Human Anatomy: External & Internal Genital Organs

External Genital Organs

• The vulva is the collective term for the external female genital organs.
• The mons pubis is a fatty mound covering the pubic bone, becoming hairy during puberty and containing oil-secreting glands.
• The labia majora are fleshy folds enclosing and protecting the vulva, becoming hairy during puberty.
• The labia minora lie inside the labia majora and surround the vaginal and urethral openings.
• The Bartholin glands secrete lubricating fluids.
• The clitoris is a sensitive structure involved in sexual pleasure.

Internal Genital Organs

• The uterus is a pear-shaped organ responsible for housing a developing fetus.
• The corpus (body) of the uterus weighs approximately 70 grams and is twice as long as the cervix during reproductive years.
• The corpus comprises the endometrium (functional and basalis layers), myometrium, and serosa.
• The cervix is the lower portion of the uterus.
• The fallopian tubes are 8 to 14 cm long, connecting the ovaries to the uterus.
• Anatomically, fallopian tubes consist of the interstitial portion, isthmus, ampulla, and infundibulum.
• The ovaries are approximately 2.5-5 cm long, situated in the upper pelvic cavity resting on the lateral wall.
• The ovary contains the cortex and medulla, with the cortex holding oocytes and developing follicles.

The Bony Pelvis

• The bony pelvis is composed of the sacrum, coccyx, and two innominate bones.
• Each innominate bone is formed by the fusion of the ilium, ischium, and pubis.
• The innominate bones join the sacrum at the sacroiliac synchondroses and each other at the symphysis pubis.

Pelvic Planes and Diameters

• The pelvis is conceptually divided into the false pelvis (above the linea terminalis) and the true pelvis (below the linea terminalis).
• The pelvic inlet is the superior opening of the true pelvis.
• The pelvic outlet is the inferior opening of the true pelvis.
• The midpelvis (plane of least pelvic dimensions) represents the narrowest part of the true pelvis.
• Important pelvic diameters include:
  • Anteroposterior: True conjugate, obstetrical conjugate, diagonal conjugate.
  • Transverse: Greatest distance between the linea terminalis on either side.
  • Two oblique diameters: Extending from one sacroiliac synchondrosis to the contralateral iliopubic eminence.

Pelvic Joints

• The symphysis pubis joins the pelvic bones anteriorly and is made of fibrocartilage and supporting ligaments.
• The sacroiliac joints connect the pelvic bones posteriorly.
• During pregnancy, pelvic joints relax significantly, increasing pelvic outlet diameter by 1.5 to 2 cm.

The McRoberts Maneuver

• The McRoberts maneuver utilizes sacroiliac joint mobility to release an obstructed shoulder during a shoulder dystocia delivery.

Types of Female Pelvis

• The Caldwell–Moloy classification identifies four types of female pelvis:
  • Gynecoid: True female pelvis, found in approximately 50% of women.
  • Android: Funnel-shaped, found in approximately 20% of women.
  • Anthropoid: Elongated and narrow, found in approximately 20% of women.
  • Platypelloid: Flat and wide, found in approximately 5% of women.

Evidence-Based Medicine

• Evidence-based medicine aims to improve care by identifying and promoting effective practices while eliminating ineffective or harmful ones.
• Evidence-based medicine promotes critical thinking and demands scientific proof for the effectiveness of interventions, diagnostic tests, and prognostic markers.

Randomized Studies and Meta-Analysis of Obstetrics

• Meta-analysis combines results from multiple scientific studies to provide a comprehensive overview.
• Advantages of meta-analyses include:
  • Systematic and explicit evidence synthesis.
  • Quantitative overall estimate and confidence intervals derived from individual studies.
  • Early evidence of treatment effectiveness, reducing the need for further studies.
  • Examination of specific subgroups.

Legal Issues in Obstetrics

• Obstetrics is often associated with a high risk of litigation.
• Common causes of obstetric litigation include:
  • Missing structural abnormalities during obstetric ultrasound and failure to inform patients.
  • Intrapartum fetal distress.
  • Shoulder dystocia.
  • Complications of vaginal birth after Caesarean section.

Reducing Medico-Legal Claims

• Effective strategies to improve patient care and reduce medico-legal claims include:
  • Effective communication.
  • Team working.
  • Documentation.
  • Training & education.
  • Robust risk management strategies.