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Maternal Anatomy

Maternal Anatomy

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Maternal Anatomy

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  1. Maternal Anatomy Chapter 2 Review Williams Obstetrics Felicia Katz 8/10/11

  2. Anterior Abdominal Wall

  3. 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

  4. 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

  5. External Genitalia

  6. Vagina • Non-keratinized squamousepithelium, smooth muscle layer • Upper 1/3 mullerian derived • Lower 2/3 urogenitalsinus derived • Lubricated by transudate across subepithelial capillary plexus

  7. 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

  8. Anterior and Posterior Triangles

  9. 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

  10. 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

  11. Cervix • Squamous epithelium on ectocervix • Columnar epithelium on endocervix

  12. Endometrium

  13. Ligaments

  14. Blood Supply

  15. 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

  16. Pelvic Bony Anatomy

  17. 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)

  18. Pelvic inlet

  19. Mid-Pelvis • Ischial spines (10cm)

  20. Outlet • Posterior boundary = coccyx • Anterior boundary = pubic arch

  21. Pelvis Types

  22. Pelvic Floor