uterus is a pear-shaped, muscular organ divided into the fundus, body (corpus), and cervix, normally lying in a position of anteversion and anteflexion, composed of three layers, the outer perimetrium (serosa), the middle myometrium (smooth muscle, responsible for the contractile force of labour), and the inner endometrium (which undergoes cyclical proliferation and shedding under hormonal control, forming the basis of the menstrual cycle). The cervix is the lower, narrower portion of the uterus, comprising the endocervix (lined by columnar epithelium) and the ectocervix (lined by stratified squamous epithelium), meeting at the squamocolumnar junction, a site of particular clinical significance as the transformation zone where the great majority of cervical dysplasia and carcinoma arise, making it the focus of cervical screening technique. Fill in the blank: The middle muscular layer of the uterus responsible for the contractile force of labour is the ________. The site where endocervical and ectocervical epithelium meet is called the ________ junction. 1.2.3 Fallopian tubes and ovaries The fallopian tubes extend laterally from the uterine cornua and are divided into four segments, the interstitial (intramural) portion within the uterine wall, the
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