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Maternal Anatomy. Chapter 2 Review Williams Obstetrics Felicia Katz 8/10/11. Anterior Abdominal Wall. Blood Supply. Femoral artery branches Superficial epigastric External pudendal Supply skin and subcutaneous tissue over lower abdominal wall and mons External Iliac branches

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Maternal Anatomy

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Maternal anatomy

Maternal Anatomy

Chapter 2 Review

Williams Obstetrics

Felicia Katz

8/10/11


Anterior abdominal wall

Anterior Abdominal Wall


Blood supply

Blood Supply

  • Femoral artery branches

    • Superficial epigastric

    • External pudendal

    • Supply skin and subcutaneous tissue over lower abdominal wall and mons

  • External Iliac branches

    • Inferior epigastric vessels

    • Supply muscles and fascia of lower abdominal wall


Innervation

Innervation

  • T7-12

  • Ilioinguinal (L1)

    • Skin of lower abdominal wall, upper portion of labia majora, and inner thigh

  • Iliohypogastric(L1)

    • Skin over suprapubic area

  • Course between layers of rectus sheath lateral to rectus muscle


External genitalia

External Genitalia


Vagina

Vagina

  • Non-keratinized squamousepithelium, smooth muscle layer

  • Upper 1/3 mullerian derived

  • Lower 2/3 urogenitalsinus derived

  • Lubricated by transudate across subepithelial capillary plexus


Vascular supply

Vascular Supply

  • Proximal portion supplied by cervical branch of uterine artery

  • Remainder by vaginal artery (variable origin)

  • Lower third and vulva lymphatics drain to inguinal nodes; remainder iliac nodes


Anterior and posterior triangles

Anterior and Posterior Triangles


Maternal anatomy

Anus

  • IAS: constant resting tone for fecal continence; may be torn with 4th deg lacs

  • Anal cushions: venous plexus; cause of hemorrhoids

  • Dentate line: external hemorrhoids painful 2/2 innervated stratefiedsquamous epithelium


Uterus

Uterus

  • Posterior aspect covered by visceral peritoneum (serosa)

  • Lower portion of anterior wall adjacent to bladder (dissected during c/s)

  • Nulliparous 6-8cm; multiparous 9-10cm

  • Majority of muscle fibers located at fundus, and at anterior and posterior walls as compared to lateral walls

  • Innervation

    • T11/T12 transmit pain sensation from contractions

    • Pudendal nerve transmits pain from lower vagina and skin


Cervix

Cervix

  • Squamous epithelium on ectocervix

  • Columnar epithelium on endocervix


Endometrium

Endometrium


Ligaments

Ligaments


Blood supply1

Blood Supply


Blood supply2

Blood Supply

  • Uterine artery

    • Branch of internal iliac

    • Courses along base of broad ligament toward cervix then branches in two and runs along uterine wall

    • Crosses over ureter 2cm from cervix

  • Ovarian artery

    • Direct branch from aorta

    • Enters broad ligament through IP ligament

    • Anastamoses with branch of uterine artery


Pelvic bony anatomy

Pelvic Bony Anatomy


Pelvic inlet

Pelvic Inlet

  • Posterior boundary = sacral promontory

  • Anterior boundary = pubic symphysis

  • Lateral boundary = lineaterminalis

    Measure adequacy of inlet via the obsetrical conjugate (subtract 1.5-2cm from diagonal conjugate)


Pelvic inlet1

Pelvic inlet


Mid pelvis

Mid-Pelvis

  • Ischial spines (10cm)


Outlet

Outlet

  • Posterior boundary = coccyx

  • Anterior boundary = pubic arch


Pelvis types

Pelvis Types


Pelvic floor

Pelvic Floor


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