Thursday, 17 April 2014

MATERNAL ANATOMY

1. Langer lines : In the anterior abdominal wall, they are arranged transversely. As a result, vertical skin incisions sustain increased lateral 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.

2. 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. Direct hernias protrude through the abdominal wall in Hesselbach triangle, whereas indirect hernias do so through the deep inguinal ring lying lateral to this triangle.

3. The anterior abdominal wall is innervated by the abdominal extensions of the intercostal nerves (T7-11), the subcostal nerve (T12), and the iliohypogastric and the ilioinguinal nerves (L1).
4. The ilioinguinal and iliohypogastric nerves can be entrapped during closure of low transverse incisions (such as the Pfannenstiel), especially if incisions extend beyond the lateral borders of the rectus muscle .

5. HART LINE : Stratified squamous epithelium covers the outer surface of each labium. The lateral portion of the inner surface is covered by stratified squamous epithelium to a demarcating line—the Hart line. Medial to this line, each labium is covered by nonkeratinised squamous epithelium.

The minor vestibular glandsare shallow glands lined by simple mucin-secreting epithelium and open along Hart line.

6. VESTIBULAR GLANDS : The pair of Bartholin glands, (greater vestibular glands),are the major glands. Their ducts are 1.5 to 2 cm long and open distal to the hymenal ring at 5 and 7 o’clock. Following trauma or infection, either duct may swell and obstruct to form a cyst or if infected, an abscess.

7. SKENE GLANDS: Largest paraurethral glands—the Skene glands .Their ducts typically lie distally near the urethral meatus. Inflammation and duct obstruction of any of the paraurethral glands can lead to urethral diverticulum formation.

8. POUCH OF DOUGLAS : Posteriorly, between the lower portion of the vagina and the rectum rectovaginal septum is present. The upper fourth of the vagina is separated from the rectum by the recto-uterine pouch, also called the cul-de-sac of Douglas.

9. The vaginal lining is composed of nonkeratinized stratified squamous epithelium There are no vaginal glands. Instead, the vagina is lubricated by a transudate that originates from the vaginal subepithelial capillary plexus and crosses the permeable epithelial layer.

10. LYMPHATIC DRAINAGE OF VAGINA : Lymphatics from the lower third, along with those of the vulva, drain primarily into the inguinal lymph nodes. Those from the middle third drain into the internal iliac nodes, and those from the upper third drain into the external, internal, and common iliac nodes.

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