1. Chapter 2 Review Williams Obstetrics Felicia Katz 8/10/11
Maternal Anatomy
Chapter 2 Review
Williams Obstetrics
Felicia Katz
8/10/11

2. Anterior Abdominal Wall
Langer lines: transverse incisions have less tension, better cosmesis.
Camper’s and scarpa’s: find pictures?

3. Rectus sheath: below arcuate line two layers: internal oblique and external oblique

4. Above arcuate line: fascia in three layers (internal oblique layer splits into two)

6. Blood Supply Femoral artery branches External Iliac branches
Superficial epigastric
External pudendal
Supply skin and subcutaneous tissue over lower abdominal wall and mons
External Iliac branches
Inferior epigastric vessels
Supply muscles and fascia of lower abdominal wall
Superficial epigastric vessels encountered when performing pfannenstiel incisions

7. Innervation T7-12 Ilioinguinal (L1) Iliohypogastric (L1)
Skin of lower abdominal wall, upper portion of labia majora, and inner thigh
Iliohypogastric (L1)
Skin over suprapubic area
Course between layers of rectus sheath lateral to rectus muscle
Picture of dermatomes and nerve course

8. External Genitalia
Labia majora: outer surface with hair, inner surface hairless with sebaceous glands; dense connective tissue with venous plexus – pregnancy hemorrhoids
Labia minora: non-keratinized beyond “Hart line”; numerous sebaceous glands

9. Vagina Non-keratinized squamous epithelium, smooth muscle layer
Upper 1/3 mullerian derived
Lower 2/3 urogenital sinus derived
Lubricated by transudate across subepithelial capillary plexus

10. Vascular Supply
Proximal portion supplied by cervical branch of uterine artery
Remainder by vaginal artery (variable origin)
Lower third and vulva lymphatics drain to inguinal nodes; remainder iliac nodes

11. Anterior and Posterior Triangles
Bulbocavernosus muscles aid in clitoral erection
Vestibular bulb corresponds to corpus spongiosum of penis = aggregate of veins; may rupture to result in vulvar hemorrhage during childbirth; closed fascial compartment
Posterior: no fascial separation between right and left fossae: infection and malignancy can spread bilaterally
Pudendal artery

12. Anus
IAS: constant resting tone for fecal continence; may be torn with 4th deg lacs
Anal cushions: venous plexus; cause of hemorrhoids
Dentate line: external hemorrhoids painful 2/2 innervated stratefied squamous epithelium

13. Uterus Posterior aspect covered by visceral peritoneum (serosa)
Lower portion of anterior wall adjacent to bladder (dissected during c/s)
Nulliparous 6-8cm; multiparous 9-10cm
Majority of muscle fibers located at fundus, and at anterior and posterior walls as compared to lateral walls
Innervation
T11/T12 transmit pain sensation from contractions
Pudendal nerve transmits pain from lower vagina and skin
Figure 2.8, figure 2.15

16. Cervix Squamous epithelium on ectocervix
Columnar epithelium on endocervix
Pic of cerivx

17. Endometrium

18. Ligaments

19. Blood Supply

20. Blood Supply Uterine artery Ovarian artery Branch of internal iliac
Courses along base of broad ligament toward cervix then branches in two and runs along uterine wall
Crosses over ureter 2cm from cervix
Ovarian artery
Direct branch from aorta
Enters broad ligament through IP ligament
Anastamoses with branch of uterine artery
Fig 2.15

21. Pelvic Bony Anatomy
Figure 2.19

22. Pelvic Inlet Posterior boundary = sacral promontory
Anterior boundary = pubic symphysis
Lateral boundary = linea terminalis
Measure adequacy of inlet via the obsetrical conjugate (subtract 1.5-2cm from diagonal conjugate)

23. Pelvic inlet
Fig 2.20, fig 2.21

24. Mid-Pelvis
Ischial spines (10cm)
Fig 2.22

25. Outlet Posterior boundary = coccyx Anterior boundary = pubic arch
Fig 2.25

26. Pelvis Types
Fig 2.24

27. Pelvic Floor
Fig 2.24 and 2.25