ch 2 maternal anatomy
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Maternal Anatomy
By: Ronald Oscar
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Anterior Abdominal Wall
External Generative Organs
Internal Generative Organs
Musculoskeletal Pelvic Anatomy
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Anterior
Abdominal Wall
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C am p er
F a s c i a
m on s
p u
b i s
l a b i a
m a j or a
p er i n e um
I s c h i o an a
l f o s s a e
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Perineumas Colles
Fascia
Scarpafascia
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Anterior
Abdominal Wall
muscle
Midline
rectusabdominis &
M.pyramidalis
M. Eternal &Internal!bli"ue
M. #ran$ersusAbdominis
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Aponeurosis %jalur of ' muscle form primary fasciaof anterior abdominal (all
Aponeuroses in$est rectus abdominalis muscle as
rectus sheath.
)inea Arcuata is the boundries bet(een the sheath
Cephalad to this border * the aponeurosis in$est
the rectus abdominis bellies on the both dorsal and ventral
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Caudal to this line * all aponeurosis lie $entral orsuper+cial to the rectus abdominis muscle andonly the thin trans$ersalis fascia and peritoneumlie beneath the rectus.
Important in midline abdominal incision.
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,lood Supply
S-in &
Subcutan bloodsupply
A.Super+cialepiastric
A.Super+cialcircum/e
iliac
A.Super+cial eternalpudendal
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#he inferior 0deep epiastric and deep circum/eiliac $essel supply muscle and fascia of abdominalanterior (all.
1ear the umbilicus * A.2 epiasatric inferior
anastomose (ith A.2 superior epiastric %branchfrom Internal thoracic $essel
3esselbach trianle 45 reion bounded
)aterally 45inferior epiastric $essel
Medial 45 rectus abdominis
Inferior 45 liamentum inuinale
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Inner$ationAnterior abdominal (all inner$ated by
#6477 Intercostal ner$e
#78 Subcostal 1er$e
)7 iliohypoastric and ilioinuinal
#rans$ersus Abdominis Plane 45 Area bet(een
M.#rans$ersus Abdominis & M. Internal !bli"ue
9un Intercostal 1er$e & Subcostal 1er$e
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Iliohipoastric ner$e perforates the eternalobli"ue aponeurosis 45 pro$ide sensation to thesuprapubic area * mons pubis* upper labia majora& medial upper thih.
Important in lo(er trans$erse incision
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EXTERNAL
GENERATIEORGAN
!"#!A !AGI$A % &'ME$
PE(I$E"M
Isc)ioanal Fossae Anal canal
Anal sp)incter complex
Pudendal nerve
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2ul$a % the pudenda mons pubis
)abia majora & minora
Clitoris3ymen
2estibular lands % reater:bartholine & minor &
paraurethral land
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Mons Pubis : Mons 2eneris
Co$ered by curly hair 45 the EX!"T!#EON
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)A,IA )abia de$ided majora & minora
)abia majora si;e %) 64<cm* = 84'cm* # 74>cm
anterior limit point 45 mont pubis
posterior limit point 45 commisura posterior
contain appocrine*eccrine*sebaceus land
)abia minora si;e % ) 84'cm W 74>cm
* ?pper lamella 45 form prepuce
* )o(er lamella 45 form frenulum clitoris
* )abia minora mere into fourchette posteriorly
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)A,IAStructure epithelial @
!uter surface 45 -eratini;ed strati+ed s"uamousepithelium
Inner surface
* )ateral hart line 45 -eratini;ed strati+ed SE
* Medial 45 non -eratini;ed SSE
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C)I#!9IS %si;e 8 cm)ocated 45 under prepuce abo$e frenulum &urethra
Composed @
7 lands %B*>cm 45 strati+ed SE
7 body 45 contain 8 ca$ernosus
8 crura 45 ischiopubic ramus andischioca$ernosus muscle
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2ES#I,?)E % almond shaped
Enclosed by
* eternal surface hymen
* )ateral hart line
*Frenulum anterior side
* Fourchette posterior side
Si openin of @ 7 urethra*7 $aina*8 ductbartholine land*8 duct s-ene lands %paraurethrallands
Fossa na$ucilare 45 bet(een fourchette4$ainalopenin 45 1ulipara
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2estibule Major land %bartholine 45B*>47 cm*) 7*>48cm
* ,ilateral
* )ies inferior of bulboca$ernosus & $ascular bulbolands
* !pens distal to hymenal rin at > & 6 oDcloc- point
Minor land 45 lined by simple mucin secretinepthel alon hart line
Paraurethral land 45 8 s-ene lands % lare lands
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2AI1A A1= 3ME13ymen
4 co$ered non -eratini;ed str SCE
4 torn at se$eral sites durin coitus
2aina 45 musculo membranous tube
Anteriorly $esico$ainal septum %separate fromurethra and bladder
Posteriorly recto$ainal septum %separate fromrectum
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G recto$ainal pouch is cul4de4sac of doulasca$ity
2ainal si;e anterior H4< cm posterior 647Bcm
?pper end of $aina subdi$ided intoanterior*posterior* and t(o lateral fornices ofcer$i
Middle portion of $aina attached to pel$is (ith
$isceral connecti$e tissue and then continued tofascia le$ator anii
2ainal linin composed of non-eratini;ed SSEand underlynin lamina propria 45 formin
ruae
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2aina
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2aina lubricated by the 2ainal Subepithelial Capillary Pleus
2ascularity 45
cer$ical branch of A.?terina and A.2ainal and direct from A.iliaca Interna
A. rectal mediana 45 posterior $aina
)ymphatic system @
7:' lo(er 45 inuinal lymph
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7:' mediana 45internal iliac nodes
7:' upper 45eternal*internal and common iliacnodes
PE9I1E?M %di d
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PE9I1E?M %diamondshaped
+oundries ,
Anterior , symp)isis pubic
Anterolateral , isc)iopubic rami % isc)ial tuberosities
Posterior , sacrotuberous ligament % coccyx
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Perineum
?roenital trianle
45
anterior
Analtrianle
45posterior
Perineal body
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Perineal ,ody
Super+cial @
M. ,ulboca$ernosus * Super+cial trans$ersalperinei*
Sphincter anal eternus=eep @
Perineal membrane @ M.Pubbococcyeus*internal anal
sphincter
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Anterior trianle
-uperior , Pubic (ami
#ateral , Isc)ial .uberosities
Posterior , M/ .ransversus Perinei
0evided into ,
-uper1icial and deep spaces by Perineal membrane
Perineal membrane attac)ed , isc)iopubic rami
2lateral34 567 distal uret)ra vagina 2medial34 perineal
body 2posterior3 ligamentum arcuatum pubis 2anterior3
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Pel$ic diaphramSupport to the pel$ic $iscera
Composed of le$ator ani and M.coccyeus
)e$ator ani tdd @ pubbococcyeus* puborectalis*illiococcyeus muscle
2ainal birth ma-es damaes to pubo$isceral ofm.le$ator ani
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Posterior trianleContains ,
Fossa isc)ioanal4 anal canal4 anal sp)incter complex
Consist ,
Anal sp)incter external and internal and puborectalismuscle
+ranc) o1 pudendal nerve and pudendal vessel
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Pudendal ner$e
Formed 1rom t)e anterior rami -89: -pinal nerves
;.)e ma<or blood supply to t)e perineum is via t)e internal pudendal artery4 and its
branc)es mirror t)e divisions o1 t)e pudendal nerve/=
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INTERNALGENERATIE
ORGAN
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7. ?#E9?S
8. CE92I
'. M!ME#9I?M A1= E1=!ME#9I?M
J. )IAME1#S
>. ,)!!= S?PP)
H. )MP3A#ICS
6. I11E92A#I!1
<. !2A9IES
K. FA))!PIA1 #?,ES
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?#E9?S- Pear shaped.- #here is an upper
trianular portion thebody or corpus* and a
lo(er* clyndrical portionLthe cer$i* (hich projectsinto the $aina.
- Situated in the pel$icca$ity bet(een the
bladder anteriorly and therectum posteriorly.- #he entire posterior (all
is almost co$ered byserosa* that is $isceralperitoneum.
- #he nullira$ida uterusmeasures H to < cm inlenth compared (ith K to7B cm in mulriparous.
- #he (eiht is HB .
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CE92I-Composed mainly of collaen* elastin* and
proteolycans* but $ery little smooth muscle.
- #he cer$i eterior to the eternal os is called the
ectocer$i and is lines predominantly by
non-eratini;ed strati+ed s"uamous epitheliumD.
-=urin prenancy* the endocer$ical epithelium
mo$es out and onto the ectocer$i in a
physioloical process termed e$ersion.
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In early prenancy* increased $ascularity (ithin
the cer$i* ephithelium creates an ectocer$icalblue tint called Chad(ic- sinD.
Cer$ical edema leads to softeninLoodell sin*
and shereas isthmic softenin is 3ear sin.
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M!ME#9I?M A1= E1=!ME#9I?M
- Most of the uterus is
composed ofmyometrium* the uterineca$ity is lined (ithendometrium.
- Myometrium is interal
to hemostasis at theplacental site durin thethird stae of labor* theendometrium $ariesreatly throuhtout themenstrual sycle anddurin prenancy.
- ,asalis layer ofendometrium reeneratethe functionalis layerfollo(in each menses.
)IAME1#S
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)IAME1#S
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- #here are se$eral liaments that etend from the
uterine surface to(ard the pel$ic side(al-s.
- #he round liament oriinates some(hat belo(
and anterior to the oriin of the fallopian tubes.
- #he broad liaments are t(o (inli-e structures
that etend from the lateral uterine marins to
the pel$ic side(al-s.
- #he cardinal liament %the trans$erse cer$ical
liament or Mac-enrodt liament is the thic-
base of the broad liament* that the medially is
united to the uterus and upper $aina.
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Each uterosacral liament oriinates (ith a
posterolateral attachment to the supra$ainalportion of the cer$i and inserts into the fascia
o$er the sacrum (ith some $ariations.
,)!!= S?PP)
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,)!!= S?PP)
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#he uterine artery* a main branch of the internal
iliac arteryLpre$iously called the hypoastric
arteryLenters the base of the broad liament.
#he uterus recei$es blood supply from the o$arian
artery.
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)MP3A#ICS #he endometrium is abundantly supplied (ith
lymphatic $essels that are con+ned larely to the
basalis layer.
#he lymphatics of the underlyin myometrium areincreased in number to(ard the serosal surface
and form an abundant lymphatic pleus just
beneath it.
I11E92A#I!1
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I11E92A#I!1
P l i i l i ti i d i tl
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Pel$ic $isceral inner$ation is perdominantly
autonomic.
#he autonomic portion is further di$ided in
sympathetic %from spinal le$el #47B throuh )48
and parasympathetic components %from neurons
at spinal le$el S48 throuh SJ.
Most aNerent sensory +bers from the uterus
ascend throuh the inferior hypoastric pleusand enter the spinal cord $ia #47B throuh #478
and )47 spinal ner$es.
!2A9IES
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!2A9IES !$aries position are $aries* but usually lie in the upper part of the
pel$ic ca$ity and rest in a sliht depression on the lateral (all ofpel$ic.
#he o$ary consists of a corte and medulla.
Epithelium of the corte contains oocytes and de$elopinfollicles.
#he medulla is the central portion* (hich is composed of loose
connecti$e tissue. #here are a lare number of arteries and $eins
in the medulla and a small number of smooth muscle +bers.
FA))!PIA1 #?,ES
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FA))!PIA1 #?,ES
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- #hese tubes etend < to 7J cm from the uterine
cornua and are anatomically classi+ed as an
interstitial portion* isthmus* ampulla and
infundibulum.
- In cross section* the etrauterine fallopian tube
contains a mesosalpin* myosalpin * and
endosalpin.
- #he tubes are supplied richly (ith elastic tissue*
blood $essels and lymphatics.
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M"$!"LO$%ELETAL &ELI!
ANATOM'
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#he pel$is is composed of four bones@
7.the sacrum*
8.coccy*
'. t(o innominate @ the ilium* ischium* andpubis
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Pel$ic Ooints@
Anteriorly
45 the symphysis pubis@ +brocartilae andthe superior and inferior pubic liaments.
Posteriorly
45 sacroiliac articulations @ the sacrum and theiliac portion of the innominate bones
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#he pel$is is conceptually di$ided into
False components 45 is bounded posteriorly bythe lumbar $ertebra and laterally by the iliac
fossa. In front* theboundary is formed by thelo(er portion of the anterior abdominal (all.
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#rue components 45 the linea terminalis ser$esas the superior border* (hereas the pel$ic outletis the inferior marin. #he posterior boundary isthe anterior surface of the sacrum* and the
lateral limits are formed by the inner surface ofthe ischial bones and the sacrosciatic notchesand liaments. In front* the true pel$is isbounded by the pubic bones* by the ascendin
superior rami of the ischial bones* and by theobturator foramina.
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Planes and =iameters of the Pel$is
as ha$in four imainary planes@
7. #he plane of the pel$ic inletLthe superior strait.
8. #he plane of the pel$ic outletLthe inferior strait.
'. #he plane of the midpel$isLthe least pel$ic
dimensions.
J. #he plane of reatest pel$ic dimensionLof no
obstetrical sini+cance.
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Pel$ic inletthe pel$ic inlet is bounded posteriorly by the
promontory and alae of the sacrum* laterally bythe linea terminalis* and anteriorly by thehori;ontal pubic rami and the symphysis pubis.
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Four diameters of the pel$ic inlet are usuallydescribed@
Anteroposterior 45 is the shortest distance
bet(een the sacral promontory and thesymphysis pubis. 1ormally* this measures 7B cmor more.
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#rans$erse 45 is constructed at riht anles tothe obstetrical conjuate and represents thereatest distance bet(een the linea terminalison either side. It usually intersects the
obstetrical conjuate at a point approimately >cm in front of the promontory and measuresapproimately 7' cm.
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#(o obli"ue diameters 45 etends from onesacroiliac synchondrosis to the contralateraliliopubic eminence. #hese obli"ue diametersa$erae less than 7' cm.
Midpel$is and Pel$ic
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Midpel$is and Pel$ic!utlet
#he midpel$is is measured at the le$el of theischial spines* also called the midplane or planeof least pel$ic dimensions.
#he ape of the posterior trianle is the tip ofthe sacrum* and the lateral boundaries are thesacrotuberous liaments and the ischialtuberosities. #he anterior trianle is formed bythe descendin inferior rami of the pubic bones.
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Pel$ic Shapes #he Cald(ell4Moloy %7K''* 7K'J anatomical
classi+cation of the pel$is is based on shape.
Speci+cally* the reatest trans$erse diameter of
the inlet and its di$ision into anterior andposterior sements are used to classify thepel$is as ynecoid* anthropoid* android* orplatypelloid.
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TERIMA %A$I#