Maternal Anatomy

Jenelle Rayza M. Bulaong, MD

Support by : William’s book
 Anterior Abdominal Wall

FIGURE 2-1 Muscles and blood vessels of the anterior abdominal wall
 Innervation
• the abdominal extensions of the intercostal nerves (T7-
11)
• the subcostal nerve (T12)
• the iliohypogastric  skin over the suprapubic area, and
the ilioinguinal nerves (L1) skin of the lower abdominal
wall, upper portion of the labia majora, medial portion of
the thigh through its inguinal branch (2 to 3 cm medial to
the anterior superior iliac spine and course between the
layers of the rectus sheath)
• The T10 dermatome approximates the level of the
umbilicus.
 External Generative Organs

• Vulva (pudenda) : includes all structures visible

externally from the symphysis pubis to the perineal
body
• Innervation: Pudendal Nerve
 Vulva

Mons Pubis Vestibule

Labia Urethral Opening
Clitoris Greater vestibular
Hymen (bartholin glands)
Minor Vestibular glands Paraurethral glands
(skene glands)
FIGURE 2-3 External female reproductive organs.
 vestibule

• 6 openings
• Urethral opening
• Vagina
• 2 bartholin gland ducts (0.5-1cm diameter)
• 5 and 7 O clock on the vestibule
• 2 paraurethral glands- skenes glands
• Inflammation of the glands leads to urethral diverticulum
formation
 Vagina

• musculomembranous structure extends from the

vulva to the uterus and is interposed anteriorly and
posteriorly between the bladder and the rectum

• Anteriorly, the vagina is separated from the bladder

and urethra by connective tissue—the vesicovaginal
septum
 Vagina

• Posteriorly, between the lower portion of the

vagina and the rectum, there are similar tissues
that together form the rectovaginal septum.
• The upper fourth of the vagina is separated from
the rectum by the recto-uterine pouch (cul-de-sac
of Douglas)
 Vagina

• Lacks glands instead lubricated by Vaginal

subepithelial plexus
• Vaginal length
• anterior wall 6 to 8 cm
• Posterior wall 7 to 10 cm in length
vagina
 Blood supply

•proximal portion  cervical branch of the

uterine artery and by the vaginal artery.
•posterior vaginal wall The middle rectal
artery
•distal walls  internal pudendal artery.
 Perineum

•Diamond shape area between the thighs

•Margins :
• Anterior: the pubic symphysis
•Anterolateral: ischiopubic rami and ischial tuberosities
•Posterior: sacrotuberous ligaments posterolaterally, and
coccyx
Perineum
Anterior triangle

- Superficial Space of the Anterior Triangle.

ischiocavernosus
bulbocavernosus,
superficial transverse perineal muscles
Bartholin glands
vestibular bulbs
clitoral body and crura
branches of the pudendal vessels and nerve

- Deep Space of the Anterior Triangle.

compressor urethrae
urethrovaginal sphincter muscles
external urethral sphincter,
parts of urethra and vagina,
branches of the internal pudendal artery, and the dorsal nerve and vein
of the clitoris
 Posterior triangle

ischiorectal fossa
anal canal
anal sphincter complex
branches of the internal pudendal vessels and
pudendal nerve
Ischiorectal Fossae.
FIGURE 2-4 Perineal anatomy. Anterior and posterior triangles are defined by a line drawn
between the ischial tuberosities. The superficial space of the anterior triangle and its
contents are shown above this line.
FIGURE 2-5 Perineal anatomy. Anterior and posterior triangles are shown. Within the anterior
triangle, the contents of the deep space are shown on the image’s right, whereas those of the
superficial space are on the left.
 Pudendal Nerve and Vessels

•The pudendal nerve the anterior rami of S2-4 spinal nerves.

- The dorsal nerve of the clitoris  the skin of the clitoris.
- The perineal nerve  muscles of the anterior triangle and labial
skin.
- The inferior rectal branch  the external anal sphincter, the
mucous membrane of the anal canal, and the perianal skin
•The major blood supply to the perineum is via the internal pudendal
artery and its branches. These include the inferior rectal artery and
posterior labial artery.
 Pedendal nerve block

• The ischial spine serve as identification landmark

 Anus

•External Anal Sphincter (EAS).

It maintains a constant state of resting contraction that
provides increased tone and strength when continence
is threatened, and it relaxes for defecation
•Internal Anal Sphincter (IAS).
the IAS may be involved in fourth-degree lacerations
 Anus

FIGURE 2-6 Anatomy of the anorectum, drawn to show relations of the internal anal sphincter,
the external anal sphincter, and the levator ani muscles. The boundaries of the ischiorectal fossa
are shown. The ischiorectal fossa is bounded deeply by the inferior fascia of the levator ani
muscles, superficially by the perineal skin, anterolaterally by the fascia of the obturator internus
muscles and ischial tuberosities, posterolaterally by the gluteus maximus muscles and
sacrotuberous ligament, and medially by the anal canal and sphincter complex.
 Perineal Body

• The median raphe of the levator ani, between the

anus and the vagina, is reinforced by the central
tendon of the perineum. The bulbocavernosus,
superficial transverse perineal, and external anal
sphincter muscles also converge on the central
tendon.
• The perineal body is incised by an episiotomy
incision and is torn with second-, third-, and fourth-
degree lacerations
 Perineal Body
Function
•Anchors the anorectum
•Anchors the vagina
•Helps maintains urinary and fecal continence
•Maintains the orgasmic platform
•Prevents expansion of the urogenital hiatus
•Provides a physical barrier between the vagina and
•rectum
Potential Morbidity
•Episiotomy may injure the perineal body
•Pudendal nerve injury may be associated with concurrent
•perineal body injury

Adapted from Woodman and Graney (2002).

Internal Reproductive Organs
 Uterus

• Between the bladder anteriorly and the rectum

posteriorly.
• Almost the entire posterior wall of the uterus is
covered by serosa, that is visceral peritoneum.
• The lower portion of this peritoneumforms the
anterior boundary of the recto-uterine cul-de-sac, or
pouch of Douglas.
 Uterus

• the upper portion of the anterior wall the

vesicouterine pouch.
• The lower portion of the anterior uterine wall 
vesicouterine space.
• pyriform or pear-shaped
 Uterus

• body or corpus, and a lower, cylindrical portion—the

cervix, which projects into the vagina.
• The isthmus is that portion of the uterus between
the internal cervical os and the endometrial cavity
• The fallopian tubes, also called oviducts
• The fundus
 Uterus

• adult nulliparous women- 6 to 8 cm in length as

• multiparous women- 9-10cm
• In nonparous women- 50 to 70
parous women it averages 80 g or more
• In nulliparous women, the fundus and cervix are approximately
equal length, but in multiparous women, the cervix is only a little
more than 1/3 of the total length
 Cervix

• The upper segment of the cervix—the portio

supravaginalis
• Covered by peritoneum on its posterior surface,
• the cardinal ligaments attach laterally
• separated from lower vaginal portion of the cervix
 portio vaginalis
 Ligaments

• Round Ligament
• Broad Ligament
• infundibulopelvic ligament or suspensory ligament
of the ovary,
• cardinal ligament—also called the transverse cervical
ligament orMackenrodt ligament
FIGURE 2-15 Blood supply to the left ovary, left fallopian tube, and left side of the uterus. The
ovarian and uterine vessels anastomose freely. Note the uterine artery and vein crossing over
the ureter that lies immediately adjacent to the cervix. (Used with permission from Jennifer
Hulsey.)
FIGURE 2-16 Pelvic blood supply.
 Ovaries

• During childbearing years  from 2.5 to 5 cm in

length, 1.5 to 3 cm in breadth, and 0.6 to 1.5 cm in
thickness.
• The cortex contains oocytes and developing follicles.
• The medulla is the central portion, which is
composed of loose connective tissue, a large number
of arteries and veins in the medulla and a small
number of smooth muscle fibers.
 Fallopian tubes

• Also called the oviducts

• 8-14cm from the uterine cornua
• Interstitial portion is embodied within the uterine
muscular
• 2-3mm isthmus
• 5-8mm ampulla
• Infundibulum is the funnel shaped ffimbraited distal
extremity of the tube
 MUSCULOSKELETAL PELVIC
ANATOMY
•Pelvic Bones

FIGURE 2-18 Sagittal view of pelvic bones

 Pelvic Bone

• The pelvis is composed of four bones: the sacrum,

coccyx, and two innominate bones.
• Each innominate bone is formed by the fusion of
the ilium, ischium, and pubis
• The false pelvis lies above the linea terminalis
• The true pelvis below this anatomical boundary, The
true pelvis is the portion important in childbearing
 The True Pelvis

• The posterior boundary is the anterior surface of the

sacrum
• the lateral limits are formed by the inner surface of
the ischial bones and the sacrosciatic notches and
ligaments.
• In front, the true pelvis is bounded by the pubic
bones, the ascending superior rami of the ischial
bones, and the obturator foramen.
 The True Pelvis

• The ischial spines are of great obstetrical importance

because the distance between them usually represents
the shortest diameter of the pelvic cavity, as valuable
landmarks in assessing the level to which the
presenting part of the fetus has descended into the
true pelvis
 Pelvic Joints

• Symphysis Pubis
• Sacroiliac Joints
FIGURE 2-19 Anteroposterior view of a normal female pelvis. Anteroposterior
(AP) and transverse (T) diameters of the pelvic inlet are illustrated
 Planes and Diameters of the Pelvis

The pelvis is described as having four imaginary planes:

1. The plane of the pelvic inlet—the superior strait.
2. The plane of the pelvic outlet—the inferior strait.
3. The plane of the midpelvis—the least pelvic
dimensions.
4. The plane of greatest pelvic dimension—of no
obstetrical significance.
 Pelvic Inlet

• Also called the superior strait

• During labor the fetal head engagement is defined by
the biparietal diameter passing through this plane
 Midpelvis

• The midpelvis is measured at the level of the ischial

spines
• important following engagement of the fetal head in
obstructed labor.
• The interspinous diameter, 10 cm or slightly greater,
is usually the smallest pelvic diameter.
• The anteroposterior diameter through the level of
the ischial spines normally measures at least 11.5 cm.
Pelvic Outlet
Pelvic Shapes
Thank you!