MATERNAL ANATOMY

Ivy Jillane T. Policarpio

Resident physician I
ABDOMINAL WALL
stretches to accommodate
the expanding uterus, and
provides surgical access to
the internal reproductive
organ
 Skin
Langer lines
• Orientation of dermal fibers within the skin
– Vertical skin incisions- sustain increased lateral
tension which result to wider scars
– Low transverse incision(pfannensteil)- follow the
langer lines and lead to superior cosmeticc result
 SUBCUTANEOUS LAYER

• Camper fascia- superficial, fatty layer

• Scarpa fascia- deeper, membranous layer
BLOOD SUPPLY
INNERVATION
EXTERNAL GENETALIA
EXTERNAL GENETALIA
 VESTIBULAR GLANDS
BARTHOLIN’S GLAND PARAURETHRAL GLAND
(MAJOR VESTIBULAR (SKENE’S GLAND)
GLAND) • Arborization of glands
• Pair of small compound whose ducts open
structures 0.5 to 0.1cm predominantly along
diameter the entire inferior
• Located at 5 and 7 aspect of the urethra
o’clock position • Located on either side
• Secretes mucoid material of the urethra
during sexual arousal
VASCULAR SUPPLY
PERINEUM
Boundaries:
• Anterior:symphysis pubis

• Anterolaterally:
ischiopubic rami and
ischial tuberosities

• Posterolaterally:
sacrotuberous ligamnets

• Posterior: coccyx
TRIANGLE
 PUDENDAL NERVE
•formed from the anterior rami s2 through s4
•ischial spine: easily identifiable landmark for anesthetic
infiltration

3 terminal branches:
a.Dorsal nerve of the clitoris  supplies the skin of clitoris
b.Perineal nerve  muscles of the anterior traingle and
labial skin
c.Inferior rectal branch external anal spinchter, the
mucosa membrane of the anal canal and the perianal skin
ANUS
 PERINEAL BODY
• Central tendon of the perineum which
provide support
• Point on which the bulbocavernosus,
superficial transverse perineal muscles and
externa anal sphincters coverge
UTERUS

• SIZE AND SHAPE:

Pyriform or pear shaped

• Fundus: convex upper

segment between points
of insertion of FT
POSITION OF UTERUS
• ANTEFLEXION
– The body of the uterus is
normally bent anteriorly
on the cervix
• ANTEVERTED
– The axis of the cervix is
likewise bent forward on
the axis of the vagina so
that the external os
faces the posterior wall
of vagina
UTERUS

Endometrium

The lining of the uterine

cavity.
It consists of the functional
endometrium and the
basal endometrium
.
• MYOMETRIUM:
• -layer of most of the
uterus
- Bundles of smooth
muscle united by
connective tissue with
elastic fibers
- -interlaciong
myometrial fibers
surrounding
myometrial vessles—
control of bleeding
from placental site
separation
Changes during PREGNANCY
THE CERVIX

Cervix: portion of
the uterus which
is fusiform and
open at each
end by small
apertures –
internal and
external os
The CERVIX
The CERVIX
The LIGAMENTS
The ROUND LIGAMENT
The BROAD LIGAMENT
The BROAD LIGAMENT
BLOOD SUPPLY
 INNERVATION
• Sympathetic nervous system
• Uterovaginal plexus of frankenhauser: uterus,
bladder and upper vagina
• T11 and T12: transmit the painful stimuli of
uterine contractions
• Pudendal nerve: lower portion of birth canal
 The FALLOPIAN TUBES
 Also called oviducts
 Extends up to 8-14cm in
length

• Four parts:
 Interstitium
 Isthmus (narrowest)
 Ampulla (widest)
 Infundibulum
Interstitial portion :embodied within the
muscular wall of the uterus. Obliquely and
outward.

Isthmus: or the narrow portion of the tube

- 2 to 3 mm in diameter, and the widest portion
of the Ampulla measures from 5 to 8 mm

Infundibulum: fimbriated extremity, is the

funnel-shaped opening of the distal end of the
fallopian tube
 The OVARIES
 Paired, almond-shaped bodies
measuring 3x2x1cm
 Has 2 surfaces (lateral and
medial),
• 2 borders (anterior and
posterior)
• 2 poles (upper and lower)
 they produce eggs (also called
ova) every female is born with a
lifetime supply of eggs
 they also produce hormones:
• Estrogen  & Progesterone
 The PELVIC BONES

 T
PLANES of the TRUE PELVIS
PELVIS: 4 imaginary planes
1.Plane of pelvic inlet: superior straight
2.Plane of pelvic outlet: inferior straight
3.Plane of midpelvis: least pelvic dimension
4.Plane of greatest pelvic dimension: no
obstetrical significance
DIAMETERS
OBSTETRICAL CONJUGATE
MIDPELVIS
PELVIC OUTLET
SHAPES OF PELVIC INLET
SHAPES OF PELVIC INLET
 BIPARIETAL DIAMETER

 Engagement –
Biparietal diameter has
passed through the
pelvic inlet and is now
situated in the
midpelvis (during
delivery).
CLINICAL PELVIMETRY
 Transverse Antero-Posterior

INLET 13 cm. DC – 11.5 cm.

TC - 11 cm.
OC – 10 cm.
MIDPELVIS 10 cm. 11.5 cm.
(Interspinous)

OUTLET 11 cm. 9.5 – 11.5 cm.

(Intertuberous)