OBSTETRICS Term 1

Lesson 1.1 Maternal Anatomy

Dr. Jane Publico

MATERNAL ANATOMY i. Camper fascia

A. Anterior abdominal wall -predominantly fatty layer
● Skin -continues onto the perineum to provide
● Subcutaneous layer fatty substance to the mons pubis and
● Fascia labia majora and then to blend with the
B. External generative organs fat of the ischioanal fossa.
● Vulva ii. Scarpa fascia
● Vagina & Hymen - a deeper, more membranous layer
● Perineum - continues inferiorly on to the perineum
● Superficial Space of the Anterior Triangle as Colles fascia.
● Deep Space of the Anterior Triangle - As a result, perineal infection or
● Pelvic Diaphragm hemorrhage superficial to Colles fascia
● Posterior Triangle has the ability to extend upward to
● Ischioanal Fossae. involve the superficial layers of the
● Anal Canal abdominal wall.
● Anal Sphincter Complex.
C. Internal generative organs ● The fibrous aponeuroses of these three latter
D. Musculoskeletal pelvic anatomy muscles form the primary fascia of the anterior
Anterior abdominal wall abdominal wall. These fuse in the midline at the
● Confines abdominal viscera linea alba, which normally measures 10 to 15 mm
● Stretches to accommodate the expanding uterus wide below the umbilicus. An abnormally wide
● Provides surgical access to the internal separation may reflect diastasis recti or hernia.
reproductive organs.
● A comprehensive knowledge of its Rectus Sheath
layered structure is required to ● The fibrous aponeuroses of the external
surgically enter the peritoneal cavity. oblique, internal oblique, and transversus
abdominis muscles join in the midline to
Skin create the rectus sheath.
● Langer lines describe the orientation of ● The construction of this sheath varies above
dermal fibers within the skin transversely. and below a demarcation line, termed the
● Vertical skin incisions sustain increased lateral arcuate line.
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.

Subcutaneous Layer

● Cephalad to this line, the aponeuroses invest

the rectus abdominis bellies above and
below.
● Caudal to this line, all aponeuroses lie anterior
to the rectus abdominis muscle, and only the
thin transversalis fascia and peritoneum lie
beneath.
● In the lower abdomen, transition from the
muscular to the fibrous aponeurotic
component of the external oblique muscles
This layer can be separated into a superficial
Page 1 of 11
S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

takes place along a vertical line through the and the rectus fascia, several centimeters from
anterosuperior iliac spine. the midline.
● Transition from muscle to aponeurosis for the ii. External Iliac Artery Branches
internal oblique and transversus abdominis ● The inferior "deep" epigastric vessels and deep
muscles takes place more medially. circumflex iliac vessels are branches of the
● For this reason, muscle fibers of the internal external iliac vessels.
oblique are often noted below the ● They supply the muscles and fascia of the
aponeurotic layer of the external oblique anterior abdominal wall.
during creation of low transverse incisions. ● The inferior epigastric vessels initially course
lateral to, then posterior to the rectus muscles,
which they supply. They then pass anterior to the
posterior rectus sheath and course between the
sheath and the rectus muscles.
● Near the umbilicus, the inferior epigastric vessels
anastomose with the superior epigastric artery
and veins, branches of the internal thoracic
vessels.
● Hesselbach triangle is the region in the anterior
abdominal wall bounded inferiorly by the
inguinal ligament, medially by the lateral border
of the rectus muscles, and laterally by the
inferior epigastric vessels.
Blood Supply o Direct hernias protrude through the
abdominal wall in Hesselbach triangle,
i. Femoral Artery Branches whereas indirect hernias do so through
● The superficial epigastric, superficial circumflex the deep inguinal ring lying lateral to this
iliac, triangle.

Laterally: inferior epigastric vessels

Inferiorly: inguinal ligament
Medially: lateral border of the rectus abdominis muscle

Innervation

and external pudendal arteries arise from the

femoral artery just below the inguinal ligament
in the region of the femoral triangle
● These vessels supply the skin and subcutaneous
layers of the anterior abdominal wall and mons
pubis.
● The superficial epigastric vessels course
diagonally toward the umbilicus.
● During low transverse skin incision creation, the
superficial epigastric vessels can usually be
identified at a depth halfway between the skin
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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

o In women, it is distributed in a
● The anterior abdominal wall is innervated by the triangular area, the base of which is
abdominal extensions of the intercostal nerves (T7- formed by the upper margin of the
11), the subcostal nerve (T12), and the iliohypogastric symphysis.
and the ilioinguinal nerves (L1). o In men and in some hirsute women, the
● The T10 dermatome approximates the level of the escutcheon is not so well circumscribed
umbilicus. and extends onto the anterior
● The iliohypogastric nerve provides sensation to the abdominal wall toward the umbilicus.
skin over the suprapubic area.
● The ilioinguinal nerve supplies the skin of the lower
abdominal wall and upper portion of the labia
majora and medial portion of the thigh through its
inguinal branch.
● These two nerves pass 2 to 3 cm medial to the
anterior superior iliac spine and course between the
layers of the rectus sheath.
● The ilioinguinal and iliohypogastric nerves can be
entrapped during closure of low transverse incisions,
especially if incisions extend beyond the lateral
borders of the rectus muscle.
● These nerves carry sensory information only, and
injury leads to loss of sensation within the areas
supplied.
● Labia Majora
External Generative Organs o Embryologically, the labia majora are
homologous with the male scrotum.
o These structures vary somewhat in
appearance, principally according to
the amount of fat they contain.
o They are 7 to 8 cm in length, 2 to 3 cm in
depth, and 1 to 1.5 cm in thickness.
o They are continuous directly with the mons
pubis superiorly, and the round ligaments
terminate at their upper borders.
o Posteriorly, the labia majora taper and merge
into the area
overlying the perineal body to form the
posterior commissure.
o The outer surface of the labia majora is
● The pudenda—commonly designated the
covered with hair, whereas on their inner
vulva—includes all structures visible
surface, it is absent.
externally from the pubis to the perineal
o In addition, apocrine and sebaceous glands
body. This includes
are abundant.
o mons pubis
o Beneath the skin, there is a dense connective
o labia majora and minora
tissue layer, which is nearly void of muscular
o clitoris elements but is rich in elastic fibers and
o hymen adipose tissue.
o vestibule o This mass of fat provides bulk to the labia
o urethral opening majora and is supplied with a rich venous
o greater vestibular or Bartholin glands plexus.
o minor vestibular gland o During pregnancy, this vasculature
o paraurethral glands commonly develops varicosities, especially
● Mons Pubis in parous women, from increased venous
o Also called the mons veneris, this pressure created by advancing uterine weight.
fat-filled cushion overlies the o They present as engorged tortuous
symphysis pubis. veins or as small grapelike clusters but
o After puberty, the skin of the mons are typically asymptomatic.
pubis is covered by curly hair that
forms the escutcheon.
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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

● Labia Minora ● Vestibule

o Each is a thin fold of tissue, which lies medial o The functionally mature
to each labia majora. female structure derived
o In males, its homologue forms the ventral shaft of from the embryonic
the penis. urogenital membrane.
o Extend superiorly, where each divides into two o In adult women, it is an almond-
lamellae. shaped area that is enclosed by Hart
o The lower pair fuses to form the frenulum of the line laterally, the external surface of
clitoris, and the upper pair merges to form the the hymen medially, the clitoral
prepuce. frenulum anteriorly, and the
o Inferiorly, the labia minora extend to approach the fourchette posteriorly.
midline as low ridges of tissue that fuse to form the o Usually is perforated by six openings:
fourchette. ▪ the urethra
o Structurally, composed of connective tissue with ▪ the vagina
many vessels, elastin fibers, and some smooth ▪ two Bartholin gland ducts
muscle fibers. ▪ two ducts of the largest
o They are supplied with a variety of nerve paraurethral glands—the
endings and are extremely sensitive. Skene glands.
o The epithelia of the labia minora vary with location. ▪ The posterior portion of
Stratified squamous epithelium covers the outer the vestibule between
surface of each labium. the fourchette and the
o The lateral portion of the inner surface is covered vaginal opening is called
by stratified squamous epithelium to a demarcating the fossa navicularis. It is
line—the Hart line. Medial to this line, each labium usually observed only in
is covered by squamous epithelium that is nulliparous women.
nonkeratinized. ● Vestibular Glands
o Although the labia minora lack hair follicles, o Bartholin glands
eccrine glands, and apocrine glands, there are ▪ Also termed greater vestibular glands,
many sebaceous glands. are the major glands.
▪ They measure 0.5 to 1 cm in diameter.
● Clitoris ▪ They lie inferior to the vestibular
o Homologue of the penis bulbs and deep to the inferior ends of
o located beneath the prepuce and above the the bulbocavernosus muscle on either
urethra. side of the vaginal opening.
o It projects downward between the branched ▪ Their ducts are 1.5 to 2 cm long and
extremities of the labia minora, and the free end open distal to the hymenal ring at 5
points downward and inward toward the vaginal and 7 o'clock.
opening. ▪ Following trauma or infection, either
o The clitoris rarely exceeds 2 cm in length and duct may swell and obstruct to form a
is composed of a glans, a corpus or body, and cyst or if infected, an abscess.
two crura. o Paraurethral glands
o The glans is usually less than 0.5 cm in diameter,
▪ an arborization of glands whose
is composed of spindle-shaped cells, and is
ducts open predominantly along the
covered by stratified squamous
entire inferior aspect of the urethra.
epithelium that is richly innervated.
▪ The two largest are called Skene
o The clitoral body contains two corpora cavernosa.
glands, and their ducts typically
o Beneath the ventral surface of this body,
lie distally near the urethral
homologues of the corpora spongiosa
meatus
unite to form a commissure.
o These homologues are anterior extensions of the
▪ Inflammation and duct obstruction of any
vestibular bulbs.
of the paraurethral glands can lead to
o Extending from the clitoral body, each corpora
urethral diverticulum formation.
cavernosa diverges laterally to form the long,
▪ The minor vestibular glands are shallow
narrow crura.
glands lined by simple mucin-secreting
o These lie along the inferior surface
epithelium and open along Hart line.
of the ischiopubic rami and deep to
● Urethral Opening
the ischiocavernosus muscles.
o The lower two thirds of the
urethra lie immediately above the
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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

anterior vaginal wall. caruncles.

o The urethral opening or meatus is in the
midline of the vestibule, 1 to 1.5 cm Vagina
below the pubic arch, and a short o Anterior wall-6-8cm; posterior wall 7-10 cm,
distance above the vaginal opening. divided into anterior posterior and 2 lateral
● Vestibular Bulbs fornices by the cervix.
o Embryologically, the vestibular o Clinical importance:
bulbs correspond to the corpus o internal pelvic organs usually can be
spongiosum of the penis. palpated through their thin walls
o These are almond-shaped o posterior fornix provides surgical access
aggregations of veins, 3 to 4 cm long, 1 to the peritoneal cavity through the cul
to 2 cm wide, and 0.5 to 1 cm thick, de sac or pouch of Douglas.
which lie beneath the o Divided by a septum from the bladder and
bulbocavernosus muscle on either side urethra.
of the vestibule. o Anteriorly- vesicovaginal septum
o The bulbs terminate inferiorly at o Posteriorly- rectovaginal septum
approximately the middle of the o Lining epithelium: non-keratinized stratified
vaginal opening and extend upward squamous epithelium
toward the clitoris. o no glands
o Their anterior extensions merge in the o abundant vascular supply
midline, below the clitoral body.
o During childbirth, the vestibular bulbs
may be injured and may even rupture Blood Lymphatic
Nerve supply
to create a vulvar supply drainage
● Vaginal Opening and Hymen Upper third of ● uterine ● exter
Vagina/Proximal artery nal iliac
o The vaginal opening is rimmed distally by ● vaginal nodes
the hymen or its remnants. artery ● intern
o In adult women, the hymen is a al iliac nodes Inferior
membrane of varying thickness Middle third inferior ● Inter hypogastric
that surrounds the vaginal vesical nal iliac plexuses
opening more or less arteries nodes
completely. Lower internal ● Superficial
o It is composed mainly of elastic and third/Distal pudendal inguinal
collagenous connective tissue, and both arteries noes
outer and inner surfaces are covered by
stratified squamous epithelium. HYMEN
o The aperture of the hymen ranges o elastic and collagenous connective tissue
in diameter from pinpoint to one o Lined by stratified squamous epithelium
that admits the tip of one or even o no glandular or muscular elements, and it is not
two fingers. richly supplied with nerve fibers
o Imperforate hymen is a rare lesion in o Appearance varies with age:
which the vaginal orifice is occluded o Newborn- very vascular and redundant
completely, causing retention of o Pregnant- thick, rich in glycogen
menstrual blood o Menopause- thin; focal cornification may
o As a rule, however, the hymen is torn develop
at several sites during first coitus.
o Identical tears may occur by other Perineum
penetration, for example, tampons
used during menstruation.
o The edges of the torn tissue soon re-
epithelialize.
o In pregnant women, the epithelium
of the hymen is thick, and the tissue
is rich in glycogen. Changes produced
in the hymen by childbirth are usually
readily recognizable. Over time, the
hymen consists of several nodules of
various sizes, also termed hymenal
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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

- diamond-shaped area between the thighs. o internal anal sphincter-smooth muscle,

contributes to the bulk of anal canal resting
Superficial Space of the Anterior Triangle pressure for recal continence
● bounded deeply by the perineal membrane and o external anal sphincter- striated muscle ,
superficially by Colles fascia. maintains constant resting contraction to aid
● closed compartment, and infection or bleeding continence.
within it remains contained. Anal Canal
● Structures: Anal Sphincters: Two sphincters surround the anal
o ischiocavernosus, canal to provide continence— the external and
o bulbocavernosus, and internal anal sphincter
o superficial transverse perineal muscles; ● Both lie proximate to the vagina, and
o Bartholin glands; one or both may be torn during vaginal
o vestibular bulbs; delivery.
o clitoral body and crura; ● Of these disruptions, many are not clinically
o branches of the pudendal vessels and nerve identified at delivery.
● Clinical correlate: Clinically, these defects can have functional consequences.
● veins in the vestibular bulbs maybe lacerated Internal Anal Sphincter (IAS)
or rupture during childbirth to create a vulvar
hematoma enclosed within the supercial ● This sphincter contributes the bulk of anal
space of the anterior triangle. canal resting pressure for fecal continence,
and it relaxes prior to defecation.
Deep Space of the Anterior Triangle ● The sphincter is formed by distal continuation
● lies deep to the perineal membrane and of the inner circular smooth muscle layer of
extends up into the pelvis the rectum and colon.
● continuous superiorly with the pelvic cavity ● The IAS measures 3 to 4 cm in length, and at
Structures: its distal margin, it overlaps the external
- parts of urethra and vagina sphincter for 1 to 2 cm.
- branches of the internal pudendal artery ● Thus, the IAS may be involved in fourth-degree
- compressor urethrae and urethrovaginal sphincter lacerations, and reunion of this ring is
muscles incorporated in their repair.
● Received predominantly parasympathetic fibers
Pelvic diaphragm
● Found deep to the anterior and posterior triangles External Anal Sphincter (EAS)
● Deepest muscle layer • striated muscle
● composed of the levator ani and the coccygeus • It maintains a constant state of resting contraction
muscle. that provides increased tone and strength when
Levator ani: continence is threatened, and it relaxes for
● pubococcygeus-more commonly damage during defecation.
childbirth ● Hsu and colleagues (2005) studied structure
● puborectalis of the EAS using magnetic resonance (MR)
● iliococcygeus muscles imaging.
❖ injuries to these muscles may predispose three structures:
women to pelvic organ prolapse or urinary o main body—EAS-M,
incontinence. o the subcutaneous sphincter—
EAS-SQ, and
Posterior Triangle o the wing- shaped end—EAS-W,
contains : which has fibers with lateral
● ischioanal fossae • The external sphincter receives blood supply from
- these two fat-filled wedge-shaped spaces are the inferior rectal artery.
found on either side of the anal canal and • Somatic motor fibers from the inferior rectal
comprise the bulk of the posterior triangle branch of the pudendal nerve supply innervation.
- injury to vessels in the posterior triangle can lead
to hematoma formation in the ischioanal fossa, Pudendal Nerve
and the potential for large accumulation ● formed from the anterior rami of S2–4 spinal nerves
● anal canal ● courses between the piriformis and coccygeus
● anal sphincter complex which consists of muscles
● runs beneath the sacrospinous ligament and above
the sacrotuberous ligament as it reenters the lesser

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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

sciatic foramen to course along the obturator ●

becomes dome shaped.
internus muscle.- ALCOCK CANAL ●
The round ligaments now appear to insert at the
● leaves this canal to enter the perineum junction of the middle and upper thirds of the
● 3 terminal branches: organ.
o Dorsal nerve of the clitoris – supplies ● The fallopian tubes elongate, but the ovaries
the skin of the clitoris grossly appear unchanged.
o Perineal nerve – supplies the muscles of BLOOD SUPPLY OF UTERUS
the anterior triangle and labial skin
o Inferior rectal nerve – supplies the
external anal sphincter, mucous
membrane of anal canal and the perineal
skin
Internal Pudental artery -major blood supply
to the perineum

INTERNAL GENERATIVE ORGANS

A. Uterus
● Thick- walled, hollow, muscular organ
● Nulliparous: 6- 8cm, fundus and cervix almost equal
in length
● Multiparous: 9-10cm, cervix is 1/3 of the total length
● Entire posterior wall of the uterus is covered by ● Uterine artery
serosa, or peritoneum, the lower portion of which o main branch of the internal iliac artery—
forms the anterior boundary of the recto-uterine cul- previously called the hypogastric artery
de-sac, or pouch of Douglas. o Approximately 2 cm lateral to the cervix,
● Blood supply: the uterine artery crosses over the ureter.
o uterine artery o The smaller cervicovaginal artery supplies
o ovarian artery blood to the lower cervix and upper vagina.
o Main cervical blood supply at 3 and 9 o clock
Uterus: Parts position. Ligated during cone biopsy.
● Corpus or body o The main branch turns upward and
● Cervix tranverses lateral margin.
● Isthmus – between the internal cervical os and the o 2 ways to differentiate ureter from pelvic
endometrial cavity; forms the lower uterine vessel:
segment during pregnancy 1. Visualization of peristalsis after
● Cornua – at the junction of the superior and lateral stimulation by surgical instrument.
margins; insertion of the fallopian tube 2. Visualization of the Auerbach’s plexus
● Fundus – convex upper segment between the (numerous wavy small vessels that
points of insertion of the fallopian tubes; where anastomose over the surface of the
the pressure during uterine contraction is the ureter.
greatest because it will push down the fetus. o Other branches of penetrate the body of the
uterus. 3 terminal branches
1. Ovarian branch-anastomose with the
terminal branch of the ovarian artery
2. Tubal branch-supplies part of fallopian
tube
3. Fundal branch-penetrates the uterus
● Ovarian artery
o Branch of aorta-enters broad ligament
through the infundibulopelvic ligament;
supplies ovary, fallopian tubes, uterus.
❖ “Dual uterine blood supply”
Pregnancy-Induced Uterine Changes -ischemia is prevented if ligation of
internal iliac artery is performed.
● Pregnancy stimulates remarkable uterine growth B. CERVIX
due to hypertrophy of muscle fibers. Uterine ● internal os - upper boundary
weight increases from 70 g to approximately ● external os- ectocervix
1100 g at term. -non keratinized squamous epithelium
● Its total volume averages about 5 L. ● cervical stroma
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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

- composed mainly of collagen, elastin, and

proteoglycans, but very little smooth
muscle.
Cervical Changes in Pregnancy
● Chadwick sign-cervix becomes bluish in color
● Goodell sign- softening of cervix
● Hegar sign-softening of isthmus

Ligaments

● Internal Iliac Artery

-ligation distal to the posterior division to
avoid compromised blood flow to the areas
supplied.
o Anterior Division – supplies pelvic organ
and the perineum
1. Inferior gluteal
2. Internal pudental
3. Middle rectal
● Round ligament 4. Vaginal
-correspondsembryologically to the male 5. Uterine
gubernaculum testis. 6. Obturator
- can aid in fallopian tube identification 7. Umbilical and superior vesical
during puerperal sterilization. o Posterior Division-supplies the
- corresponds embryologically to the buttocks and thigh
gubernaculum testis of men 1. Superior gluteal
- During pregnancy, undergo considerable hypertrophy 2. Lateral sacral
and increase appreciably in both length and diameter. 3. Iliolumbar
- Sampson artery- branch of the uterine artery,
runs within this ligament.
LYMPHATICS OF THE UTERUS
● BROAD LIGAMENT Lymph nodes of pelvis
o are made up of two winglike structures ● Internal iliac lymph node
that extend from the lateral margins of o Surround internal iliac vessels
the uterus to the pelvic walls. o Receive afferents from pelvic visceraperineum,
o divide the pelvic cavity into anterior and buttock and back of thigh.
posterior compartments. ● External iliac lymph nodes
o upper part is made up of three folds that o Lie along external iliac artery
nearly cover the oviduct o Receive afferents from lower limb and some parts
● Cardinal ligament of pelvic viscera
o also called the transverse cervical ● Sacral lymph node
ligament or Mackenrodt ligament ● Common iliac lymph node
o densest portion 1. Lie along common iliac artery
● Uterosacral ligament 2. Receive afferents from all the above nodes
o originates with a posterolateral 3. Efferent pass to lumbar lymph node.
attachment to the supravaginal portion of
the cervix and inserts into the fascia over ❖ Lymphatic from the cervix terminate mainly in the
the sacrum, with some variations. internal iliac lymph nodes.
❖ The ligaments are composed of connective tissue, ❖ Lymphatics from the uterine corpus-internal iliac lymph
small bundles of vessels and nerves, and some nodes and paraaortic lymph nodes.
smooth muscle. They are covered by peritoneum
and form the lateral boundaries of the pouch of INNERVATION OF THE UTERUS
Douglas. ● Sympathetic innervation
BLOOD SUPPLY OF PELVIS

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S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

o Superiorhypogastric plexus or presacral nerve 🟊 Cortex

formed from T10-T12.At sacral promontory ◈ Outer layer
divides into: ◈ Contains oocytes and developing follicles
▪ Right hypogastric nerve 🟊 Medulla
▪ Left hypogastric nerve ◈ Central portion
● Parasympathetic innervation ◈ Composed of loose connective tissue
o Derived from S2-S4; combine to form the pelvic 🖝 Blood supply: Ovarian artery which is a direct
splanchic nerves branch of the aorta
● Inferior hypogastric plexus-blending of two 🖝 Innervation: both sympathetic nerves from the
hypogastric nerves (sympathetic) and two pelvic ovarian plexus and parasympathetic nerves.
splanchnic nerves, lies at S4 and S5.
● Fibers of inferior hypogastric plexus accompany the D.FALLOPIAN TUBES
internal iliac branches to respective viscera: 🖝 Vary in length from 8 to 14 cm
o Vesical plexus 🖝 Lumen is lined by mucous membrane
o Middle rectal
🖝 Parts
o Uterovaginal plexus od Frankenhauser plexus-
🟊 Interstitial portion: communication between
proximal fallopian tubes,uterus and upper
uterine cornu and fallopian tubes
vagina;branches to clitoris and vestibular bulbs.
🟊 Isthmus: narrowest; common site of ectopic
o Uterine contractions-sensory afferent through inferior
pregnancy
hypogastric plexus and enter spinal cord via T10-L1
🟊 Ampulla: common site of fertilization
spinal nerves which then is transmitted to the CNS.
🟊 Infundibulum or fimbriated extremity:
o Cervix and upper part of birth canal-pass through the
funnel-shaped opening at the distal
pelvic splanchnic nerves to S2-S4 sacral nerves.
o Lower portion of birth canal-pass through the 🖝Cliated cell most abundant at fibriatedend. More
pedental nerve. complexlongitudinal folds in the mucosa toward the
fimbria.
C.OVARY
🖝 Tubal smooth muscle
🟊 Inner circular and outer longitudinal
🟊 Undergo rhythmic contraction or peristalsis toward
the uterine cavity
🖝 Epithelium
🟊 Close contact with muscle layer because there
is no submucosa
🟊 Composed of columnar cells (some ciliated,
others secretory
🖝 Has the ability to go into tubal peristalsis which is believed
to be an extraordinary important factor in the
🖝 Vary considerably in size transport of the ovum to the endometrium
🖝 During childbearing years: 🖝 Diverticula may extend occasionally from the lumen of the
🟊 2.5 to 5 cm in length, 1.5 to 3 cm in breadth, tube and may play a role in ectopic pregnancy
and 0.6 to 1.5 cm in thickness 🖝 Supplied richly with elastic tissue, blood vessels and
🟊 Approximate volume <10cc. lymphatics
🖝 After menopause 🖝 Innervation : sympathetic innervation of the tubes is
🟊 Ovarian size diminishes remarkably as well as the extensive, in contrast to their parasympathetic
function innervation.
🟊 Approximate volume <1.5 cc
🖝Cross section of fallopian tube
🖝 Rest in a slight depression on the lateral wall of the
pelvis, called ovarian fossa of Waldeyer between 🟊Mesosalpinx-single cell mesotheial
the divergent external and internal iliac vessels layer, visceralperitoneum.
🖝 Attached to the: 🟊Myosalpinx-smooth muscle layer:inner circular
🟊 Broad ligament by the mesovarium and outer longitudinal;;contract rhythmically.
🟊 Uterus by the utero-ovarian ligament
🟊 Endosalpinx-single columnar epthelium
🟊 Lateral pelvic wall by the infundibulopelvic
composed of ciliated and secretory cells.
ligament
🖝 Covered by the peritoneum
🖝 Made up of muscles and connective tissues Musculosskeletal Pelvic Anatomy
Pelvic Bones
🖝 Parts:
● composed of four bones
Page 9 of 11
S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

o sacrum, ● True conjugate

o coccyx, and ● Obstetric conjugate
o two innominate bones. o Clinically important;usually measure 10 cm
● Each innominate bone is formed by the fusion of ● Diagonal conjugate
three bones— o Measurable;OC is estimated by substracting, 1.5-
o the ilium, 2cm from diagonal conjugate.
o ischium, and
o pubis
FALSE AND TRUE PELVIS
● Pelvic brim- a line from the sacral promontory to the
upper part of the pubic symphisis
● False pelvis - lies above the pelvic brim
● True pelvis- lies below pelvic brim
● Pelvic axis- path of baby during birth

PLANES AND DIAMETERS OF THE PELVIS

● Pelvic Inlet- superior strait
● Midpelvis – least pelvic dimensions
● Pelvic outlet-inferior strait
● Plane of greatest pelvic dimension-no obstetric
MIDPLANE/MIDPELVIS
significance.
● Also called plane of least pelvic dimensions
● Measured at the level of the ischial spines.
● During labor, the degree of fetal heard descent into the
true pelvis may be described by station and the
midpelvis and ischial spines serve to mark zero station.
● Fetal station is determined with reference to the ischial
spines.
● Interspinous diameter-10cm or slightly greater

PELVIC INLET
● Engagement-when the BPD of the fetal head passes
through this plane.
PELVIC OUTLET
● Pubic arch 90-100degree
● Diameters:
o AP,transverse(bituberous)and posterior saggital
● Seldom obstructs vaginal delivery

Page 10 of 11
S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A
 OBSTETRICS Term 1
Lesson 1.1 Maternal Anatomy
Dr. Jane Publico

CALDWELL-MOLOY CLASSIFICATION
● Posterior segment determines the type of pelvis while
anterior segment determines the tendency.

CAVITY AND OUTLET

GYNECOID ANTHROPOID ANDROID PLATYPELLOID

Sacrosciatic Wide and Wide and Narrow and Slightly narrow and
notch shallow shallow deep small
Straight or
Straight or
sidewalls slightly convergent divergent
divergent
divergent
Long and Long and
Pubic arch curved Short and curved
curved straight
Subpubic Wide Slightly Very wide
narrow
angle (85degree) narrow (>90degree)
Bituberous Normal or
Normal short wide
diameter short

Page 11 of 11
S2-T1AFAN, M | AGUITE, D | ASERON, J | BUCAD, M | BURAGA, G | CALIP, J |DANGUILAN, F |DONGA, K | DOYAOEN, C |DUHALNGON, G | FABIAN, F |
FORAYO, L | JUAN, C | KIGI-E, J | MADRIAGA, J | NABEJET, P | NG, D | REYES, C | REYES, L | SALVADOR, K | TABUNIAR, J | TOLLINO, A | VERDADERO, A | WANASON, A