MATERNAL ANATOMY Flashcards by Zea Pineda

A 30 year old Primi recently had a CS -Pfannensteil for prolonged labor. A month later, she claims that there is a feeling of numbness in the hypogastric area extending down the inner aspect of her thigh. Which of the ff nerves may have been damaged during the operation?

a. Sciatic nerve
b. Femoral nerve
c. Illioinguinal nerve
d. Illiohypogastric Nerve

c. Illioinguinal nerve

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Which organ corresponds to the penis of the male reproductive system?

a. Clitoris
b. Vestibule
c. Labia majora
d. Labia minora

a. Clitoris

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Bartholin’s gland opens into the?

a. Fallopian tubes and release secretion which makes sperms motile
b. Uterus and release a lubricating fluid during the birth of young ones
c. Urinary bladder and assist in the release of urine
d. Vestibule and release a lubricating fluid in the vagina

d. Vestibule and release a lubricating fluid in the vagina

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What is the main uterine support?

a. Round ligament
b. Infundibulo-pelvic ligament
c. Cardinal ligament
d. Uterosacral ligament

a. Round ligament

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After ovulation, the Graafian follicle becomes endocrine organ called?

a. Fibrin
b. Ovarian tube
c. Globulin
d. Corpus luteum

d. Corpus luteum

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The opening of the infundibulum into the cavity isa called?

a. Isthmus
b. Ampulla
c. Ostium
d. Thalamus

a. Isthmus

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The subcutaneous layer is composed of

Camper fascia

Scarpa fascia

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Superficial, fatty, continues to mons pubis and labia majora, ischianal fossa

Camper fascia

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Deeper membranous tissue

Scarpa fascia

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Scarpa fascia continues onto the perineum as

Colles fascia

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Fat filled cushion overlying the symphysis pubis; covered by curly hair

Mons pubis

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> Covered with hair, apocrine, eccrine and Sebaceous glands
Round ligaments terminate at their upper border
Nearly void of muscles but rich in elastic fibers and fat
Rich venous plexus may develop varicosities from increased venous pressure created by the enlarging uterus

Labia majora

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Lack hair follicles, eccrine and apocrine gland but with sebaceous glands

Labia minora

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Principal erogenous organ

Clitoris

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Blood supply of clitoris

Internal pudendal artery branches

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6 openings or Vestibule in the vagina

Urethra
Vagina
Bartholin gland / Greater vestibular duct (2)
Skene glands (2)

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Diamond shaped area between the thighs

Perineum

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Contents of the Superficial space of The anterior triangle

Bartholins glands
Vestibular bulbs
Clitoral body and Crura
Branches of pudendal vessels and Nerve
Ischiocavernosus
Bulbospongiosus
Superficial transverse perineal muscle

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Help maintain clitoral erection by compressing the crus to obstruct venous drainage

Ischiocavernosus

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Constrict the vaginal lumen and aid release of secretions from the Bartholin glands.
Also contribute to clitoral erection by compressing the deep dorsal vein of the clitoris

Bulbospongiosus

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May be attenuated or even absent, but when present, contribute to the perineal body

Superficial transverse perineal muscle

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Continuous superiorly with the pelvic cavity

Deep space of the Anterior triangle

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Contents of the Deep space of Anterior triangle

Portions of urethra
Vagina
Internal pudendal artery branches
Muscles of urogenital sphincter complex

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Supplies constant tonus and provides emergency reflex contraction to sustain continence

Urogenital Sphincter complex

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Formed from the anterior rami of spinal nerves S2-4

Pudendal nerve

Serves as landmark in pudendal nerve block

Ischial spine

Provides support to the pelvic viscera

Pelvic diaphragm

Pelvic diaphragm is composed of:

Levator ani | Coccygeus muscle

Avulsion of Levator ani leads to

Pelvic organ prolapse

Provide fecal continence | May be involved in 3rd and 4TH degree lacerations during vaginal delivery

Anal sphincters

Types of Anal sphicters

External anal sphincter | Internal anal sphincter

- Striated muscle - Maintains a constant resting contraction to aid continence - Provides additional squeeze pressure when continence is threatened - Relaxes for defacation

External anal sphincter

- Smooth muscle - Contributes to the bulk of anal canal resting pressure for fecal continence - Relaxes prior to defacation

Internal anal sphincter

Orientation of dermal fibers within the skin and arranged transversely

Langer lines

Abnormal wide separation of linea alba (>15mm)

Diatasis recti or Hernia

Components of Hasselbach triangle

``` Inguinal ligament (inferior) Rectus abdominis (medial) Inferior epigastric artery (lateral) ```

Type of hernia which protrudes through the abdominal wall

Direct hernia (medial)

Type of hernia which protrudes through deep inguinal ring, which is lateral to the triangle and then may exit out to superficial inguinal ring

Indirect hernia (lateral)

Nerve which may be severed during Pfannensteil incision

``` Intercostal nerve (T7-11) Subcostal nerve (T12) ```

Nerve targeted in regional anesthesia

Umbilicus (T10)

Nerve which may be severed during a low transverse incision or entrapped during closure

Iliohypogastric and Ilioinguinal nerve (L1)

Location of Ilioinguinal nerve

Mons pubis, Upper labia majora, Medial upper thigh

Location of Iliohypogastric nerve

Skin over the suprapubic area

Curly hair after puberty located in the mons pubis

Triangular escutcheon

Principal female erogenous organ | Homologous to penis

Clitoris

3 erectile tissue

2 Corpora cavernosa | 1 Corpus spongiosa

Homologous to scrotum

Labia majora

Homologous to ventral portion of penis or skin of the penis

Labia minora

Epithelial lining of outer Labia majora

Keratinized stratified squamous

Epithelial lining of the inner Labia majora

Non keratinized stratifies squamous

Epithelial lining of Labia minora

Non-KSS

- Almond shape | - From embryonic urogenital membrane

Vestibule

Boundaries of vestibule

Anterior - Clitoris Posterior - Fourchette Medial - Hymen Lateral - Hart line

During 1st coitus, it is the one that first ruptures usually at the 6 o'clock position

Hymen

Epithelial lining of hymen

Non-KSS

Remnants of the adult female hymen

Caruncle multiformes

Glandular structure under the vestibule

Periureteral/Skene's glands | Vulvovaginal/Bartholin's glands

Another name for Paraurethral or Skene's glands

Lesser vestibular glands

Another name for Vulovovaginal or Bartholin's glands

Greater vestibular glands

Homologous to prostate

Paraurethral or skene's gland

Homologous to bulbourethral gland

Vulvovagina or Bartholin's gland

Paraurethral or skene's gland type of gland

Tubo-alveolar

Vulvovagina or Bartholin's gland type of gland

Compound alveolar or Compound acinar

Paraurethral or skene's gland location

Adjacent to urethra

Vulvovagina or Bartholin's gland location

4 and 8 o 'clock

- Vulvovagina or Bartholin's gland pathology | - common site of infection

Bartholin's cyst or abscess

Membrane of varying thickness that surrounds the vaginal opening

Hymen

The hymen transforms into several modular various types

Hymeneal or misinform caruncles

The lower portion of vagina is _______ | while the upper portion is _______

- Constricted | - Capacious

Vagina extends from

vulva to cervix

Length of anterior vagina

6-8 cm

Length of posterior vagina

7-10 cm

Separating the vagina from anterior structures such Bladder and Urethra

Vesicovaginal septum

Separating the vagina from posterior structure, rectum

Rectovaginal sptum

Upper fourth vaginal septum from the rectum

Rectouterine pouch/cul de sac/pouch of douglas

(+) infection or pus in the pouch of douglas

suspect Ectopic pregnancy

Blood supply of Upper 1/3 of the vagina

Cervicovaginal branch of the uterine artery

Nerve supply of the Upper 1/3 of the vagina

hypogastric plexus

Support for the Upper 1/3 of the vagina

Upper cardinal ligament and Parametria

Related structures to the upper 1/3 of the vagina

Bladder and ureters

Blood supply of the middle 1/3 of the vagina

Inferior vesical artery

Lymphatics of the middle 1/3 of the vagina

External and Internal iliac nodes

Nerve supply of the middle 1/3 of the vagina

s3-s4

Support for the middle 1/3 of the vagina

Levator ani and Lower cardinal ligament

Related structures to the middle 1/3 of the vagina

Vesical neck and trigone, Rectum, Levators

Blood supply of the Lowe 1/3 of the vagina

Middle rectal and Internal pudendal artery

Lymphatics of the Lower 1/3 of the vagina

Inguinal nodes

Nerve supply of the Lowe 1/3 of the vagina

Pudendal nerve

Support of the lower 1/3 of the vagina

Urogenital and Pelvic diaphragm

Related structures of the lower 1/3 of the vagina

Urethra and Perineal body

Diamond shape are between the thighs

Perineum

Boundaries of the Perineum

Anterior: Pubic symphysis Anterolateral: Ischiopubic rami and Ischial tuberosities Posterolateral: Sacrotuberous ligaments Posterior: Coccyx

Anterior triangle aka:

Urogenital triangle

Posterior triangle aka:

Anal triangle

Blood supply of the perineum

Internal pudendal artery

Branches of the internal pudendal artery

1. Inferior rectal artery | 2. Posterior labial artery

3 parts of External anal sphinter

1. Main body 2. Subcutaneous sphincter 3. Wing-shaped end

Blood supply of the External anal sphincter

Inferior rectal artery

___ degree in the Extrenal anal sphincter is involved in perineal laceration

3rd

___ degree in the Internal anal sphincter is involved in Perianal laceration

4th

Helps maintain clitoral erection

Ischiocavernosus muscle

Constrict the vaginal lumen and aid in the release of secretion of Bartholin's gland

Bulbocavernosus muscle

Contributes to the Perineal body

Superficial transverse perineal muscles

- A type of Episiotomy which involves Bulbocavernosus and Transverse perineal muscle - Commonly used - More prone to hematoma

Mediolateral episiotomy

- A type of episiotomy which involves perineal bodies and rectal fossa - Affectation less muscle involve - Easy to repair

Midline or Medial episiotomy

1st degree affectation of Episiotomy

Skin and Subcuataneous

2nd degree affectation of episiotomy

1st degree + Muscle

3rd degree affectation of Episiotomy

2nd degree + External sphincter

4th degree affectation of Episiotomy

Rectal fossa

Site for pudendal block

Anterior rami of the 2nd to 4th sacral nerve

Course of Pudendal nerve and vessel

Between pyriformis and coccygeus --> exit through greater sciatic foramen, psoteromedial to ischial spine --> obturator internus muscle --> pudendal cana (alclock canal) --> perineum/3 terminal branches

Landmark for pudendal nerve block

Ischial spine

Nerve that supplies the skin of the clitoris

Dorsal nerve of the clitoris

Nerve that supplies external anal sphincter, mucus membrane of the anal canal, perineal skin

Inferior rectal nerve

Thick-walled, hollow, muscular organ

Uterus

Location of the uterus of a non-pregnant woman

Lies in the pelvic cavity between the bladder anteriorly and rectum posteriorly

Almost the entire posterior wall of the uterus is covered by

Serosa or perineum

Cervical canal is fusiform and is open at each end by small apertures:

Internal os and External os

Blood supply of the uterus

Uterine and ovarian artery

Size of a nulliparous uterus

6-8 cm, 50-70g

Size of multiparous uterus

9-10 cm, >80 g

Lower uterine portion

isthmus

Posterior wall of the uterus is completely covered by

Visceral peritoneum

Area of the cervix wherein sample for pap smear is obtained from

Transformation zone

Nerve supply of the anterior abdominal wall

1. Intercostal 2. Subcostal 3. Illiohypogastric 4. Illioinguinal

Anterior rami of thoracic spinal nerves

Intercostal and Subcostal nerve

Space used for postCS analagesia blockade

Transversus abdominis plane

Anterior branches of Intercostal and Subcostal nerve may be severed during

Pfannenstiel incision

- Anterior rami of 1st lumbar nerve | - Carry sensory info

Iliohypogastric and Ilioinguinal

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

Ilioinguinal nerve

___ dermatome approximates the umbilicus

T10

Vulva is also known as

Pudenda

Innervation of the vulva

Pudendal nerve

Curly hair in the mons pubis

Triangular escutcheon

Lower lamellae of the labia minora fuse to form

Frenulum of the prepuce

Upper lamellae of the labia minora fuse to form

Prepuce

Labia minora approach the midline and join to form

Fourchette

Covering of the outer surface of each labium

Keratinized stratified squamous

Demarcating line

Hart line

MATERNAL ANATOMY Flashcards

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