MATERNAL

ANATOMY

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ANTERIOR ABDOMINAL
WALL
Skin
Subcutan layer
Rectus sheath

ANTERIOR ABDOMINAL
WALL

FIGURE 2-1 Muscles and blood vessels of the anterior

abdominal wall

INNERVATION
the abdominal extensions of the intercostal nerves (T711)
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.

ORGAN GENITALIA
EXTERNA
Vulva : includes all structures visible externally from
the pubis to the perineal body
Mons Pubis
Labia Mayora ~ mans scrotum
Labia Minora

ORGAN GENITALIA
EXTERNA (2)
Klitoris
Vestibulum
Kelenjar-kelenjar Vestibular : The pair of Bartholin
glands, paraurethral glands
Meatus Urethra

ORGAN GENITALIA
EXTERNA (3)
Bulbus Vestibuli: correspond to the corpus spongiosum
of the penis. These are almond-shaped aggregations of
veins, 3 to 4 cm long, 1 to 2 cm wide, and 0.5 to 1 cm
thick, which lie beneath the bulbocavernosus muscle
on either side of the vestibule.
Vagina dan Hymen

FIGURE 2-2 External female reproductive

organs.

VAGINA
musculomembranous structure extends from the vulva
to the uterus and is interposed anteriorly and
posteriorly between the bladder and the rectum
The upper portion arises from the mllerian ducts, and
the lower portion is formed from the urogenital sinus
Anteriorly, the vagina is separated from the bladder
and urethra by connective tissuethe 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,
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

VAGINA
Histologi : The vaginal lining is composed of
nonkeratinized stratified squamous epithelium and
underlying lamina propria. Below this there is a
muscular layer, which consists of smooth muscle,
collagen, and elastin

PEMBULUH DARAH DAN

SISTEM LIMFATIK VAGINA
The proximal portion cervical branch of the
uterine artery and by the vaginal artery.
posterior vaginal wall The middle rectal
artery
the distal walls internal pudendal artery.
Lymphatics from the lower third inguinal
lymph nodes.
middle third internal iliac nodes
Upper third external, internal,
common iliac nodes.

and

FIGURE 2-3 Uterine and vaginal blood supply. The origin of the
vaginal artery varies and may arise from the uterine, inferior vesical,
or internal iliac artery.

PERINEUM
Margins : the pubic symphysis anteriorly, ischiopubic rami and
ischial tuberosities anterolaterally, sacrotuberous ligaments
posterolaterally, and coccyx posteriorly.
Trigonum Anterior:
- Superficial Space of the Anterior Triangle.
several important structures : the ischiocavernosus,
bulbocavernosus, and superficial transverse perineal muscles;
Bartholin glands; vestibular bulbs; clitoral body and crura; and
branches of the pudendal vessels and nerve
- Deep Space of the Anterior Triangle.
contains the compressor urethrae and 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

PERINEUM
Trigonum Posterior :
- contains the ischiorectal fossa, anal canal,
anal
sphincter complex, and branches of
the internal
pudendal vessels and
pudendal nerve
- Ischiorectal Fossae.

PUDENDAL NERVE AND

VESSELS
The
pudendal nervethe anterior rami of the second
through fourth sacral nerves

- The dorsal nerve of the clitoris the skin

clitoris.

of the

- 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.

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
images right, whereas those of the superficial space are on the left.

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

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
TABLE 2-1. 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).

ORGAN REPRODUKSI
INTERNA

FIGURE 2-8 Vertical section through the uterine

end of the right broad ligament. (Used with
permission from Jennifer

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 peritoneumforms 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 portionthe
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
The uterus of adult nulliparous womenmeasures 6 to 8 cm in
length as compared with 9 to 10 cm in multiparous women. In
nonparous women, the uterus averages 50 to 70 g, whereas in
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 cervixthe 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 ligamentalso 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.

TUBA FALOPII

FIGURE 2-17 The fallopian tube of an adult woman with cross-sectioned

illustrations of the gross structure in several portions: (A) isthmus, (B)
ampulla, and (C) infundibulum. (Used with permission from Dr. Kelley S.

FIGURE 2-17 These are photographs of corresponding

histological sections. (Used with permission from Dr. Kelley S.
Carrick.)

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.

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
imaginary planes:

as

having

four

1. The plane of the pelvic inletthe superior

strait.
2. The plane of the pelvic outletthe inferior
strait.
3. The plane of the midpelvisthe least pelvic
dimensions.
4. The plane of greatest pelvic dimensionof
no obstetrical significance.

PELVIC INLET

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

OTOT-OTOT DASAR
PELVIS