ch 2 maternal anatomy

7/23/2019 Ch 2 Maternal Anatomy

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Maternal Anatomy

By: Ronald Oscar



Anterior Abdominal Wall

External Generative Organs

Internal Generative Organs

Musculoskeletal Pelvic Anatomy



Anterior

Abdominal Wall



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



Perineumas Colles

Fascia

Scarpafascia



Anterior

Abdominal Wall

muscle

Midline

rectusabdominis &

M.pyramidalis

M. Eternal &Internal!bli"ue

M. #ran$ersusAbdominis



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



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.



,lood Supply

S-in &

Subcutan bloodsupply

A.Super+cialepiastric

A.Super+cialcircum/e

iliac

A.Super+cial eternalpudendal



#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



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



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



EXTERNAL

GENERATIEORGAN

!"#!A !AGI$A % &'ME$

PE(I$E"M

Isc)ioanal Fossae Anal canal

Anal sp)incter complex

Pudendal nerve



2ul$a % the pudenda mons pubis

)abia majora & minora

Clitoris3ymen

2estibular lands % reater:bartholine & minor &

paraurethral land



Mons Pubis : Mons 2eneris

Co$ered by curly hair 45 the EX!"T!#EON



)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



)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



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



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



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



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



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



2aina



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



7:' mediana 45internal iliac nodes

7:' upper 45eternal*internal and common iliacnodes

PE9I1E?M %di d



PE9I1E?M %diamondshaped

+oundries ,

Anterior , symp)isis pubic

Anterolateral , isc)iopubic rami % isc)ial tuberosities

Posterior , sacrotuberous ligament % coccyx



Perineum

?roenital trianle

45

anterior

Analtrianle

45posterior

Perineal body



Perineal ,ody

Super+cial @

M. ,ulboca$ernosus * Super+cial trans$ersalperinei*

Sphincter anal eternus=eep @

Perineal membrane @ M.Pubbococcyeus*internal anal

sphincter



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



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



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



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/=



INTERNALGENERATIE

ORGAN



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



?#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 .



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.



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.



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



)IAME1#S



- #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.



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)



,)!!= S?PP)



#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.



)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



I11E92A#I!1

P l i i l i ti i d i tl



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



!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



FA))!PIA1 #?,ES



- #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.



M"$!"LO$%ELETAL &ELI!

ANATOM'



#he pel$is is composed of four bones@

7.the sacrum*

8.coccy*

'. t(o innominate @ the ilium* ischium* andpubis



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



#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.



#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.



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.



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.



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.



#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.



#(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



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.



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.



TERIMA %A$I#

ch 2 maternal anatomy

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