FEMALE PELVIC ANATOMY

RUQ - Right Upper Quadrant

RLQ - Right Lower Quadrant

LUQ - Left Upper Quadrant

LLQ - Left Lower Quadrant

***Abdomen divided by sagittal plane crossing through midline at umbilicus and a transverse plane crossing through the abdomen at the level of the umbilicus

Right Hypochondrium - liver, GB, hepatic flexure of colon

Epigastric - pancreas, stomach, transverse colon

Left Hypochondrium - spleen, stomach, left kidney (upper pole)

Right Lumbar - right kidney, ascending colon

Umbilical - Transverse colon, small bowel

Left Lumbar - left kidney (mid/lower poles), descending colon

Right Iliac - ovary, seminal vesicle

Hypogastric - bladder, uterus, prostate, rectum, sigmoid

Left Iliac - ovary, seminal vesicle

• Above the pelvic brim
• Communicates with the abdominal cavity
• Contains sigmoid colon and ileum
• Muscles
  • Rectus Abdominis - forms anterior wall of abdominopelvic cavity, from xiphoid to symphysis pubis
  • Transverse Abdominis - form the anterolateral borders of the abdominopelvic cavity
  • Psoas Major - 2 muscles (left and right) originate in lumbar vertebral region and extend to the iliac crests;
  • Iliopsoas - psoas muscle connects with iliacus muscle to form iliopsoas muscle

• Below the pelvic brim
• Formed by the bony bowl of the pelvic bones
• Enclosed inferiorly by membranes and muscles
• Contains uterus, vagina, fallopian tubes, ovaries, rectum and bladder

Pelvic Muscles in True Pelvis:

• All muscles should be hypoechoic to the surrounding pelvic organs, some have visible striations
• Levator Ani
• Most inferior structure
• Pubococcygeus and Iliococcygeus muscles together are referred to as the levator ani muscles
• Connects the coccyx and the pubis bone
• Forms the floor of the pelvis
• Has 3 openings for urethra, vagina and rectum
• Can be identified on ultrasound as the flat muscle extending laterally on both sides of the vaginal cuff
• Pelvic diaphragm formed by the levator ani and coccygeus muscles
• Weakness in the levator ani muscles can lead to uterine or rectal prolapse
• Obturator Internus
• Located laterally at the acetabulum
• Triangular sheet
• Covers anterior and lateral walls of the pelvis
• Piriformis
• Superior and lateral to levator ani muscles
• Originates from sacrum and connects to the greater trochanter
• Covers posterior wall
• Most commonly mistaken for ovaries on ultrasound
• Coccygeus
• Forms the posterior portion of the pelvic wall
• Originates from the coccyx
• Psoas
  • Originates in lumbar vertebral region
  • Connects with the iliacus muscle to form the iliopsoas muscle
• Rectus Abdominis
  • Forms the anterior abdominal wall
  • Extends from the xiphoid process to the symphysis pubis
  • Linea alba separates the muscles in the midline of the abdomen, extends from xiphoid to pubis

• Provides a weight bearing bridge between spine and ribs
• Directs the pathway of the fetal head during childbirth
• Protects reproductive organs
• Innominate bones
  • AKA hip bones
  • Ischium
  • Ilium (the ileum is in the GI tract, the ilium is a pelvic bone)
  • Pubis
• Sacrum
• Coccyx
• Bones are echogenic with posterior shadowing

1. Anterior Cul-de-Sac: 
• Fold in the peritoneum between anterior uterus and posterior bladder
• AKA vesicouterine pouch

2. Posterior Cul-de-Sac:
• Fold in the peritoneum between posterior uterus and anterior rectum
• AKA rectouterine pouch or pouch of Douglas
• Most dependent portion of the pelvis
• Most likely location for pooling of free fluid

3. Space of Retzius:
• Anterior to bladder, posterior to symphysis pubis
• Space between the transversalis layer and outer fascia of the peritoneum
• AKA retropubic space
• Not contiguous with abdominopelvic cavity
• Very unusual for fluid collection
• Usually contains fat

• NOT true ligaments
• Wing like folds of the peritoneum extending from the uterine cornua to the lateral pelvic walls
• Separates pelvic cavity into anterior and posterior portions
• Covers anterior and posterior surfaces of the uterus
• Encases most of fallopian tubes and round ligament, ovarian ligament and vessels
• Loosely positions uterus in pelvic cavity and supports tubes and ovaries
• Mesovarium - portion of the peritoneum connecting anterior ovary to posterior broad ligament; contains vessels
• Mesosalpinx - free margin of the broad ligament where the fallopian tube travels; contains vessels
• Spaces within the peritoneal cavity that are posterior to the broad ligaments = Adnexa
• Fluid in the pelvis (ascites) will cause the broad ligament to become visible Sonographically

• Fibromuscular bands extending from uterine horns to labia majora
• Maintains normal uterine fundal position and provides structural support
• Assists in birth

• AKA Transverse Cervical Ligament of Mackenrodt
• Band of fibrous tissue and muscle
• Extends from upper lateral cervix to lateral pelvic wall
• Contains the uterine and vaginal vessels
• Determines the cervix position/orientation in the pelvis with the uterosacral ligaments

• Extend from upper cervix to lateral sacrum
• Determines the cervix position/orientation in the pelvis with the cardinal ligaments

• AKA infundibulopelvic ligament
• Folds of peritoneum that contain the ovarian vessels
• Supports fallopian tubes and ovaries within pelvis

Uterine Venous Drainage:

• Uterine veins empty into the internal iliac veins
• Internal iliac veins are posterior and medial to the internal iliac arteries
• Iliac vessels are located lateral and posterior to the ovaries
• In a non-pregnant patient, the internal iliac vein is smaller in caliber than the external iliac vein
• Merges with the external iliac vein to form the common iliac vein
• Drains pelvic organs