LABOUR ANATOMY

Question 1

What is the divide between the pelvis and perineum?

Answer 1

the levator ani muscle

Question 2

Which type of nerve allows for uterine “cramping”?

Answer 2

hormonal (sympathetic/parasympathetic)

Question 3

Which type of nerve allows for pelvic floor contraction eg during sneezing?

Answer 3

somatic motor

Question 4

Which types of pain in the reproductive system are carried by visceral afferents?

Answer 4

pain from pelvis

• adnexae
• uterus
• vagina

Question 5

Which types of pain in the reproductive system are carried by somatic sensory?

Answer 5

pain from perineum

- vagina

Question 6

describe pelvic pain pathway for pelvic organs which touch the peritoneum

Answer 6

visceral afferents run along sympathetic nerves and enter the spinal cord at T11-12

Question 7

Where does a patient feel superior pelvic pain?

Answer 7

suprapubic

Question 8

describe pelvic pain pathway for pelvic organs which are inferior to the peritoneum

Answer 8

visceral afferents run along parasympathetic nerves and enter spinal cord at S2, 3 and 4

Question 9

Where does a patient feel inferior pelvic pain?

Answer 9

perineum (S234 dermatome)

Question 10

describe perineal pain pathway

Answer 10

somatic sensory supplied by pudendal nerve, enters spinal cord at S234

Question 11

Where does a patient feel perineal pain?

Answer 11

localised pain within perineum

Question 12

Which pelvic organs touch the peritoneum?

Answer 12

uterine tubes, uterus and ovaries

Question 13

Which pelvic organs are inferior to the peritoneum?

Answer 13

cervix and superior vagina

Question 14

Give 3 types of anaesthesia for female reproductive system

Answer 14

1. spinal block via lumbar puncture
2. caudal epidural block
3. pudendal nerve block

Question 15

What is blocked in

a) spinal anaesthesia
b) epidural anaesthesia
c) pudendal nerve block

Answer 15

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)

Question 16

Where are spinal and epidurals administered?

Answer 16

L3-L4

Question 17

In a spinal anaesthetic what does the needle pass through?

Answer 17

supraspinous ligament
interspinous ligament
ligamentum flavum
epidural space
dura mater
arachnoid mater
subarachnoid space

Question 18

In an epidural anaesthetic what does the needle pass through?

Answer 18

supraspinous ligament
interspinous igament
ligamentum flavum
epidural space

Question 19

significance of pudendal nerve

Answer 19

it is the somatic motor and somatic sensory nerve of perineum

Question 20

Anatomy of pudendal nerve block

Answer 20

the pudendal nerve crosses the lateral aspect of the sacrospinous ligament and the ischial spine can be used as a landmark to administer

Question 21

When is a pudendal nerve block used?

Answer 21

Labour (forceps delivery or painful vaginal)

Repairing a tear or episiotomy

Question 22

What damage can occur during labour?

Answer 22

stretching of pudendal nerve branches

levator ani or external anal sphincter can be torn

Question 23

clinical significance of damage to structures due to perineal tearing

Answer 23

weakened pelvic floor or faecal incontinence

Question 24

Why is an episiotomy performed?

Answer 24

an incision is made into the relatively safe fat filled ischioanal fossa to avoid tear into the rectum

Question 25

Sings of spinal anaesthesia and why

Answer 25

skin of lower limbs looks flushed, warm lower limbs, reduced sweating

–> blockade of sympathetics causes vasodilation

Question 26

Describe the path of the pudendal nerve

Answer 26

exists greater sciatic foramen, passes posterior to sacrospinour ligament, enters pelvis via lesser formaen and travels in pudendal canal where it branches to supply perineal structures