LABOUR ANATOMY Flashcards
What is the divide between the pelvis and perineum?
the levator ani muscle
Which type of nerve allows for uterine “cramping”?
hormonal (sympathetic/parasympathetic)
Which type of nerve allows for pelvic floor contraction eg during sneezing?
somatic motor
Which types of pain in the reproductive system are carried by visceral afferents?
pain from pelvis
- adnexae
- uterus
- vagina
Which types of pain in the reproductive system are carried by somatic sensory?
pain from perineum
- vagina
describe pelvic pain pathway for pelvic organs which touch the peritoneum
visceral afferents run along sympathetic nerves and enter the spinal cord at T11-12
Where does a patient feel superior pelvic pain?
suprapubic
describe pelvic pain pathway for pelvic organs which are inferior to the peritoneum
visceral afferents run along parasympathetic nerves and enter spinal cord at S2, 3 and 4
Where does a patient feel inferior pelvic pain?
perineum (S234 dermatome)
describe perineal pain pathway
somatic sensory supplied by pudendal nerve, enters spinal cord at S234
Where does a patient feel perineal pain?
localised pain within perineum
Which pelvic organs touch the peritoneum?
uterine tubes, uterus and ovaries
Which pelvic organs are inferior to the peritoneum?
cervix and superior vagina
Give 3 types of anaesthesia for female reproductive system
- spinal block via lumbar puncture
- caudal epidural block
- pudendal nerve block
What is blocked in
a) spinal anaesthesia
b) epidural anaesthesia
c) pudendal nerve block
a) waist down (intraperitoneal, subperitoneal and somatic areas)
b) sub-peritoneal plus somatic areas innervated by pudendal nerve
c) area innervated by pudendal nerve (just somatic)
Where are spinal and epidurals administered?
L3-L4
In a spinal anaesthetic what does the needle pass through?
supraspinous ligament interspinous ligament ligamentum flavum epidural space dura mater arachnoid mater subarachnoid space
In an epidural anaesthetic what does the needle pass through?
supraspinous ligament
interspinous igament
ligamentum flavum
epidural space
significance of pudendal nerve
it is the somatic motor and somatic sensory nerve of perineum
Anatomy of pudendal nerve block
the pudendal nerve crosses the lateral aspect of the sacrospinous ligament and the ischial spine can be used as a landmark to administer
When is a pudendal nerve block used?
Labour (forceps delivery or painful vaginal)
Repairing a tear or episiotomy
What damage can occur during labour?
stretching of pudendal nerve branches
levator ani or external anal sphincter can be torn
clinical significance of damage to structures due to perineal tearing
weakened pelvic floor or faecal incontinence
Why is an episiotomy performed?
an incision is made into the relatively safe fat filled ischioanal fossa to avoid tear into the rectum
