Applied Maternal Anatomy

Question 1

What are the layers of the abdomen?

Answer 1

Skin
SQ layer -> Camper’s facia (superficial layer; fatty), Scarpa’s fascia (more membranous, deeper layer)

Muscles (rectus abdominis, pyramidalis muscle, external & internal Oblique, Transversus abdominis)

Transversalis fascia

Peritoneum

Question 2

What is the strongest layer of the abdomen?

Answer 2

Fascia

Question 3

What are the 3 arteries that arise from the fetal artery?

Answer 3

Superficial circumflex artery
Superficial epigastric artery
External pudendal artery

Question 4

What are the borders of the Hesselbach triangle?

Answer 4

Lateral = inferior epigastric vessels
Inferior = inguinal ligament
Medial = lateral border of the recuts abdominis

Question 5

What is the diff betw indirect and direct inguinal hernia?

Answer 5

Direct = hernia protrudes through the abdominal wall in the boundary of the H triangle

Indirect = hernia bulges through the deep inguinal ring that lies lateral to the H triangle

Question 6

What are the nerves and corresponding incision types?

Answer 6

Intercostal & Subcostal nerve = Pfannenstiel Incision

Ilioinguinal & Iliohypogastric = Low transverse

Question 7

What are the important dermatomes in suitability in delivery?

Answer 7

T4 = Cesarean deliveryif pureperal sterilization

T10 = labor & vaginal delivery

Question 8

What condition is common in pregnancy where uterus enlarges due to the advancing age of gestation and the round ligmanet also stretches?

Answer 8

Round ligament syndrome

Question 9

What are the landmarks for Pudendal block?

Answer 9

Ischial spines

Question 10

What are the 6 openings?

Answer 10

Urethra
Vagina
2 greater vestibule (bartholine) gland ducts
2 paraurethral (skene) gland ducts

Question 11

What is the position of the Bartholin GLand ducts ?

Answer 11

At 5 o’clock and the other at the 7 o’clock on the vestibule

Question 12

What are the largest pareurethral glands canlled?

Answer 12

Skene’s glands (near urethra)

Question 13

What are the blood supplies of the vagina?

Answer 13

Proximal wall = cervical br of the uterine a and vaginal a

Posterior wall = middle rectal artery

Distal wall = internal pudendal artery

Question 14

What are the boundaries of the perineum?

Answer 14

Anterior = pubic symphysis
Anterolateral = ischiopubic rami and ischial tuberosities

Posterolateral = sacrotuberous ligaments

Posterior = Coccyx

Question 15

What are the components of the perineal body?

Answer 15

Bulbospongiosus
Superficial transverse perineal muscle
External anal sphincter muscles

Question 16

What is the significance of the perineal body?

Answer 16

Incised during episoiotomy (done if there is a tear forms in the perineal body during delivery)

Question 17

What muscle will not be cut during a mediolateral episiotomy?

Answer 17

Superficial transverse perineal muscle

Question 18

What is composed of th pelvic diaphragm?

Answer 18

Levator ani muscles
Coccygeus muscle

Question 19

Whata are the risk factors for Pelvic Organ Prolapse during vaginal birth?

Answer 19

Eldgerly age
Muliparity
level of activitiy (hard and intense work)

Question 20

What is the most commonly damages muscle in Pelvic Organ Prolapse?

Answer 20

Pubovisceral muscle

Question 21

What divides the perineum into anterior and anal triangle?

Answer 21

Perineal body

Question 22

What is the normal vs pregnant appearance of cervix?

Answer 22

Normal: smooth, pinkish, no lesions

Pregnant (normal):
- Chadwick’s sign, Goodell’s sign, Hegar’s sign, Leukorrhea (as long as whitish w/o foul smell)

Question 23

What is the appearance of the Chadwick’s sign, Goodell’s sign, Hegar’s sign?

Answer 23

Hegar’s sign = softening of the uterine isthmus

Goodell’s sign = softening of the vaginal portion of the cervix due to INC vascularity

Chadwick’s sign = purplish to blue cervix due to INC vascularity

Question 24

Where does the round ligmanet terminate?

Answer 24

Labia majora

Question 25

What condition has pregnant px complaining of inguinal pain at the vagina area?

Answer 25

Round ligament syndrome = this is being stretch

Question 26

What artery is seen in the round ligament?

Answer 26

Sampson artery aka Artery of the round ligament

Question 27

What are the boundaries of uterosacral ligaments?

Answer 27

Form the lateral boudnaries of the Pouch of Douglas

Question 28

What is the blood supply of the uterus?

Answer 28

Inferior Vena cava = Left renal vein (ovarian vein), Right renal vein, Common Iliac vein (External, Internal iliac vein)

Aorta = Ovarian a, Common iliac (external & iliac arteries)

Question 29

What are the 2 major divisions of the internal iliac artery?

Answer 29

Posterior division (SIL): Superior gluteal a, Iliolumbar a, Lateral sacral a

Anterior division = Parietal, Visceral

Parietal = Obturator, Internal pudendal, Inferior gluteal
Visceral = Umbilical, middle vesical, middle hemorrhoidal, uterine, vaginal

Question 30

What is the most common site of ectopic pregnancy?

Answer 30

Ampulla

Question 31

What are the blood and nerve supply of the bladder?

Answer 31

BS: Superior vesical arteries
NS: Vesical plexus

Question 32

What aer the boundaries of the pelvic inlet?

Answer 32

Anterior = pubic symphysis, superior pubic rami

Posterior = sacral promontory, sacral alae

Lateral = Linea terminalis

Question 33

What is the most important part of the pelvic inlet?

Answer 33

Obstetrical conjugate: shortest distance between the sacral promontory & symphysis pubis

Question 34

What is the normal obstetrical conjugate?

Answer 34

DC - 1.5 to 2cm

Question 35

What are the diff types of pelvis?

Answer 35

Gynecoid = most round shape (50% of women)
Platypelloid = longer transverse diameter
Anthropoid = Longer anteropposterior diameter
Android = heart-shaped pelvis