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MATERNAL ANATOMY

ANTERIOR ABDOMINAL WALL


EXTERNAL GENERATIVE ORGANS
INTERNAL GENERATIVE ORGANS
MUSCULOSKELETAL PELVIC ANATOMY
Anterior Abdominal Wall
Skin
Fascia superficial
Fascia profunda
Muscles
Fascia transversalis
Extraperitoneal fat
Peritoneum parietal
Skin
Langer lines describe the orientation of
dermal fibers within the skin. In the
anterior abdominal wall, they are
arranged transversely. As a result,
vertical skin incisions sustain increased
lateral tension and thus, in general,
develop wider scars. In contrast, low
transverse incisions, such as the
Pfannenstiel, follow Langer lines and
lead to superior cosmetic results.
Skin
Persyarafan : T7-L1
Skin
Pendarahan
Arteri:
Kulit di sekitar garis tengah: cabang arteria
epigastrica superior dan inferior
Kulit pinggang: cab. Arteria intercostalis,
arteria lumbalis, dan arteria circumflexa
ilium profunda
Skin
Pendarahan
Vena:
Darah vena dikumpulkan melalui jejaring vena
yang memancar dari umbilicus. Anyaman vena
tersebut dialirkan ke atas ke vena axillaris
melalui vena thoracis lateralis, dan ke bawah
ke vena femoralis melalui vena saphena
magna.
Beberapa venae kecil, venae paraumbilicales,
menghubungkan jejaring vena melalui
umbilikus dan sepanjang ligamentum teres
hepatis ke vena porta.
Skin
Drainase Limfe
Di atas umbilikus bermuara ke dalam
limfonodus aksilaris
Di bawah umbilikus bermuara ke
dalam nodus inguinalis superfisialis
Fascia Superficialis
Fascia Camperi (Panniculus adiposus)
Lemak superfisial yang meliputi bagian
tubuh
Fascia Scarpae (Stratum
membranosum)
Fascia Profunda
Lapisan tipis jaringan ikat yang
menutupi otot-otot
Muscles
M. Obliquus eksternus abdominis
M. Obliquus internus abdominis
M. Transfersus abdominis
M. Rectus abdominis
Fasia Transfersalis
Merupakan lapisan tipis yang berada
diantara M. Tranversalis dengan
lemak ekstraperitoneal
Fascia transversalis, diagfragmatika,
illiaka, dan pelvis
berkesinambungan melapisi rongga
abdomen dan pelvis
Lemak ekstraperitoneal
Merupakan lapisan tipis jaringan ikat
yang mengandung lemak
External Female Structures

Collectively, the external


female reproductive
organs are called the
Vulva.
External Female Structures

Mons Pubis.
Labia Majora
Labia Minora.
Clitoris.
Vestibule.
Perineum
Mons Pubis
Is rounded, soft fullness of
subcutaneous fatty tissue, prominence
over the symphysis pubis that forms
the anterior border of the external
reproductive organs.
It is covered with varying amounts
of pubic hair.
Labia Majora & Minora

The labia Majora are two rounded,


fleshy folds of tissue that extended
from the mons pubis to the perineum.

It is protect the labia minora, urinary


meatus and vaginal introitus.
Labia Minora
It is located between the labia majora,
are narrow.
The lateral and anterior aspects are
usually pigmented.
The inner surfaces are similar to
vaginal mucosa, pink and mois.
Their rich vascularity.
Clitoris.
The term clitoris comes from a
Greek word meaning key.
Erectile organ.
Its rich vascular, highly sensitive
to temperature, touch, and
pressure sensation
Vestibule.
Is oval-shaped area formed
between the labia minora, clitoris,
and fourchette.
Vestibule contains the external
urethral meatus, vaginal introitus,
and Bartholins glands.
Perineum
Is the most posterior part of the
external female reproductive organs.
It extends from fourchette anteriorly
to the anus posteriorly.
And is composed of fibrous and
muscular tissues that support pelvic
structures.
External Genitalia
External Genitalia
Internal Female Structures

Vagina
Uterus
Fallopian tubes
Ovaries
Vagina

It is an elastic fibro-muscular tube


and membranous tissue about 8 to
10 cm long.
Lying between the bladder
anteriorly and the rectum
posteriorly.
The vagina connects the uterus
above with the vestibule below.

The upper end is blind and called


the vaginal vault.
The vaginal lining has multiple
folds, or rugae and muscle layer.
These folds allow the vagina to
stretch considerably during
childbirth.
The reaction of the vagina is
acidic, the pH is 4.5 that
protects the vagina against
infection.
Functions of the vagina

To allow discharge of the


menstrual flow.
As the female organs of coitus.
To allow passage of the fetus from
the uterus.
Support structures
The bony pelvis support and
protects the lower abdominal
and internal reproductive
organs.
Muscle, Joints and ligaments
provide added support for
internal organs of the pelvis
against the downward force of
gravity and the increases in
intra-abdominal pressure
Fallopian tubes
The two tubes extended from the
cornu of the uterus to the ovary.
It runs in the upper free border of
the broad ligament.
Length 8 to 14 cm average 10 cm
Its divided into 4 parts.
1. Interstitial part

Which runs into uterine cavity,


passes through the myometrium
between the fundus and body of
the uterus. About 1-2cm in
length.
2. Isthmus

Which is the narrow part of


the tube adjacent to the
uterus.
Straight and cord like ,
about 2 3 cm in length.
3. Ampulla

Which is the wider part about


5 cm in length.

Fertilization occurs in the


ampulla.
4. Infundibulum

It is funnel or trumpet shaped.


Fimbriae are fingerlike processes, one
of these is longer than the other and
adherent to the ovary.
The fimbriae become swollen almost
erectile at ovulation.
Functions

Gamete transport (ovum pickup,


ovum transport, sperm transport).

Final maturation of gamete post


ovulate oocyte maturation, sperm
capicitation.
Fluid environment for early
embryonic development.

Transport of fertilized and


unfertilized ovum to the uterus.
Ovaries
Oval solid structure, 1.5 cm in thickness,
2.5 cm in width and 3.5 cm in length
respectively. Each weights about 48 gm.

Ovary is located on each side of the


uterus, below and behind the uterine tubes
Structure of the ovaries

Cortex
Medulla
Hilum
Ovaries and Relationship
to Uterine Tube and Uterus

Figure 2814
Function of the ovary

Secrete estrogen & progesterone.

Production of ova
Uterus
The uterus is a hollow, pear shaped
muscular organ.

The uterus measures about 7.5 X 5


X 2.5 cm and weight about 50 60
gm.
Its normal position is anteverted
(rotated forward and slightly
antiflexed (flexed forward)

The uterus divided into three parts


1. Body of the uterus

The upper part is the corpus, or body


of the uterus
The fundus is the part of the body or
corpus above the area where the
fallopian tubes enter the uterus.
Length about 5 cm.
2. Isthmus
A narrower transition zone.
Is between the corpus of the uterus
and cervix.
During late pregnancy, the isthmus
elongates and is known as the lower
uterine segment.
3. Cervix

The lowermost position of the


uterus neck.
The length of the cervix is about
2.5 t0 3 cm.
The os, is the opening in the cervix
that runs between the uterus and
vagina.
The upper part of the cervix is marked
by internal os and the lower cervix is
marked by the external os.
Layers of the uterus
Perimetrium.
Myometrium.
Endometrium.
1. Perimetrium

Is the outer peritoneal layer of


serous membrane that covers
most of the uterus.
Laterally, the perimetrium is
continuous with the broad
ligaments on either side of the
uterus.
2. Myometrium
Is the middle layer of thick
muscle.
Most of the muscle fibers are
concentrated in the upper uterus,
and their number diminishes
progressively toward the cervix.
The myometrium
contains three types of
smooth muscle fiber
Longitudinal fibers (outer layer)

Which are found mostly in the


fundus and are designed to expel
the fetus efficiently toward the
pelvic outlet during birth.
Middle layer figure-8 fibers

These fiber contract after


birth to compress the blood
vessels that pass between
them to limit blood loss.
Inner layer circular fibers
Which form constrictions where the
fallopian tubes enter the uterus and
surround the internal os
Circular fibers prevent reflux of
menstrual blood and tissue into the
fallopian tubes.
Promote normal implantation of
the fertilized ovum by controlling
its entry into the uterus.
And retain the fetus until the
appropriate time of birth.
3. Endometrium
Is the inner layer of the uterus.
It is responsive to the cyclic
variations of estrogen and
progesterone during the female
reproductive cycle every month.
The two or three layers of the
endometrium are:
*Compact layer
*The basal layer
*The functional or Sponge layer this
layer is shed during each menstrual period
and after child birth in the lochia
The Function of the uterus

Menstruation ----the uterus


sloughs off the endometrium.

Pregnancy ---the uterus support


fetus and allows the fetus to grow.
Labor and birth---the uterine
muscles contract and the cervix
dilates during labor to expel the
fetus
Bony Pelvis

Bony Pelvis Is Composed of 4


bones:
1. Two hip bones.
2. Sacrum.
3. Coccyx.
1. Two hip bones.
Each or hip bone is composed
of three bones:
*Ilium
*Ischium
*Pubis
*Ilium
It is the flared out part.
The greater part of its inner
aspect is smooth and concave,
forming the iliac fossa.
The upper border of the ilium is
called iliac crest
*Ischium
It is the thick lower part.
It has a large prominence
known as the ischial tuberosity
on which the body rests while
sitting.
Behind and little above the
tuberosity is an inward
projection the ischial spine.
2. Sacrum
Is a wedge shaped bone consisting of
five vertebrae.
The anterior surface of the sacrum is
concave
The upper border of the first sacral
vertebra known as the sacral
promontory
3. Coccyx.

Consists of four
vertebrae forming a
small triangular bone.
External Genitalia
Mons pubis /veneris
Labia mayora
Labia minora
Klitoris
Vulva
Bulbus vestibuli
Introitus vaginae dan himen
Perineum/Fourchette
Internal Genitalia
Vagina
Uterus
Tuba Fallopi
Ovarium
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
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
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
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
Cervix
Squamous epithelium on ectocervix
Columnar epithelium on endocervix
Endometrium
Ligaments
Blood Supply
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
Pelvic Bony Anatomy
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)
Pelvic inlet
Mid-Pelvis

Ischial spines (10cm)


Outlet
Posterior
boundary =
coccyx
Anterior
boundary =
pubic arch
Pelvis Types
Pelvic Floor

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