Anatomy for Obstetricians and Gynaecologists

Internal Iliac Artery

This artery arises from common iliac artery which is a branch of abdominal aorta.

Inferior Gluteal Artery

This artery passes between Piriformis and Ischiochocygeus muscle and then around sacrospinous ligament.

Superior Gluteal Artery

It is the largest branch of Internal Iliac artery.

Uterine Artery 

Descending Cervical Artery supply the angles of Cervix.

Pelvis

Ligaments in Pelvis:-

The main ligaments of the pelvis include :-

• Sacrospinous ligament
• Sacrotuberous ligament
• Illioinguinal ligament
• Arcuate ligament

Arcuate Ligament :-

It is the thick band of fibres filling the angle created by two symphysis bones .

False Pelvis

The part of female pelvis lying above the linea terminalis , playing no role in the delivery of baby is called false pelvis.

Blood Supply

An inferior gluteal artery is the artery that passes in between the piriformis and ischiococcygeus muscles and then round the sacrospinous ligament .

Clitoris

Nerve Supply

The clitoris gets most of its nerve supply from the Pudendal nerve. 

Vagina 

Blood Supply

Azygous artery of Vagina.

Labium Majora

Nerve Supply

• Mons Veneris and Anterior Labium Majora supplied by Anterior Hypogastric Nerve (T12)
• Deep labia structures are supplied by Genitofemoral Nerve ( L1 and L2 ) .

Perineal Body

Most Caudal component of Levator Ani Complex = Puborectalis (Anal incontinence is caused by damage to Puborectalis)

Delancey three levels of Pelvic Supports

Level-1 Support 

• This level gives support to the Uterus , Cervix and  upper third of vagina .
• This is made up of Cardinal ligament and the Uterosacral ligament.
• Damage of this support results in Apical Prolapse or Uterine Prolpase.

Level-2 Support 

• This is made up of endopelvic fascia , pubovescicle fascia , pubocervical fascia and collagens etc.
• Provides support to the middle third of Vagina.
• The weakness of this level of support results in Cystocele and Rectocele.

Level-3 Support 

• Provides support to the lower third of vagina.
• Weakness of this level of support results in urethrocele, distal rectocele and anal incontinence.