maternal anatomy chapter 2 review williams obstetrics felicia katz 8/10/11
TRANSCRIPT
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Maternal Anatomy
Chapter 2 ReviewWilliams Obstetrics
Felicia Katz8/10/11
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Anterior Abdominal Wall
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Blood Supply
• Femoral artery 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
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Innervation
• T7-12 • Ilioinguinal (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
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External Genitalia
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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
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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
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Anterior and Posterior Triangles
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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
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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
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Cervix
• Squamous epithelium on ectocervix• Columnar epithelium on endocervix
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Endometrium
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Ligaments
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Blood Supply
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Blood Supply
• Uterine 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
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Pelvic Bony Anatomy
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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)
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Pelvic inlet
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Mid-Pelvis
• Ischial spines (10cm)
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Outlet
• Posterior boundary = coccyx
• Anterior boundary = pubic arch
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Pelvis Types
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Pelvic Floor