WILLIAMS OBSTETRICS

Chapter 2: Maternal Anatomy

Anterior Abdominal Wall
A. Skin, Subcutaneous Layer, Fascia
a. Skin Langer lines Pfannenstiel incision
b. Subcutaneous
i. Camper fascia (superficial, fatty) mons pubis labia major ischioanal
fossa
ii. Scarpa fascia (deep, membranous) Colles fascia
c. Muscles
i. External oblique apo./m. rectus sheath linea alba
ii. Internal oblique apo./m. rectus sheath linea alba
iii. Transversus abdominis apo./m. rectus sheath linea alba
iv. Arcuate line
1. Cephalad: aponeuroses (i-iii) both dorsal & ventral rectus abdominis

v.
vi.
vii.
viii.

m.
2. Caudal: aponeuroses ventral only
Transversalis fascia
Preperitoneal fat
Peritoneum
Pyramidalis m. (orig. Pubic crest, insert. Linea alba)

B. Blood Supply
a. Femoral triangle (Inguinal lig., Sartorius m., Adductor longus m.) femoral a.v.
superficial inferior epigastric a.v., superficial circumflex a.v., superficial external
pudendal a.v. supply skin + subcutaneous layers (Camper + Scarpa)
b. External iliac a.v. deep inferior epigastric a.v. + deep circumflex iliac a.v.
supply muscle + fascia
c. Deep inferior epigastric a.v. anastomoses with superior epigastric a.v. internal
thoracic a.v.
d. Hesselbachs triangle (inferior epigastric a.v., Inguinal lig., rectus abdominis m.)
direct inguinal/Hesselbachs hernia
e. Lateral to Hesselbachs triangle deep inguinal ring superficial inguinal ring
indirect inguinal hernia

C. Innervation
a. Thoracic spinal nn. anterior rami intercostal n. (T7-11) + subcostal n. (T12) in
transversus abdominis plane pierce rectus abdominis m. at lateral border skin
b. L1 spinal n. anterior ramus iliohypogastric n. + ilioinguinal n. psoas m.
quadratus lumborum iliac crest pierce transversus abdominis m. medial to
SIAS pierce internal oblique m. midline
c. Iliohypogastric n. lateral rectus border pierce external oblique apo. skin over
suprapubic area
d. Ilioinguinal n. inguinal canal superficial inguinal ring skin of mons pubis,
upper labia majora, and medial upper thigh

External Generative Organs

A. Vulva (Pudenda)
a. Mons pubis (mons veneris)
i. Fat overlying simphysis pubis
ii. Escutcheon hair inverted triangle
b. Labia majora
i. Superior Mons pubis termination of round ligament
ii. Posterior perineal body Posterior commissure
iii. Hair on outer surface apocrine, eccrine & sebaceous glands in the skin
elastic fibers & adipose tissue as connective tissue venous plexus
Varicosities
c. Labia minora
i. Superior two lamellae
1. Lower lamellae Frenulum of clitoris
2. Upper lamellae Prepuce Blood: dorsal a. of clitoris
ii. Inferior Fourchette
iii. Keratinized stratified squamous epithelium Hart line Non-keratinized
squamous epithelium
iv. Sebaceous glands
d. Clitoris
i. Glans
1. Stratified squamous epithelium
2. Blood: dorsal a. of clitoris
ii. Corpus
1. Corpora cavernosa
2. Blood: deep a. of clitoris
iii. Crura
1. Along ischiopubic ramus, deep to ischiocavernosus m.
e. Vestibule
i. Bartholin glands (greater vestibular glands)
1. Inferior to vestibular bulb, deep to inferior end of bulbocavernosus
m.
2. Opens distal to hymeneal ring 5 oclock & 7 oclock
3. Trauma/infecton cyst infected abscess
ii. Minor vestibular glands
1. Mucin-secreting epithelium along Hart line
iii. Paraurethral glands
1. Along entire inferior aspect of urethra
2. Largest: Skene glands
3. Inflammation/obstruction urethral diverticulum
B. Vagina & Hymen
C. Perineum