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    Ma. Elizabeth F. Fontanilla

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    tam mei
    The document provides an overview of the female pelvis and reproductive anatomy. It describes the layers of the skin, subcutaneous tissue, and rectus sheath. It details the blood vessels, nerves, and structures of the vulva. It discusses the vagina, perineum, uterus, fallopian tubes, ovaries and their features. The document also describes the bones of the pelvis, the true and false pelvis, pelvic inlet, midpelvis, outlet and diameters. It summarizes the stages of labor.

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    Ma. Elizabeth F. Fontanilla

    Uploaded by

    tam mei
    107 views48 pages
    The document provides an overview of the female pelvis and reproductive anatomy. It describes the layers of the skin, subcutaneous tissue, and rectus sheath. It details the blood vessels, nerves, and structures of the vulva. It discusses the vagina, perineum, uterus, fallopian tubes, ovaries and their features. The document also describes the bones of the pelvis, the true and false pelvis, pelvic inlet, midpelvis, outlet and diameters. It summarizes the stages of labor.

    Original Title

    Maternal Anatomy

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    The document provides an overview of the female pelvis and reproductive anatomy. It describes the layers of the skin, subcutaneous tissue, and rectus sheath. It details the blood vessels, nerves, and structures of the vulva. It discusses the vagina, perineum, uterus, fallopian tubes, ovaries and their features. The document also describes the bones of the pelvis, the true and false pelvis, pelvic inlet, midpelvis, outlet and diameters. It summarizes the stages of labor.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    107 views48 pages

    Ma. Elizabeth F. Fontanilla

    Uploaded by

    tam mei
    The document provides an overview of the female pelvis and reproductive anatomy. It describes the layers of the skin, subcutaneous tissue, and rectus sheath. It details the blood vessels, nerves, and structures of the vulva. It discusses the vagina, perineum, uterus, fallopian tubes, ovaries and their features. The document also describes the bones of the pelvis, the true and false pelvis, pelvic inlet, midpelvis, outlet and diameters. It summarizes the stages of labor.

    Copyright:

    © All Rights Reserved
    Download as PPTX, PDF, TXT or read online from Scribd
    Download as pptx, pdf, or txt
    of 48

    Ma. Elizabeth F.

    Fontanilla

    Skin Langer lines: orientation of dermal fibers within the skin Subcutaneous Layer This layer can be separated into a superficial, predominantly fatty layer Camper fascia, and a deeper, more membranous layerScarpa fascia. Rectus Sheath

    Femoral Artery Branches


    superficial epigastric superficial circumflex iliac external pudendal

    External Iliac Artery Branches


    intercostal nerves (T711) subcostal nerve (T12) Iliohypogastric nerve ilioinguinal nerves (L1 )

    inferior "deep" epigastric vessels deep circumflex iliac vessels


    Blood supply Innervation

    Vulva
    The pudendacommonly designated the vulva includes all structures visible externally from the pubis to the perineal body. Includes:

    mons pubis labia majora and minora Clitoris Hymen Vestibule urethral opening greater vestibular or Bartholin glands minor vestibular glands paraurethral glands

    Musculomembranous structure Extends from the vulva to the uterus Upper portion: mllerian duct; lower portion: urogenital sinus Anteriorly: vesicovaginal septum; Posteriorly: rectovaginal septum. The upper fourth of the vagina is separated from the rectum by the recto-uterine pouch, also called the cul-de-sac of Douglas. Vaginal length varies considerably, but commonly, the anterior and posterior vaginal walls are, respectively, 6 to 8 cm and 7 to 10 cm in length. Upper end of the vaginal vault is subdivided into anterior, posterior, and two lateral fornices by the cervix.

    Proximal portion: cervical branch of the uterine artery and by the vaginal artery posterior vaginal wall: middle rectal artery distal walls: internal pudendal artery

    Vascular supply

    diamond-shaped area between the thighs The anterior, posterior, and lateral boundaries of the perineum are the same as those of the bony pelvic outlet:
    Anteriorly: pubic symphysis Anterolaterally: ischiopubic rami and ischial tuberosities Posterolaterally: sacrotuberous ligaments Posteriorly: coccyx

    urogenital triangle bounded by the pubic rami superiorly, the ischial tuberosities laterally, and the superficial transverse perineal muscle posteriorly

    anal triangle contains the ischiorectal fossa, anal canal, anal sphincter complex, and branches of the internal pudendal vessels and pudendal nerve

    Anterior triangle

    Posterior triangle

    Uterus

    Fallopian
    Ovaries

    tubes

    pear-shaped muscular organ, it resembles a flattened pear 2 major parts:


    upper triangular portion (body or corpus) lower, cylindrical portion (cervix)

    Isthmus: lower uterine segment Composed of 3 layers:


    ENDOMETRIUM MYOMETRIUM EXTERNAL SEROSA

    Supported by several ligaments:


    1 anterior (vesicouterine fold of peritoneum) 1 posterior ligament (rectovaginal fold of peritoneum) 2 broad ligaments 2 transverse cervical ligaments 2 round ligaments 2 uterosacral ligaments

    Arcuate

    arteries - encircle endometrium Radial arteries connect arcuate to straight Straight arteries deliver blood to basilar zone Spiral arteries deliver blood to functional zone

    Barrel shaped structure measuring about 3cm long Extends from the isthmus of uterus to the upper portion of vagina Divided into:

    Supravaginal portion Vaginal portion

    Musculotubular structures measuring 8-14 cm long Four parts:


    Interstitium Isthmus (narrowest) Ampulla (widest) Infundibulum

    The ends of the fallopian tubes lying next to the ovaries feather into ends called fimbria
    Millions of tiny hair-like cilia line the fimbria and interior of the fallopian tubes. The cilia beat in waves hundreds of times a second catching the egg at ovulation and moving it through the tube to the uterine cavity. Fertilization typically occurs in the fallopian tube

    Paired, almond-shaped bodies measuring 3x2x1cm Has 2 surfaces (lateral and medial), 2 borders (anterior and posterior) and 2 poles (upper and lower) they produce eggs (also called ova) every female is born with a lifetime supply of eggs they also produce hormones:

    Estrogen & Progesterone

    composed

    of four bones: the sacrum, coccyx, and two innominate bones (ilium, ischium, pubis)

    False pelvis
    lies above the linea terminalis Boundaries: posteriorly by the lumbar vertebra and laterally by the iliac fossa, anteriorly by the lower portion of the anterior abdominal wall

    True pelvis
    below the linea terminalis Boundaries: above by the promontory and alae of the sacrum, the linea terminalis, and the upper margins of the pubic bones, and below by the pelvic outlet.

    Pelvic

    inlet Midpelvis Pelvic outlet

    Boundaries:
    Posteriorly:promontory and alae of the sacrum Laterally: linea terminalis Anteriorly: horizontal pubic rami and the symphysis pubis

    4 diameters of the pelvic inlet are usually described: anteroposterior, transverse, and two oblique diameters. The obstetrically important AP diameter: obstetrical conjugate (>10cm; cannot be measured directly)

    Measured

    at the level of the ischial spines The interspinous diameter, 10 cm or slightly greater, is usually the smallest pelvic diameter.

    This consists of two approximately triangular areas that are not in the same plane. They have a common base, which is a line drawn between the two ischial tuberosities The apex of the posterior triangle is at the tip of the sacrum, and the lateral boundaries are the sacrosciatic ligaments and the ischial tuberosities. The anterior triangle is formed by the area under the pubic arch. Three diameters of the pelvic outlet usually are described: the anteroposterior, transverse, and posterior sagittal.

    Tests to determine adequacy of PELVI C INLET:


    Diagonal conjugate determination Engagement Fixation (No more movement left to right) Mueller-Hillis maneuver Bimanual exam to ensure position of the BPD at station 0.

    Tests to determine adequacy of MIDPELVIS:


    Ischial spines are not prominent Sidewalls are not converged

    Deep sacral concavity


    MPI 14.0 considered adequate. IS + PS = MPI

    Tests to determine adequacy of PELVI C OUTLET:


    Subpubic arch (90-1000) Biischial diameter - done by placing a closed fist on the perineum (Normally > 8 cm because the closed fist is approximately 8 cm.)

    Transverse INLET 13 cm.

    Antero-Posterior DC 11.5 cm. TC - 11 cm. OC 10 cm.

    MIDPELVIS
    OUTLET

    10 cm. (Interspinous)
    11 cm. (Intertuberous)

    11.5 cm.
    9.5 11.5 cm.

    Gynecoid
    Inlet Shape Anterior and posterior segment round Almost equal and spacious

    Anthropoid

    Android

    Platypelloi d
    Transversel y oval Both reduced flat

    Anteroposte Triangular riorly oval Both increased with slight anterior narrowing Long and narrow Not prominent Long and curved Posterior segment short and anterior segment narrow

    Sacrum

    Well curved

    Inclined Inclined forward and posteriorly straight and straight prominent Long and straight Not prominent Short and curved

    Outlet

    Ischial spines Pubic arch

    Not prominent curved

    Sub pubic angle


    Bi tuberous

    wide
    normal

    Slight narrow
    Normal or

    narrow
    Short

    Very wide
    wide

    Physiologic process during which the products of conception are expelled outside of the uterus Labor is a clinical diagnosis Characterized as regular, painful uterine contractions Following painful uterine contractions, other signs that point out to true labor:

    Bloody Show Rupture of Membranes Complete cervical effacement


    Engagement
    Descent Flexion Internal

    Rotation Extension External Rotation Expulsion

    FIRST STAGE OF LABOR:


    Average duration: 8 hrs (nulliparous), 5 hrs (multiparous) Begins with regular uterine contractions and ends with full cervical dilatation at 10 cm 2 phases:

    Latent phase: period between the onset of labor and when the rate of cervical dilatation changes most rapidly, usually at about 3-4cm Active phase: period of increased rapidity of cervical dilatation and ends with complete cervical dilatation of 10cm

    SECOND STAGE OF LABOR:


    Average duration: 2 hours (nulliparous), 1 hr (multiparous) Commences with full cervical dilatation and ends with the delivery of the fetus

    Factors that lengthen second stage:


    Contracted pelvis Large fetus Impaired expulsive efforts Anesthesia

    SECOND STAGE RULES:


    2 hours for nullipara and extended to 3 hours when under regional anesthesia 1 hour for multipara and extended to 2 hours under regional anesthesia

    THIRD

    STAGE OF LABOR:

    After delivery of the fetus until the delivery of the placenta Delivery of the placenta may require less than 10 minutes, but the duration may last as long as 30 minutes before active intervention is considered

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