Maternal anatomy Flashcards by Sam James

importance of langer lines

They describe the orientation of dermal fibers within the skin.

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langer lines in the anterior abdominal wall are arranged

transversely

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Pfannenstiel is a

low transverse incision that follows the langer lines of the anterior abdominal wall

which leads to superior cosmetic results

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the subcutaneous layer of the anterior abdominal wall can be separated into

Camper fascia - superficial fatty

Scarpa -deeper membranous

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campe fascia continues onto the perineum to provde fatty substance to the

mons pubis and labia majora and then bled with the fat of the ischioanal fossa

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Scarpa fascia continues inferiorly onto the perineum as

colles fascia

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Importance of scarpa’s fascia

perineal infection or hemorrhage superficial to colles fascia has the ability to extend upward to involve the superficial layers of the abdominal wall

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anterior abdominal wall consist of the

midline rectus abdominis
pyramidalis muscles
external oblique
internal oblique
transversus abdominis muscles

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what form the primary fascia of the anterior abdominal wall

fibrous aponeuroses of external oblique, internal oblique and transversus abdominis

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fibrous aponeuroses of external oblique, internal oblique and transversus abdominis
fused in the

midline at the linea aba

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linea alba measures

10-15 mm wide below the umbilicus

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abnormally wide separation at the linea alba may reflect

diastasis recti or hernia

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the three aponeuroses also invest the rectus abdominis as

rectus sheath

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the construction of the rectus sheath varies above and below a boundary called

arcuate line

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cephalad to the arcuate line

the aponeuroses invest the rectus abdomnis bellies on both dorsal and ventral surfaces

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caudal to te arcuate line

all aponeuroses lie ventral or superficial to the rectus abdominis muscle

only the thin transversalis fascia and peritoneum lie beneath the rectus

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originate from the public crest, insert into the linea alba

lie atop the rectus abdominis muscle, but beneath the anterior rectus sheath

pubic crest

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These vessels supply the skin and subcutaneous layers of the anterior abdominal wall

superficial epigastric
superficial circumflex iliac
superficial external pundendal

SE + SCI + SEP arteries

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superficial epigastric
superficial circumflex iliac
superficial external pundendal

SE + SCI + SEP arteries
aries from the

femoral artery

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superficial epigastric
superficial circumflex iliac
superficial external pundendal

SE + SCI + SEP arteries

aries from the femoral artery in this area

just below the inguinal ligament

within the femoral triangle

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from their origin, course diagonally toward the umbilicus

with incision, identified at a depth halfway between skin and anterior rectus sheath, above scarpa fascia, several centimeters from midline

superficial epigastric vessels

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inferior “deep” epigastric vessels
and
deep circumflex iliac vessels

IDE, DCI

are branches of the

external iliac vessels

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supply the muscles and fascia of the anterior abdominal wall

inferior “deep” epigastric vessels
and
deep circumflex iliac vessels

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what incision may lacerate inferior epigastric artery during muscle transection

Maylard incision during cesarean delivery

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what happens when an inferior epigastric artery ruptures following abdominal trauma

rectus sheath hematoma

Hesselbach triangle bounded

laterally by - inferior epigastric vessels inferiorly - inguinal ligament medially- lateral border of rectus muscle

Hernias the protrude through the abdominal wall in Hesselbach triangle are termed

direct inguinal hernias

indirect inguinal hernias protrude through the

deep inguinal ring

deep inguinal ring lies ____ to the hesselbach triangle

lateral

the anterior abdominal wall is innervated by

``` intercostal nerves (T7-11) subcostal nerve (T12) iliohypogastric ilioinguinal nerves (L1) ```

what is the transversus abdominis plane

the intercostal and subcostal nerves (anterior rami of thoracic spnal narves) run along lateral then anterior abdominal wall between the transveres abdominis ad internal oblique muscles

why is there a risk of severing intercostal and subcostal nerves during a pfannenstiel incision

because these nerves (intercostal and subcostal nerves) pierce the posterior sheath, rectus muscle and then anterior sheath to reach the skin. they may be severed dat the point in which the overlying anterior rectus sheath is separated from the rectus muscle

iliohypogstric and ilioinguinal original from the anterior ramus of the

first lumbar spinal nerve

iliohypogastric and ilioinguinal nerves emerge lateral to this muscle

psoas muscle

emerge lateral to the psoas muscle, travel retroperitoneally across the quadratus lumborum inferiomedially toward the iliac crest

iliohypgastric and ilioinguinal nerves

near the iliac crest the iliohypogastric and ilioinguinal nerves pierce the

transversus abdominis musle and course ventrally

IH and II | at a site 2-3 cm medial to aSIS, the nerves pierce this muscle

internal oblique muscle and course superficial to it toward the midline

perforates the external oblique aponeurosis near the lateral rectus border to provide sensation to the skin over the suprapubic area

iliohypogastric nerve

superficial inguinal ring formes by splitting of

external abdominal oblique aponeurosis fbers

this nerve supplies the skin of mons pubis, upper labia majora, and medial upper thigh

ilioinguinal nerve

these nerves can be severed during a low transverse incision or entrapped during closure, especially if incisions extend beyond the lateral borders of rectus musle

ilioinguinal and iliohypogastric nerves

injury to ilioinguinal and iliohypogastric leads to

loss of sensation within the areas supplied (skin of suprapubic area, mons pubis, upper labia majora, medial upper thigh) rarely chronic pain may develop

dermatome that approximates the level of the umbilicus

T10 dermatome

regional anesthesia for CS delivery or for puerperal sterilization ideally blocks at what dermatomal levels

T10- L1 levels

can provide broad blockade to the intercostal and subcostal nerves

transversus abdominis plane block

block that may be placed postcesarean to reduce analgesia requirements

transversus abdominis plane

pudendsa commonly designated as the

vulva

pundenda (vulva) includes

all structures visible externally from the symphysis pubis to the perineal body 1. mons pubis 2. labia major 3. labia minora 4. clitoris 5. hymen 6. vestibule 7. urethral opening 8. greater vestibular or bartholin glands 9. minor vestibular glands 10. paraurethral glands

mons pubis aka

mons veneris

fat filled cushion overlying the symphysis pubis

mons pubis

after puberty the mons pubis is covered by curly hair that forms the

escutcheon

labia majora is homologous with the

scrotum

round ligaments terminate at the

upper borders of the labia majora

labia majora are contiguous superiorly with the

mons pubis

posteriorly the labia majora taper and merge into the area overlying the perinel body to form the

posterior commisure

glands abundant in the labia majora

apocrine, eccrine, sebaceous glands

labium minus is homogous to

ventral shaft of penis

the lower lamellae of the labia major fuse to form the

frenulum of the clitoris

the epithelia of the labia minor is covered by keratinized stratified squamous epithelium up to this demarcating line

hart line -medial to this is nonkeratinized squamous epithelium

labia minor contains this glands

sebaceous glands

principal female erogenous organ

clitoris

erectile homologue of the penis

clitoris

clitoris is composed of a

glands, corpus, 2 crura

usually less than 0.5 cm in diameter, is covered by stratified squamous epithelium, and is richly innervated.

glans

clitoral body contains

2 corpora cavernosa

clitoral blood supply stems from the

internal pudendal artery (deep artery)

supplies the clitoral body

deep artery of the clitoris (internal pudendal)

suplies the glands and prepuce

dorsal artery of the clitoris (internal pudendal artery)

this is the functionally mature female structure derived from the embryonic urogenital membrane

vestibule

almond shaped area enclosed by the hart line (laterally) | and external surface of the hymen (medially)

verstibule

largest paraurethral glands

skene glands

6 openings of the vestibule

urethra, vagina, 2 bartholin gland ducts, 2 ducts of skene glands

posterior portion of the vestibule between the fourchette and vaginal opening is called

fossa navicularis

fossa navicularies is usually observed only in

nulliparas

bartholin glands position

5 and 7 o clock

are a collective arborization of glands whose multiple small ducts open predominantly along the entire inferior aspect of the urethra

paraurethral glands

2 largest paraurethral glands

skene glands

inflammation and duct obstruction of any of the paraurethral glands can lead to

urethral diverticulum formation

__ part of urethra lie immediately above the anterior vaginal wall

lower 2/3 of urethra

adequate pelvis

inlet: 1. diagonal conjugate - sacral promontory not accessible > = 11.5 cm midpelvis 1. ischial spines not prominent 2. pelvic side walls not convergent 3. sacrum curved outlet 1. intertuberous diameter >8 cm 2. subpubic arch >90

is a rare malformation in which the vaginal orifice is occluded completely causing retention of the menstrual blood

imperforate hymen

over time the hymen transforms into severall nodules termed as

hymeneal or myrtiform caruncles

anteriorly, the vagina is separated from the bladder and urethra by a connectie tissue called

vesicovaginal septum

posteriorly , between the lower portion of vagina and rectum is this connective tissue

rectovaginal septum

upepr 4th of vagina is separated from the rectum by

rectouterine pouch or cul-de-sac or pouch of Douglas

vaginal lining is composed of

nonkeratinized stratified squamous epithelium and underlying lamina propria

vagina is lubricated by

a transudate that originates from the vaginal subepithelial capillary plexus

vaginal blood supply

proximal portion- cervical branch of uterine artery and by | vaginal artery

vaginal artery arise from

uterine or inferior vesical or directly from internal iliac artery

contributes supply to the posterior vaginal walld

middle rectal artery

the distal vaginal walls receive blood supply from

internal pudendal artery

diamond-shapred area between the thighs

perineum

Perineum has boundaries that mirror those of the

pelvic outlet: anterior - pubic symphysis anterolaterally- ischiopubic rami and ischial tuberosities posterolaterally - sacrotuberous ligmanets posteriorly- coccyx

this arbitarary line that divides the perineum is based on this landmark

ischial tuberosities

anterior triangle also called

urogenital triangle

posterior triangle | also called

anal triangle

is a fibromuscular mass found in the midline at the junction between anterior and posterior triangles

perineal body

central tendon of perineum

perineal body

Anterior triangle is divided into superficial and deep spaces by the

perineal membrane

perineal membrane previously known as the

inferior fascia of the urogenital diaphragm

this muscle helps maintain clitoral erection by compressing the crus to obstruct venous drainage

ischiocavernosus muscle

this muscles constrict the vaginal lument and aid in release of secretions from the bartholin glands

bilateral bulbocavernosus muscles

they contribute to clitoral erection by compressing the deep dorsal vein of the clitoris

bulbocarvernosus

pull the clitoris downward

bulbocavernosus and ischiocavernosus

embryologically the vestibular bulbs correspond to ___ of penis

corpora spongiosa

pelvic diaphragm is composed of

levator ani | and coccygeus muscle

levator ani is composed of

pubococcygeus puborectalis iliococcygeus

pubococcygeus also termed

pubovisceral

pubococcygeus is subdivided based on points of insertion

pubovaginalis puboperinealis puboanalis

vaginal birth conveys significant damage to levator ani | of this ____ is more commonly damaged

pubovisceral

risk after vaginal birth damage to levator ani

pelvic organ prolapse or urinary incontinence

clinically, injury to the vessels in the posterior triangle can lead to hematoma formation in the

ischioanal fossa

this distal continuation of the rectum begins at the level of the kevator ani attachment to the rectum and ends at the skin

anal canal

anal canal mucosa consists of columnar epithelium in the uppermost, but at this boundary stratified squamous epithelium begins an continues to the anal verge

dentate or pectinate line

anal cushions (submucosl arteriovenous plexuses) aid in

complete closure of the canal and fecal continence

external hemorrhoids receive sensory innervation from the

inferior rectal nerve

internal hemorrhoids are those that form above the dentate line and covered by

insensitive anorectal mucosa

two sphincters surround the anal canal to provide fecal continence

external and internal anal sphincters

Maternal anatomy Flashcards

(118 cards)