One of the risks of the endometrial biopsy that was performed on this patient is perforation of the uterus. The endometrial biopsy device is placed through the cervix and into the endometrial cavity. If complete perforation occurs, what is the sequence of layers that the biopsy device would penetrate prior to entering the peritoneal cavity?
Correct Answer: Endometrium, myometrium, serosa
Description: The uterus is a hollow, muscular organ that lies between the bladder and the rectum in the true pelvis. The uterus can be divided into three major segments: the uterine fundus, the uterine corpus (or body), and the cervix. The fallopian tubes enter the uterine fundus laterally in the region called the cornua. Moving from the inside (or hollow) poion of the uterus to the peritoneal cavity, the layers that would be penetrated are the endometrium, the myometrium, and the serosa. The endometrium is the poion of the uterus that proliferates during the menstrual cycle and sheds (the menses) if pregnancy does not occur, or suppos the pregnancy if conception and implantation take place. The myometrium is comprised of three layers: an inner layer of longitudinal smooth muscle, a middle layer of circular smooth muscle (the stratum vasculare), and an outer layer of longitudinal and circular smooth muscle (the stratum supervascularae). The final layer is the uterine serosa. The ovary, fallopian tube, and broad ligament are found posterolateral to the uterus. A biopsy device that perforated the uterus could also injure these structures, but the direct path of perforation is through the endometrium, myometrium, and serosa. Note: The round ligament, cardinal ligament, and uterosacral ligament are suppoing structures attached to the uterus. Again, while a perforating biopsy instrument could possibly involve these structures, this would not be the direct path of perforation. The serosa, myometrium, and endometrium are the correct structures that would be perforated, but they are in the wrong order. Staing within the uterus, the first layer is the endometrium, next is the myometrium and finally the serosa. Ref: Shaw's Textbook of Gynaecology, 13th Ed Page 7-10
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Gynaecology & Obstetrics
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