ABSTRACT
A complete and thorough knowledge of female abdominal and pelvic anatomy is important for specialists in obstetrics and gynecology since patient safety in the operating room during surgery is critically dependent on this knowledge along with the appropriate functioning of the operating room team.1 erefore, this chapter reviews anatomy of the female pelvis with emphasis on avoiding anatomic complications of laparotomy and/or laparoscopic and robotic pelvic surgery2 and on structures important in pelvic organ support and urinary continence.3,4
ANTERIOR ABDOMINAL WALL Boundaries and surface landmarks
e anterior abdominal wall is bound above by the xiphisternal junction in the midline and the arching margin of the lower costal cartilages (costal margin) laterally. Below, it is bound by the symphysis pubis in the midline and laterally by the pubic crest, inguinal (Poupart’s) ligament, and iliac crest (Figure 1.1). ere are no bony structures laterally, the wall being limited by a vertical line from the middle of the axillary depression (midaxillary line) that crosses the 10th rib to the iliac crest. Additional
CONTENTS Anterior abdominal wall 1
Boundaries and surface landmarks 1 Skin and subcutaneous tissue 2 Muscles and rectus sheath 4 Transversalis fascia, extraperitoneal tissue, and peritoneum 6 Abdominal surgical incisions 6
Uterus 7 Parts and relations of the nongravid uterus 7 Size and positional changes of the gravid uterus 8
First trimester 8 Second and third trimesters 8
e myometrium during pregnancy 8 e cervix of the gravid uterus 11 Changes in the uterine cavity during pregnancy 12
Fallopian tube 12 Ovary 13 Ligaments of the uterus 15 Uterine blood vessels, lymphatics, and nerves 15
Arteries 15 Veins 16 Lymphatics 16 Nerves 16
Pelvic portion of ureter 16 Bladder and urethra 17
Bladder 17 Urethra 18
Sigmoid colon, rectum, and anal canal 18 Sigmoid colon 18 Rectum 19 Anal canal 19 Obesity in pregnancy 19
Acknowledgment 19 References 19
bony landmarks are the xiphoid process in the midline above, the pubic tubercle located below at the lateral end of the pubic crest, and the anterior superior iliac spine at the anterior end of the iliac crest. e inguinal ligament courses from the pubic tubercle to the anterior superior iliac spine, separating the abdominal wall from the thigh. e pubic bone and symphysis pubis separate the wall from the genitalia.
