Obstetrics and Gynecology

Obstetrics and Gynecology

Leon Plowright and Christine Chen

Test Taking Tip

Remember to review the management of tubo-ovarian abscesses and the physiologic changes of the pregnant patient during each of the trimesters.


FIGURE 30-1. The muscles and vasculature of the pelvis. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)


What are the branches of the internal iliac artery (hypogastric)?

Posterior division: Iliolumbar, lateral sacral, superior gluteal Anterior division: Obturator, internal pudendal, inferior gluteal, umbilical, middle vesicle, inferior vesicle, middle hemorrhoidal, uterine, vaginal

Arterial supply to the uterus:

Uterine artery from the hypogastric and ovarian arteries directly from the aorta

Right ovarian vein originates from:

Inferior vena cava

Left ovarian vein originates from:

Left renal vein

Vaginal arterial supply

Upper: cervical branch of the uterine artery

Middle: inferior vesical

Lower: internal pudendal and middle hemorrhoidal

The major arterial supply to the cervix is located:

In the lateral cervical walls at the 3 and 9 o’clock positions

The external pudendal artery supply:

The rectum, labia, clitoris, perineum

Artery that supplies the round ligament:


Inferior epigastric artery and vein originates from:

External iliac artery and external iliac vein, respectively

Levator ani complex:

Iliococcygeus, pubococcygeus, puborectalis

Boundaries of the femoral triangle:

Sartorius, adductor longus muscle, and inguinal ligament

Floor of the femoral triangle is formed by:

Iliopsoas, pectineus, and adductor longus


FIGURE 30-2. The avascular spaces of the female pelvis. (Reproduced from Brunicardi FC, Andersen DK, Billiar TR, et al. Schwartz’s Principles of Surgery. 9th ed. www.accessmedicine.com. Copyright © The McGraw-Hill Companies, Inc. All rights reserved.)

Space of Retzius:

The area between the bladder and the symphysis pubis, bounded laterally by the obliterated hypogastric arteries

Cul-de-sac of Douglas:

Also known as the rectouterine pouch or fold and is located anterior to the rectum, separating the uterus from the large intestine

Boundaries of the paravesical space:

Anterior: pubic symphysis

Posterior: cardinal ligament

Medial: superior vesical artery

Lateral: obturator internus muscle

Boundaries of the pararectal space:

Anterior: cardinal ligament

Posterior: sacrum

Medial: rectum

Lateral: iliac vessels

Anatomic relationship between the uterine artery and the ureter:

At approximately 2 cm from the cervix, the uterine artery crosses above and in front of the ureter.

Support of the uterus:

The cardinal and uterosacral ligaments

Vaginal lymphatics:

Upper third: Iliac

Middle third: hypogastric

Lower third: inguinal

Aorta lies at this spinal level:


Innervation to the uterus:

Hypogastric plexus by sympathetic merging at Frankenhauser plexus (uterovaginal plexus) Pain sensory to T11 to 12

Sensory innervation of the vagina:

Pudendal nerve (S2–S4)

Obturator nerve:

Sensory and motor to the medial thigh

Sciatic nerve:

L4 to S2; passing through the greater sciatic foramen to supplying the muscles of lateral leg and foot


Increases in pregnancy:

GFR by 50%: 90 mL/min prepregnancy versus 125 mL/min pregnancy

Total T4

Total T3



Plasma fibrinogen: 300 mg/dL prepregnancy versus 600 mg/dL pregnancy


TBG: thyroxine-binding globulin


Heart rate: Increased 10 to 15 bpm

Cardiac output: 1.5 mL/min more than prepregnant average



Plasma volume

Red cell volume

Alkaline phoshatase

Human placental lactogen



Decreases in pregnancy:

Total serum calcium

Albumin (decrease by 30%)

BUN and creatinine: due to increase in GFR

Hgb and Hct

Factor XI

Factor XIII


Systemic vascular resistance

pCO2: 35 to 40 mm Hg prepregnant to 28 to 30 mm Hg pregnant

Respiratory volume

Antithrombin III (anti-factor Xa)

Anticoagulant protein S

Cross the placenta:

Propylthiouracil, TRH, iodine, magnesium sulfate, IgG, propanolol, warfarin

Does not cross the placenta:

T3, T4, TSH, insulin, glucagon, heparin, prednisone

hCG peaks at:

8 to 10 weeks gestation

Average weight gained in pregnancy:

25 lb

Average weight and volume of non-pregnant uterus:

40 to 70 g and 10 mL

Average weight and volume of pregnant uterus:

1100 to 1200 g and 5000 mL

What supports pregnancy during the first 14 weeks of pregnancy prior to the development of the placenta?

The corpus luteum, which secretes progesterone

Gestational age at which the uterus rises out of the pelvis:

12 weeks gestation

In late pregnancy blood flow rate to the uterus:

450 to 650 mL/min

Percentage of uterine blood flow direct to the placenta at term:

80% to 90%

Pulmonary function in pregnancy:

Increase: Tidal volume, inspiratory capacity, minute ventilation, minute oxygen uptake

Decrease: Functional residual capacity (by 15%), residual volume, expiratory reserve volume

Unchanged: Maximum breathing capacity, forced expiratory volume (FEV1)

Physiologic hydronephrosis of pregnancy resolve in:

12 to 16 weeks postpartum

Gastric acid production and gastric emptying:

Increased and decreased, respectively, in pregnancy

Two GI disorders in third trimester pregnancy:

Acute fatty liver of pregnancy and cholestasis of pregnancy


Incidence of hypertensive disease in pregnancy:

12% to 22%

New onset hypertension and proteinuria after 20 weeks gestation in a previously normotensive woman:


Criteria for diagnosis of preeclampsia:

Mild: BP 140/90, 6 hours apart plus at least 1+ protein on urine dip or >300 mg of protein on 24-hour urine

Severe: BP 160/110 6 hours apart plus at least 3+ protein on urine dip or 5000 mg of protein on 24-hour urine protein

New-onset hypertension without proteinuria after 20 weeks gestation in a previously normotensive woman:

Gestational hypertension

New-onset grand mal seizure in woman with preeclampsia:


Treatment of preecalmpsia:

Magnesium sulfate for seizure prophylaxis, labetalol and hydralazine for BP control and expedient delivery

HELLP syndrome is characterized by:

Aug 13, 2019 | Posted by in ABDOMINAL MEDICINE | Comments Off on Obstetrics and Gynecology
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