Childrens attention span is only about

as many minutes as they are old (ex. 2

minutes for 2 years old).

VICTORY CHRISTIAN FELLOWSHIP KIDS CHURCH

MINISTRY

MATERNAL ANATOMY
CHAPTER 2
PAGE 16-35

Internal Generative
Organs
FEMALE REPRODUCTIVE TRACT

Uterus
Cervix
Ovaries
Fallopian tubes
Veins,Arteries,Nerves

Reading pleasure

External Generative Organs

Vulva (Mons Pubis, Labia and clitoris)
Vagina and Hymen
Superficial and Deep Space of the Anterior Triangle
Posterior Triangle
Anal Sphincter Complex

Vestibule
Perineum
Pelvic Diaphragm
Ischioanal Fossae
Pudendal nerve

Situated between the bladder

(anterior) and the rectum (posterior).
Visceral peritoneum
-covers the entire posterior uterine
wall. Lower portion of the peritoneum
forms the anterior boundary of Pouch
of Douglas
-Only the upper portion of the anterior
wall of uterus is covered with
peritoneum.

Uterus

vesicouterine pouch
vesicouterine space

Uterus
Pear shaped
2 major unequal parts:
-body or corpus
-cervix
Isthmus- forms the LUS in
pregnancy
Uterine cornu- from which the FT
emerges

Fallopian tube
Round ligament
Uteroovarian ligament
Fundus

Uterus

muscular

Inner surfaces lie almost in contact with each other,

the cavity between these walls forms a mere slit.

Effects of Pregnancy

Fundus and cervix, equal in length- nulligravid

Cervix is only little more than a third of the total

length-multiparas

6-8 cm- nulligravid uterus

9-20 cm- multiparous women

60 grams in nulligravid, weighs more in parous

woman

Effects of Pregnancy
Flattened

fundus becomes dome shaped.

Round

ligaments appear to insert in the junction

of the middle and upper thirds of the uterus.

Fallopian

tubes elongate, ovaries unchanged

Cervix
Fusiform
Open at each end by small
apertures
Cervical stroma- collagen, elastin,
proteoglycans and very little
smooth muscle

Portio supravaginalisupper cervical segment,

where cardinal ligaments
attached laterally
Portio vaginalis- lower
cervical segment that
protrudes in the vagina

Speculum exam

Cervix on speculum

Beforechildbirth
childbirth
Before

After labor

Proximally- internal os
Ectocervix
- portion of the cervix exterior to the external os.
-nonkeratinized stratified squamous epithelium.

Endocervical canal
-covered by a single layer of mucin secreting columnar epithelium

Pregnancy effects
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Hegar sign

Chadwick sign

Goodell sign

Isthmic softening

Ectocervical blue tint

Softening of cervix

Myometrium
Myometrium

smooth muscle bundles united by connective

tissue with elastic fibers

Interlacing myometrial fibers contract and

compress myometrial vessels for hemostasis

Endometrium

composed of overlying epithelium,

invaginating glands,vascular stroma
Divided into:
Functionalis layer- sloughed with
menses
Basalis layer-regenerate the functionalis
layer following menses

Ligaments

Putting off the

things I dont
want to do today
will disqualify me
to do the things
I want to do
tomorrow.

Round ligament
Round ligament- corresponds embryologically to the male gubernaculum testis
- originated below and anterior to the origin of FT.
- clinically important for id of FT during sterilization.

Extends laterally and downward into the inguinal canal, through which it passes, to
terminate in the upper portion of labia majora.

Sampson artery, runs within this ligament

Broad ligaments

-are two winglike structures that extend from the

lateral uterine margins to the pelvic sidewalls.

Uterine vessels and ureter are found at its

base.

Each broad ligament consist of a fold

peritoneum termed anterior and posterior
compartments.

Mesosalpinx-drapes the FT
Mesoteres- around the round ligament
Mesovarium-over the uteroovarian
ligament
Infundibulopelvic/Suspensory ligamentfrom the fimbriated end of FT towards
pelvic wall
-contains nerve and ovarian vessels

Cardinal ligament

Aka Transverse cervical ligament or Mackendrot ligament

Thick base of the broad ligament

Medially, it is united firmly to the uterus and upper vagina

Uterosacral ligament

Originates with a posterolateral attachment to the supravaginal portion

of the cervix and inserts into the fascia over the sacrum

Composed of connective tissue, small bundles of vessels and nerves

and smooth muscle

Covered by peritoneum, these ligaments form the lateral boundaries of

the pouch of Douglas

Parametrium is used to describe the connective tissues

adjacent and lateral to the uterus within the broad
ligament.

Paracervical tissues- are those adjacent to the cervix

Paracolpium-is the tissue lateral to the vaginal walls

Blood supply

Uterine artery

-enters the base of the broad ligament

and makes it medially to the side of the
uterus.
Approximately 2 cms lateral to the
cervix, uterine artery crosses over the
ureter.
The ureter may be accidentally injured
or ligated during hysterectomy when this
vessel is clamped and ligated

Uterine artery division as it reaches

supravaginal portion of the cervix
1. Cervicovaginal artery-supplies
the lower cervix and upper
vagina
2. Main branch- turns abruptly
upward and extends as a highly
convoluted vessel that
traverses along the lateral
margin of the uterus.
3. Upper portion of the cervix, and
other branches penetrate the
body of the uterus to form the
arcuate arteries

Uterine artery division as it

penetrate the uterus
Spiral artery-supplies the functionalis
layer
Spiral arteries respond to hormones
and thus serve an important role in
menstruation
Basal arteries- extend only into basalis
layer and are not responsive to
hormones.

Uterine artery

Before the uterine artery reaches the

fallopian tube
ovarian branch anastomose with the
terminal branch of the ovarian artery
Tubal branch goes through the mesosalpinx
and supplies part of the fallopian tube

Fundal branch penetrates the

uppermost uterus

Ovarian artery

supplies the uterus

direct branch of the aorta

enters the broad ligament through the infundibulopelvic

ligament

At the ovarian hilum

It divides into smaller branches that enter the ovary

It also sends several branches through the mesosalpinx to

supply the FT.

Ovarian artery

main stem forms an anastomosis with the ovarian

branch of the uterine artery.

Dual uterine blood supply creates a vascular reserve

to prevent uterine ischemia if ligation of the uterine
or internal iliac artery is performed to control
postpartum hemorrhage

Uterine veins

Accompany their respective arteries

Arcuate
veins

Uterine
veins

Internal
iliac
veins

Common
iliac veins

Blood from the upper uterus, ovary and upper part of the
broad ligament is collected by several veins

Right
ovarian vein

Vena cava

Pampinifor
m plexus

broad ligament

Left
ovarian
vein

Left renal
vein

Pelvis

Internal iliac artery

Anterior division- supplies the pelvic organs and perineum

-inferior gluteal a.
-internal pudendal a.
-middle rectal a.
-vaginal a.
-uterine a.
-obturator a.
-umbilical a.- superior vesical a.

Pelvis

Posterior division branches extend to the buttock and thigh

- superior gluteal a.
- lateral sacral a.
- iliolumbar a.

During internal iliac artery ligation, many advocate ligation distal to the
posterior division to avoid compromised blood flow to the areas supplied
by this division.

Lymphatics

Endometrium is supplied with lymphatic vessels that are confined to the basalis
layer.

Myometrial lymphatics increase in number in the serosal surface.

Cervical lymphatics terminate to internal iliac nodes near the bifurcation of

common iliac vessels.

Uterine lymphatics- 2 groups- 1 group drains into internal iliac nodes

region

- 2nd group after joining lymphatics from ovarian

terminates in the paraaortic lymph nodes

Innervation

Sympathetic innervation

Superior hypogastic plexus aka presacral nerve

Below the aortic bifurcation

plexus is formed by sympathetic fibers arising

from spinal level T10 through L2

Sacral promontory

Divides into right and left hypogastric nerve

which run downward along the pelvic side
walls.

Parasympathetic nerves

Derived from neurons at spinal levels S2

through S4

Pelvic splanchnic nerves ( Nevi erigentes)

are combination of axons of anterior rami

exiting at different level at each side.

2 hypogastric
nerves
(sympathetic)

2 pelvic
splanchnic nerves
(parasympathetic)

Inferior
hypogastric nerve
Aka pelvic plexus
Lies at S4 and S5

Vesical plexus
-innervates the bladder

Inferior hypogastric
nerve
aka pelvic plexus
Lies at S4 and S5 level

Middle rectal
-travels to the rectum
Uterovaginal plexus
aka Frankenhauser plexus
-reaches the prox FT, uterus
and upper vagina

Extensions of the inferior hypogastric plexus also reach the

perineum along the vagina and urethra to innervate the clitoris
and vestibular bulbs.

Afferent sensory fibers from the uterus ascend through the

inferior hypogastric plexus and enter the spinal cord via T 10
through T12 and L1 spinal nerves.

Sensory nerves from the cervix and upper part of the birth canal
pass through the pelvic splanchnic nerves to the 2nd,3rd,4th sacral
nerves

Lower portion of the birth canal pass through the pudendal

nerve.

Ovaries

Childbearing years:
2.5-5 cm (length)
1.5 to 3 cm (breadth)
0.6 to 1.5 cm (thickness)
-lie in the upper part of the pelvic cavity and rest in a slight depression
on
the lateral wall of the pelvis (ovarian fossa of Waldeyer)
Ovarian fossa of Waldeyer- between the divergent external and internal
iliac vessels

Uteroovarian ligament

originates from the lateral and upper posterior portion of the uterus,
beneath the tubes, and extends to the uterine pole of the ovary.

3-4 mm diameter

made up of muscle and connective tissue, covered by peritoneum

(mesovarium)

Ovary
consist of cortex and medulla
Cortex

outermost portion

smooth with dull white surface

Tunica albuginea

Single layer of cuboidal epithelium (Germinal Epithelium of

Waldeyer)

Oocytes and developing follicles

Medulla

Central portion

Composed of loose connective tissue

Arteries and veins

Small number of smooth muscle fibers

Sympathetic nerves

derived from ovarian plexus that accompanies the

ovarian vessels and originates in the renal plexus.

derived from the plexus that surrounds the ovarian

branch of uterine artery.

Parasympathetic nerves

vagus

nerve

Sensory

afferents follow the ovarian

artery and enter at T10 spinal cord level

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Fallopian tube

Fallopian tubes
Aka

oviducts

8-14

cm

Interstitial,

isthmus, ampulla, infundibulum

Interstitial portion
embodied within the uterine
muscular wall

Isthmus
2-3 mm isthmus adjoins the
uterus and widens gradually

Ampulla

5-8 mm

Infundibulum

Funnel-shaped fimbriated distal

extremity

Cross section of FT
Mesosalpinx

Single-cell mesothelial layer functioning as visceral peritoneum

Myosalpinx

Smooth muscle is arranged in an inner circular and outer

longitudinal layer

Rate of rhythmic contractions varies with cyclical ovarian hormonal

changes

Endosalpinx

Tubal mucosa

Single columnar epithelium composed of ciliated and secretory cells on a sparse

lamina propria

Ciliated cells- more abundant at the fimbriated extremity

Mucosa- arranged in longitudinal folds that become progressively more complex
toward the fimbria

Ampulla
-lumen occupied almost completely by the arborescent
mucosa
Tubal peristalsis created by cilia and muscular layer
contraction is believed to be an important factor in
ovum transport

Tubes are supplied richly with elastic tissue, blood vessels and
lymphatics.

Sympathetic innervation of the tubes is extensive.

Nerve supply derives partly from the ovarian plexus and partly from
the uterovaginal plexus.

Sensory afferent fibers ascend to T10 spinal cord levels.