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• VAGINA
Parts: 2 major unequal parts
2. UTERUS
the upper 2/3, triangular portion
the lower 1/3, cylindrical portion
Layers
endometrium/mucusal layer/DECIDUA
myometrium/muscular layer
perimetrium/serosal layer
2. UTERUS
•measurements:
• NP- 3 inches long, 2 inches wide, one inch thick
• Preg.- 32 cms, 24 cms., 20-24 cms
•weight: NP= 50-60 gms
• P= 1000 gms (immediately after delivery
•capacity : 10 ml – 75 ml cavity {ave. of 30 ml}
5 L at term
• 20 L- can hold at this maximum
2. UTERUS
•Function:
organ of menstruation
organ of pregnancy/implantation
labor power-powerful contract
Size and Shape of uterus
original n-p shape –pear shape
as pregnancy advances by 3rd lunar
month-globular S.
subsequently uterus
increase rapidly by length
2. UTERUS
decrease not width giving-ovoid shape
end of 12 weeks-uterus becomes an
abdominal organ for it become too large to
remain in pelvis
vascular supply
uterine and ovarian arteries
3. FALLOPIAN TUBES/OVIDUCTS
Function
site of fertilization
passageway of ovum from ovaries
passageway of sperm from uterus
Note:
5 minutes-sperm as quickly as this reach
site of fertilization from time of
ejaculation
12-24h average-mature ovum is capable
being fertilized after ovulation
4. OVARIES
FUNCTION
1. cardinal and primary function
2. endocrine
PARTS
1. cortex
2. medulla
Almond shape
mittleschermz-pain during ovulation due to rupture
of follicle, fluid and blood escape into peritoneum
and irritates
Lifetime history of germ cell maturation
Testis
semineferous gland
interstitial
Epididymis-stores where it matures
and it becomes motile
vas deferens- passage of sperm
prostate gland
secret alkaline fluid for sperm to
swim
cm 2.5-3.5 glandular structure that
surrounds the neck of bladder and
urethra
Bulburethra/ cowpers gland
72 hours- normal lifespan of sperm outside male’s body
or after ejaculation to woman genital
in normal men, semen volume and density decreases
when ejaculation occurs more often than 48hrs
right testis is lower than left because the large liver wide
space to occupy and pushes it
composition of semen
1. Sperm
a. head
b. body
c. tail
2. secretions by seminal vesicle
3. prostate gland
4. cowper’s/bulbourethral gland
PHYSIOLOGY –MENSTRUATION – periodic discharge of
bloody fluid from uterus occurring at more or less regular
intervals during the life of a woman for puberty to
menopause
Menstruation
E and P low
APG-FSH
acts
on follicles of ovary, but only one will grow
and develop GF-growing and developing
primoidial follicle called Graafian follicle
HYPO
APG stops LH
Causes the CL to degenerate in 14 days as its
normal life span,a drop in Pragesterone causes
the
Shedding or sloughing of endometrial lining=
MENSTRUATION
Success of menstruation depends on
different 4 body structure involved and its
interaction
1. HYPO - FSHRF & LHRF
2. APG - FSH & LH
3. OVARY - E/P
4. UTERUS
Phases of Menstrual Cycle
A. UTERINE RESPONSE:
1. Menstrual Phase
2. Proliferative
3. Secretory phase
B. OVARIAN RESPONSE
1. FOLLICULAR PHASE
2. LUTEAL PHASE
AMNIOTIC FLUID
tissue
1st Lunar Month
GERM layer differentiation
VITAL ORGAN formation
2nd lunar
all organs formed is continued/ sex differentiation& formation/ placenta
full development
3rd lunar
Function
4th lunar
Lanugo, FHT
5th lunar
Vernix, Quickenning, FHT by stet, age of viability
6th lunar
sensory receptors are well established
7th lunar
alveoli
8th lunar
Start deposition of the SC, disappearance of lanugo
9th lunar
Peak of SC deposition, disappearance of vernix caseosa
10th lunar
characteristics of a FT infant is achieved
DIAGNOSIS
NORMAL DURATION
SIGNS
NORMAL ADAPTATION
DIAGNOSIS OF PREGNANCY
Urine examination
Uterine soufflé
Funic soufflé
ultrasound/quickening
NORMAL DURATION/LENGTH OF
PREGNANCY
MONTHS:
10 lunar month
9 calendar month
3. Am sickness ballotement
6. quickening
2 Common Problems
leukorrhea
alkaline envi
trichonomanas vaginalis
Moniliasis
GIT-
AM sickness- due to progress
Hyperemesis gravidarum
constipation
flatulence
hemorrhoids
Heartburn
Respiratory –shortness of breath
Cardiovascular - 30-50% increase the cardiac volume
results to physiologic anemia
Renal - urinary frequency,decrease threshold
for sugar (coz of increase GFR), stasis in the urine
Musculoskeletal - “pride of Pregnancy” – Lordosis
Relaxin is increase causing wobbly
joints
IV. PRE NATAL CHECK UP
SCHEDULE
COMPONENTS
HEALTH TEACHINGS
COMPONENTS OF PRENATAL
I. Schedule
A. Every month - 1 to 8 months or from the time
pregnancy is detected -32 weeks AOG
B. Twice a month / every 2 weeks – 32 to37 wks
C. Weekly - 37weeks – birth or EDB
D. 2X A Week - for all Post term or > 42 wks
II. Components
A. Health history taking- G,P, OB Score, LMP
B. assessment – VS, Wt.,LM, Pap Smear, Pelvimetry
C. laboratory/ diagnostic procedure
A. History Taking
includes: personal data; medical data; family
history; OB-Gyne History
Gravida- total number of pregnancy regardless of
outcome
parity- total number of pregnancy that has reach the
age of viability whether dead or alive
viability – ability of the fetus to live extrauterine life
OB score T-P-A-L
Past Pregnancy- method, where, whom,
complication, risk
Present pregnancy
IMPORTANT ESTIMATES OF AOG & EDB
NAGELE’S RULE
-3+7 if April – Dec
+9+7 if Jan Feb & March
Mc DONALDS RULE
FH in cms X2 divided by 7 = AOG in mos.
X8 = AOG in wks
BARTHOLOMEW’S RULE
Important landmarks :
1. symphysis pubis
2. umbilicus
3. xiphoid process
10 Danger signs
1. vaginal bleeding
2. swelling of face and hands
3. cont. HA
4. dimness/blurring of vision
5. flashes of lights before the eyes
6. persistence of vomiting
7. pain in abdomen
8. chills/fever
9. sudden escape of fluid from vagina
10. (-) FHT/movement
TERMS
nulligravida-never been pregnant
primigravida- pregnant for the 1st time
primipara-woman who deliveries only once
of a fetus who has reached viability
multigravida- 2 or more successive
multipara-2 or more deliveries
grand multigravida- 6 or more pregnancy
grand multipara- 6 or more deliveries to
viability
ASSESSMENT
VS
WEIGHT :
allowable weight gain : 20 – 25 lbs
wt. distribution : 1st tri – 1 lb/mon
2nd & 3rd – 1 lb/wk
pattern of wt. gain : a.3,5,12
b.5,5,12
c.3,12,12
d.5,12,12
ASSESSMENT
LEOPOLD’S MANNEUVER
LM1 - fundic grip
LM2 – abdominal/umbilical grip
LM3 – Pawlik’s grip
LM4 - pelvic grip
ASSESSMENT
PATIENT PREPARATION:
1. Explain procedure
2. Empty bladder
3. Put patient on proper position
4. Palpate with warm hands
ASSESSMENT
PAPANICOLAU SMEAR – is a diagnostic
cytological test for early detection of cervical
cancer.
INDICATIONS:
CLASS I - normal
CLASS II - atypical cell is present
CLASS III - suggestive of malignancy
CLASS IV- strongly suggestive of
malignancy
CLASS V - conclusive of malignancy
STAGES:
& hyphae
-- pres. Of gm(-) diplococci
-- presence of T. vaginalis
Ultrasonography:
1. AOG
2. Sex of baby
3. amount of amniotic fluid
4. locates the placenta
5. Ectopic pregnancy,H-mole
6. Gyne: tumors, cyst,myomas
7. limited congenital anomalies
HEALTH TEACHINGS
NUTRITION
IMMUNIZATION
DRUGS
EXERCISE
SMOKING,ALCOHOL INTAKE, RADIATION
EXPOSURE
SEX
EMPLOYMENT
Nutrition
malnutrition causes
iron
CHON
Vitamin C
Caloric
Folate/Folic acid
Iodized salt
Minerals
IMMUNIZATION
DRUG CATEGORY INTERPRETATION
PDA
Safest antipyretic/analgesic: Paracetamol
ACE Inhibitors - conginatal renal
anomaly
Steroids/Phenobarbital- cleft lip & palate
Iodides - enlargement of the thyroid
DES or Diethylstilbestrol – CA of the repro
VERTEX = “OCCIPUT”
FACE = “ MENTUM”
BREECH = “ SACRUM ’’
TRANSVERSE = “ ACROMIUM”
Cranial bones
1. frontal
2. occiput
3. parietal
Membrane spaces/suture lines - important they
allow bones to move and overlap and change
shape to fit in birth canal called molding
1. sagittal suture-membranes interspace which
join 2 parietal bones
2. coronal suture- frontal bone and 2 parietal
bones
3. lamboidal- occiput and parietal
4. Transverse Diameter
a. biparietal D. = 9-9.5 cms
b. Bitemporal D. = 8 cms
c. Bimastoid D. = 7 cms
Phases of labor
PHASES IE INTENSITY ACTIVITY
Multi = 3o mins
Modified Ritgen’s Manneuver – is
the forward upward pressure
applied in the perineum with the
main purpose of preventing
laceration as well as promote
flexion of the head in brow
presentation.
MECHANISM OF LABOR
Known as the
Degrees of Laceration: