Maternal Anatomy Flashcards by joseph dizon

Langer lines a low transverse incision like

Pfannenstiel or bikini cut

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Superficial fatty layer
Continues onto the perineum to provide fatty substance to the mons pubis and labia majora and then blend with the fat of the ischioanal fossa

Camper fascia

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Deeper membranous layer

Scarpa fascia

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Scarpa fascia continues inferiorly onto the perineum as

Colles fascia

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Fibrous aponeurosis of the muscles form the primary fascia of the anterior abdominal wall which fuse in the midline as

Linea alba

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Abnormally wide separation may reflect

Diastasis recti or hernia

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Rectus sheath

Construction of this varies above and below a boundary called

Arcuate line

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Rectus sheath

Invest the rectus abdominis bellies on both the dorsal and ventral surfaces

Cephalad

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Rectus sheath

Lie ventral and superficial to the rectus abdominis muscle

Caudal

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Supplies the skin and subcutaneous layers

Femoral artery

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Femoral artery branches out to the

Superficial epigastric
Superficial circumflex iliac
Superficial external pudendal arteries

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Supplies the muscles and fascia

External iliac vessels

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External iliac vessels branches out to the

Inferior deep epigastric vessels

Deep circumflex iliac vessels

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Lacerated during Maynard incision for CS delivery

Inferior epigastric artery

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Hasselbach triangle

Lateral - inferior epigastric vessels
Inferiorly - inguinal ligament
Medially - lateral border of the rectus muscle

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Hernias direct

Hasselbach triangle

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Hernias indirect

Deep inguinal ring lateral to the hasselbach triangle

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Innervation

Anterior abdominal wall is innervated by the

Intercostal (T7-11)
Sub costal (T12)
Illiohypogastric and illioingunal (L1)

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Innervation

Provide sensation to the skin over the suprapubic area

Illiohyphogastric nerve

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Innervation

Supplies the skin of the mons pubis, upper labia majora and medial upper thigh

Illioingunal nerve

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Innervation

Level of the umbilicus

T10 dermatome

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Includes all structure visible externally from the symphysis pubis to the perineal body.

Pudenda or vulva

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Fat filled cushion overlying the symphysis pubis covered by curly hair after puberty that form the escutcheon

Mons pubis/ mons veneris

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Mons pubis shaped in men and women

Triangle - F

Diamond - M

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Homologous with the male scrotum

Labia majora

Labia majora Posteriorly

Form posterior commisure

Labia majora Abundant

Apocrine Eccrine Sebaceous gland

Labia majora Supplies with a rich venous plexus which commonly develops

Varicosities during pregnancy

Thin tissue fold that lies medial to each labia majora

Labia minora

Labia minora Homologous in male

Ventral shaft of penis

Labia minora Superiorly and divides into 2 lamellae

Lower: clitoris Upper: prepuce

Labia minora Inferiorly

Fourchette

Labia minora Size

Width - 1-5 cm | Length - 2-10cm

Labia minora Composed of connective tissue with

Nemerous vessels Elastin fibers Very few smooth muscle fibers

Labia minora Epithelium outer

Thinly keratinized stratified squamous

Labia minora Inner epithelium

Same as outer up to the hart line which is covered by non keratinized squamous epithelium

Labia minora Lacks of

Hair follicle Eccrine Apocrine

Principal female erogenous organ

Clitoris

Clitoris Homologous in male

Penis

Clitoris Size

2 cm in length

Clitoris Composed of

Glans - stratified squamous epi Corpus - contain 2 corpora cavernosa 2 crura

From embryonic urogenital membrane

Vestibule

Vestibule Almond shaped area enclosed by

Lateral: hart line Medial: external surface of the hymen Anterior: clitoral frenulum Posterior: Fourchette

Vestibule Openings

Urethra Vagina 2 bartholin glands Scene glands

Vestibule Posterior portion between the Fourchette and vaginal opening is called

Fossa navicularis | Usually observed in nulliparas

Membrane of varying thickness that surrounds the vaginal opening more or less completely

Hymen

Hymen Epithelium

Non keratinized stratified squamous epithelium

Rare malformation in which the vaginal orifice is occluded

Imferporate hymen

Musculo membranous tube that extends to the uterus and is interposed lengthwise between the bladder and the rectum.

Vagina

Vagina Anterior Separated from the bladder and urethra by connective tissue

Vesiculovaginal septum

Vagina Posterior Between the lower portion of the vagina and rectum

Rectovaginal septum

Vagina Upper 1/4 is separated from the rectum bt the

Recto uterine poutch or cul de sac or pouch of Douglas

Vagina Upper end is subdivided into

Anterior Posterior 2 lateral fornices by the cervix

Vagina Lining

Non keratinized stratified squamous epithelium and underlying lamina propia.

Vagina In premenopausal women, the lining is thrown into numerous thin transverse ridges

Rugae

Vagina Blood supply proximal

Cervical branch of the uterine a and vaginal a

Vagina Blood supply posterior

Middle rectal a

Vagina Lymphatics

Lower 1/3 and vulva - inguinal lymphnodes Middle 1/3 - internal iliac nodes Upper 1/3 - external, internal and common iliac nodes

Diamond shape area between the thighs

Perineum

Perineum boundaries

Anterior: pubic symphysis Anterolateral : ischiopubic rami and ischial tuberosities Postero lateral: sacrotuberous ligaments Posterior: coccyx

Fibromascular mass found in the midline at the junction between anterior and posterior triangle

Perineal body (central tendon of the perineum)

Deep to the anterior and posterior triangles | Support to the pelvic viscera

Pelvic diaphragm

Pelvic diaphragm composed of

Levator ani Pubococcygeus Puborectalis Illococcygeus

More commonly damaged and may predispose women to pelvic organ prolapse or urinary in continence

Pubovisceral muscle

Pubovisceral muscle contains

Pubovaginalis Puboperinealis Puboanalis

Posterior triangle contains

Ischioanal fossae Anal canal Anal sphincter complex

Two fat filled wedge shaped spaces found on either side of the anal canal, comprise the bulk of the posterior triangle

Ischioanal fossae

Superficial space of the anterior triangle contains

``` Bartholins glands Vestibular bulbs Clitoral body and crura Pudendal vessels Ischiocavernosus Bulbocavernosus ```

Superficial space of the anterior triangle Lateral

Ischial tuberosities

Superficial space of the anterior triangle Posterior

Superficial transverse perineal

Superficial space of the anterior triangle bounded deeply by the

Perineal membrane | Colles fascia

Colles fascia Lateral

Pubic rami and fascia lara of the thigh

Colles fascia Medial

Urethra Clitoris Vagina

Extends up into the pelvis | Contains portion of the urethra and vagina

Deep space of the anterior triangle

Anal canal Epithelium

Columnar at the uppermost portion | Simple stratified squamous after

Anal canal Outer layer contains

Pubo recitals muscle Cephalad External anal sphincter caudal

Anal canal Venous engorgement within the cushions

Hemorrhoids

Hemorrhoids Arise distal to the pectinate line

External

Hemorrhoids Above dentate line

Internal

Uterus In non pregnant

Between bladder and rectum

Uterus Posterior wall covered by

Serosa (visceral peritoneum)

Uterus Fold of peritoneum between the lower portion of the posterior wall of the uterus and the rectum

Pouch of Douglas

Pouch of Douglas contains

Body/corpus Cervix Isthmus

Uterus Union of the body and the cervix

Isthmus

Uterus At the superolateral margin from which the Fallopian tube emerges

Uterine Cornu

Fusiform and open of each end by small apertures

Cervix

Cervix Lies above the vaginas attachment to the cervix, lower cervical portion protrudes here

Portio vaginalis

Cervix Posterior

Peritoneum

Cervix Lateral

Cardinal ligaments

Cervix Extension to the external os and is lined by SSNK

Ectocervix

Blue tint d/t increased vascularity

Chadwick sign

Cervical edema d/t softening

Goodell sign

Isthmic softening

Hegar sign

Smooth muscle bundles united by connective tissue containing many elastic fibers

Myometrium

Lines the uterine cavity | Composed of overlying epithelium invagination glands and a supportive vascular stroma

Endometrium

Endometrium layers

Functionalis - sloughed with menses | Basalis - regenerate the functionalis after menses

Gubernaculum testis | Originates below and anterior to the origin of the Fallopian tube

Round ligaments

Two wings like structure that extend from the lateral uterine margins to the pelvic side walls

Broad

Thick base of the broad ligament Medially united firmly to the uterus and upper vagina

Cardinal (transverse cervical/mackenrodt ligament)

From postero lateral attachment to the supravaginal portion of the cervix and inserts into the fascia of the sacrum Form lateral boundaries of the pouch of Douglas

Uterosacral

Lymphatic

Myometrium - lymphatic plexus Cervix- hypogastric plexus Body- internal iliac nodes, peri aortic nodes

Innervation Symphatetic - uterovaginal plexus of the frankenhauser

Uterus Bladder Upper angina T11-12

Innervation Sensory S2-4

Cervix, upper birth canal

Innervation Pudendal nerves

Lower birth canal

Ovaries Size

2.5-5cm in length

Ovaries Position

Upper part of the pelvic cavity in a slight depression on the lateral wall of pelvis

Ovaries Between exterior and interior iliac vessels

Ovarian fossa of waldeyer

Ovaries ``` Outermost smooth portion Dull white surface Tunica albuginea Oocytes Cuboidal ```

Cortex

Ovaries Central Loose connective tissue Large arteries Small smooth muscle

Medulla

Ovaries Supplied by

Sympa- ovarian plexus | Para- vagus

Ovaries Sensory afferent

T10

Oviducts | Serpentine tubes

Fallopian tubes

Fallopian tubes Most proximal Embodied within the uterine muscle wall

Interstitial

Fallopian tubes 2-3 cm Adjoins the uterus and widens gradually into

Isthmus

Fallopian tubes 5-8mm more lateral Lumen is occupied almost completely by arborescent mucosa

Ampulla

Fallopian tubes Funnel shape fimbriated distal extremity which opens into the abdominal cavity

Infundibullum

Isthmus, ampulla and infundibullum are covered by the

Mesosalpinx

Fallopian tubes Outer single mesothelium layer functioning as visceral peritoneum

Mesosalphinx

Fallopian tubes Smooth muscle arranged in an inner circular and an outer longitudinal layer

Myosalphinx

Fallopian tubes Single columnar tubular mucosa epithelium in close contact with myosalphinx

Endosalphinx

Orientation of dermal fibers within the skin arranged transversely

Langer lines