8

CHAPTER 2

Maternal Anatomy

2–1. Which artery is frequently encountered when a 2–4. The labia minora is invested by which of the
Pfannenstiel skin incision is performed during a following structures?
cesarean delivery? a. Hair follicles
a. Hypogastric artery b. Eccrine glands
b. Inferior epigastric artery c. Apocrine glands
c. Superficial epigastric artery d. Sebaceous glands
d. Superficial circumflex iliac artery
2–5. Which of the following does not perforate the
2–2. Which artery should be found and ligated prior to vestibule?
the performance of a Maylard incision? a. Urethra
a. Hypogastric artery b. Skene glands
b. Inferior epigastric artery c. Bartholin glands
c. Superficial epigastric artery d. All perforate the vestibule
d. Superficial circumflex iliac artery
2–6. The posterior vaginal wall’s vascular supply primarily
2–3. Chronic pain may develop in the area of a comes from which artery?
Pfannenstiel skin incision if which of the following a. Uterine artery
nerves are severed or entrapped?
b. Hypogastric artery
c. Middle rectal artery
d. Internal pudendal artery

2–7. Which of the following is not a component of the

perineal body?
a. Iliococcygeus muscle
b. Pubococcygeus muscle
c. Bulbospongiosus muscle
d. Superficial transverse perineal muscle

2–8. Which of the following muscles compose the levator

ani muscle?
a. Puborectalis
b. Iliococcygeus
Modified with permission from Corton MM: Anatomy. In Hoffman BL, Schorge JO, c. Pubococcygeus
Bradshaw KD, et al (eds): Williams Gynecology, 3rd ed. New York, McGraw-Hill Education,
2016, Figure 38-3.
d. All of the above

a. Femoral nerve
b. Subcostal nerve
c. Intercostal nerve
d. Iliohypogastric nerve
 Maternal Anatomy 9

2–9. Which of the following statements regarding the 2–14. During a postpartum hysterectomy for intractable
borders of the ischiorectal fossae is incorrect? bleeding, a Heaney clamp is placed on the uterine
a. Anterior border: inferior border of the posterior artery near its insertion to the uterus. What is the
relationship between the ureter and uterine artery at

CHAPTER 2
triangle
this point?
b. Medial border: anal sphincter complex and fascia
of the levator ani a. The ureter is 2 cm medial to the uterine artery at
this location.
c. Lateral border: obturator internus muscle fascia
and ischial tuberosity b. The ureter is 2 cm medial to the uterine artery
and crosses under it.
d. Posterior border: gluteus maximus muscle and
sacrotuberous ligament c. The ureter is 2 cm lateral to the cervix and crosses
over the uterine artery.
2–10. Which combination of structures provides support d. The ureter is 2 cm lateral to the cervix and crosses
for fecal continence? under the uterine artery.
a. Internal and external anal sphincter
2–15. The vascular supply of the uterus comes from which
b. External anal sphincter and levator ani muscle
of the follow arteries?
c. Puborectalis muscle and internal anal sphincter
a. Uterine artery
d. Puborectalis muscle and external anal sphincter
b. Sampson artery
2–11. A 33-year-old nulligravida undergoing labor without c. Middle sacral artery
anesthesia arrests at +2 station. You decide to perform d. Middle rectal artery
an outlet forceps delivery with a pudendal nerve
block. What is the landmark you use to perform the 2–16. Which of the following arteries comes off the posterior
nerve block? division of the internal iliac artery?
a. Ischial spine
b. Sacrospinous ligament
c. Sacrotuberous ligament
d. All of the above

2–12. Which of the following statements is accurate in

regard to the uterus?
a. It is made up of two equal parts.
b. The bulk of uterine tissue is fibroelastic tissue.
c. Visceral peritoneum covers the anterior surface.
d. Pregnancy stimulates uterine growth through
hyperplasia.

2–13. Which of the following refers to the blue tint of the

cervix that is due to increased cervical vascularity in
pregnancy? Reproduced with permission from Corton MM: Anatomy. In Hoffman BL, Schorge JO,
Bradshaw KD, et al (eds): Williams Gynecology, 3rd ed. New York, McGraw-Hill Education,
a. Hegar sign 2016, Figure 38-12.

b. Goodell sign
c. Chadwick sign a. Uterine artery

d. All of the above b. Obturator artery

c. Superior vesical artery
d. Superior gluteal artery
 10 Maternal Anatomy and Physiology

2–17. Which of the following statements regarding the 2–21. The mobility of which joint aids in the delivery of
pelvic visceral innervation is inaccurate? the obstructed shoulder in the case of a shoulder
a. Parasympathetic innervation is from L4–S1. dystocia?
a. Sacroiliac
SECTION 2

b. Origins of sympathetic innervation is from

T10–L2. b. Sacrococcygeal
c. The superior hypogastric plexus is also known as c. Pubic symphysis
the presacral nerve. d. All of the above
d. The pelvic plexus is the result of blending of the
sympathetic and parasympathetic nerves. 2–22. Which of the following is the correct anatomical
description of the ureter?
2–18. Which of the following is the correct anatomic a. Passes just lateral to the ovarian vessels
progression of the fallopian tube from proximal to
b. Lies inferolateral to the uterosacral ligaments
distal?
c. Crosses underneath the bifurcation of the
a. Isthmus, ampulla, infundibulum
common iliac artery
b. Ampulla, infundibulum, isthmus
d. Lies medial to the anterior branches of the
c. Infundibulum, ampulla, isthmus internal iliac artery as it descends in the pelvis
d. Ampulla, isthmus, infundibulum
2–23. The pelvic ureter receives blood supply from which
2–19. A cross-section of the extrauterine fallopian tube of the following blood vessels?
contains which of the following? a. Uterine
b. Internal iliac
c. Common iliac
d. All of the above

2–24. Which plane is the plane of least pelvic dimensions?

a. The plane of the midpelvis
b. The plane of the pelvic inlet
c. The plane of the pelvic outlet
d. None of the above

2–25. The pelvic inlet is bounded by which of the

following?
a. Posteriorly by the promontory
b. Laterally by the linea terminalis
Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds):
Maternal anatomy. In William Obstetrics, 25th ed. New York, McGraw-Hill, 2018,
c. Anteriorly by horizontal pubic rami
Figure 2-14. Photo contributor: Dr. Kelley S. Carrick. d. All of the above

a. Myosalpinx
b. Mesosalpinx
c. Endosalpinx
d. All of the above

2–20. Which bones make up the pelvis?

a. Sacrum
b. Coccyx
c. Innominate
d. All of the above
 Maternal Anatomy 11

2–26. Which of the following does not characterize the 2–28. What is the most common Caldwell-Moloy
obstetric conjugate? anatomical pelvis?

Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds):
Maternal anatomy. In William Obstetrics, 25th ed. New York, McGraw-Hill, 2018,
Figure 2-16.
CHAPTER 2
Reproduced with permission from Cunningham FG, Leveno KJ, Bloom SL, et al (eds):
Maternal anatomy. In William Obstetrics, 25th ed. New York, McGraw-Hill, 2018,
Figure 2-17.

a. Android
a. It cannot be directly measured. b. Gynecoid
b. It normally measures 11 cm or more. c. Anthropoid
c. It is the least clinically important diameter of the d. Platypelloid
pelvic inlet.
d. It is the shortest distance from the sacral 2–29. A 22-year-old primigravida presents in active labor
promontory and the symphysis pubis. at 5 cm and -2 station. Which of the following is
true?
2–27. Which of the following is accurate regarding the
a. The fetal head is engaged.
midpelvis?
b. The biparietal diameter has reached the level of
a. Contains the smallest pelvic diameter
the midpelvis.
b. Serves as the point to measure station
c. The biparietal diameter has reached the level of
c. Is marked by the interspinous diameter the pelvic inlet.
d. All of the above d. None of the above

2–30. Regarding the patient in Question 2–29, 2 hours

later she is 8 cm dilated and the fetal head is noted
to be at 0 station. Which of the following is true?
a. The fetus is too big to fit through her pelvis.
b. Internal rotation of the fetal head to transverse
should be occurring.
c. The top of the fetal head is noted at the level of
the midpelvic interspinous diameter.
d. None of the above
 12 Maternal Anatomy and Physiology

2–31. After three more hours the patient in Question 2–29
is completely dilated and the head is at +5 station.
Which of the following is true?
a. The caput may be visualized at the level of the
SECTION 2
2–32. The fetal head presents at +5 station in a transverse
diameter. What is the most likely pelvic shape?
a. Android

b. Gynecoid
introitus.
c. Anthropoid
b. The caput is now 5 cm distal to the midpelvic
interspinous diameter. d. Platypelloid
c. The fetal head has most likely internally rotated
into an occiput anterior presentation.
d. All of the above