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Edgar M.

Rotairo, RN, RM

The

students will learn the anatomy and physiology of the male and female reproductive system Learn about the different gametes and their functions Further learn about different hormones governing male and female reproductive systems

Penis

composed of 3 cylindrical masses of erectile tissues (corpus spongiosum and corpus cavernosa) Glans penile head; sensitive to touch Scrotum rugated skin-covered muscular pouch suspended from the perineum Testes two ovoid glands 2-3 cm wide that lie in the scrotum.

Epididymis

tightly coiled tube approximately 20ft long. Storage and maturation of sperms occurs here. Secretes 5% of total seminal fluid. Vas Deferens carries sperm from epididymis trough the inguinal canal into the abdominal cavity where it ends at the seminal vesicle and the ejaculatory ducts. Seminal Vesicles two convoluted pouches that lie along the lower portion of the posterior surface of the bladder and empty into the urethra by way of the ejaculatory ducts. Secretes 30% of total seminal fluid.

Ejaculatory

Ducts the two ejaculatory ducts pass through the prostate gland. They join the seminal vesicle with the urethra. Prostate Gland secretes a thin alkaline fluid (60%). This fluid further protects the sperms from being immobilized by naturally low pH level of the urethra. Urethra hollow tube leading from the base of the bladder and continues to the shaft and glans of the penis. Cowpers Glands secretes 5% of the total seminal fluid.

Mons

Veneris a pad of adipose tissue located over the symphysis pubis. Protects the pubic bone from trauma Labia Majora positioned lateral to the labia minora. Protects the external genitalia, urethra, and the posterior genitalia. Labia Minora posterior to the mons veneris. Internal surface is covered with mucus membranes and external is covered by skin Clitoris 1-2cm in size, rounded organ of erectile tissue at the forward junction of the labia minora

Skenes

Glands (paraurethral glands) secrete fluid to lubricate the vagina during coitus. Bartholins Glands (vulvovaginal glands) have the same functions with Skenes Fourchette ridge of tissue formed by the posterior joining of the two labia majora and minora. Hymen tough but elastic semicircle of tissue that covers the opening to the vagina in childgood.

Ovaries

produce, mature, and discharge the ova. Approximately 4x2x1.5 cm in dimension. Greyish white in colour. Supported by ovarian ligament. Secrete several hormones for the regulation of menstruation. Fallopian tubes arise from each upper corner of the uterine body. Approximately 10cm in length in a mature woman. Divided into four separate parts (interstitial, isthmus, ampulla, infundibular).

Uterus

hollow muscular, pear-shaped organ located in the lower pelvis, posterior to the urinary bladder and anterior to the rectum. A mature uterus has a dimension of 5-7cm long, 5cm wide, and 2.5cm thick (3-2-1in), and 60g in weight. Divided in 3 parts: fundus, body (corpus), & isthmus. Layers: Endometrium, Myometrium, & Perimetrium. Cervix lowest portion of the uterus. 2-5cm in length. Divided in two: Internal Os and External Os.

Ligaments

uterine supports Round Ligament two fibrous muscular cords that pass from the body of the uterus near the attachment of the fallopian tubes through the broad ligaments into the inguinal canal and insert into the fascia of the vulva Posterior Ligament forms the cul-de-sac of Douglas Broad Ligament covers the uterus front to back and extend to the pelvic sides Ovarian Ligament supports each ovary

Parts 2 innominate bones ischium, ilium, and pubis Sacrum forms the upper posterior portion of the pelvic ring. Coccyx tail bone. 5 small bones fused together. Division False Pelvis upper portion True Pelvis lower portion

GnRH

Gonadotropin-Releasing Hormone secreted by the Hypothalamus. Stimultes the APG to release FSH & LH FSH secreted by the APG for the release of ABP (Androgen-binding protein). LH also secreted by the APG to release Testosterone. Testosterone responsible for male 2 sexual characteristics. Together with ABP, promotes spermatogenesis.

Estrogen
promote

formation of female secondary sex characteristics Stimulate endometrial growth Increase uterine growth Reduce bone resorption, increase bone mass Ripens the egg cell Responsible for the thinning of the cervical mucus Ferning of the cervical mucus

Progesterone
the

"hormone of pregnancy Promotes release of ovum from the ovary Relaxes the smooth muscle of the uterus Decreases the womans immune system to allow implantation of the zygote in the uterus. Inhibits breast milk production If metabolized by the fetus, synthezises fetal cortisol and produces prostaglandin for uterine contraction

TERM
Beginning (Menarche) Interval between cycles Duration of menstrual flow Amount of menstrual flow

DESCRIPTION
Ave .age of onset: 12 or 13 yrs; Ave. range of age: 9-17 yrs Ave. 28 days; 23-35 days not unusual Ave. 2-7 days; ranges 1-9 days not abnormal Approximately 30-80ml per menstrual period; saturating a pad or tampon in less than an hour is heavy bleeding Dark red; combination of blood, mucus, and endometrial cells

Colour of menstrual flow

1st

Phase of Menstrual Cycle (Proliferative Phase) thickening of the endometrial lining 2nd Phase of Menstrual Cycle (Secretory / Luteal Phase) the glands of the endometrium become twisted and corkscrew in appearance highly dilated with increase in mucin and glycogen 3rd Phase of Menstrual Cycle (Ischemic Phase) after 8-10 days, the corpus luteum in the ovary regresses & degeneration of endometrium begins Final Phase of Menstrual Cycle (Menses) blood and uterine products are discharged as menses

Hypothalamus

FSHRH
APG

LHRH

FSH Ovaries

LH

Estrogen

Progesterone

Uterus

Which of the following hormones readies the uterus for implantation by increasing the glycogen and proteins?
A. B.

C.
D.

Progesterone Estrogen FSH LH

What is the widest diameter of the fallopian tube?


A. B. C.

D.

Isthmus Infundibulum Interstitial Ampulla

What lies in the posterior border of pelvic inlet?


A. B. C.

D.

Sacrum Coccyx Ischium Ilium

What part of the male reproductive system is responsible for the maturation of the sperm cells?
A. B.

C.
D.

Seminal vesicle Seminiferous tubules Epydidymis Prostate gland

Which of the following is not a function of testosterone?


A. B. C.

D.

Spermatogenesis Increasing muscle tone Body hair growth None of the above

Which of the following hormones is referred as the hormone of pregnancy?


A. B. C.

D.

Progesterone Estrogen HCG HPL

This is a part of the vulva where the labia minora and labia major join together. This is the common site of episiotomy.
A. B.

C.
D.

Vestibule Fourchette Perineum Hymen

This is the erectile tissue in the female reproductive system.


A. B. C.

D.

Clitoris Labia Minora Labia Majora Prepuce

What part of the uterus usually an embryo implants?

Isthmus B. Fundus C. Corpus D. Salphyngio


A.

Which of the following is not a function of the fluid secreted by Skenes & Bartholins Glands?
A. B.

C.
D.

Lubrication during coitus Decreases the pH of the vagina Neutralizes the acidity of vaginal canal None of the above

Describe

the growth & devt of the fetus by gestational week Assess fetal growth & devt through maternal and pregnancy landmarks Learn about the normal physiologic changes during pregnancy Describe health practices important for a positive pregnancy outcome Assess a womans health practices and concerns during pregnancy

1. Fertilization Also known as conception, impregnation, or fecundation Occurs in the ampulla of the fallopian tube Joining of the sperm and ovum Factors Affecting Fertilization: Maturation of the gametes Ability of the sperm to reach the ovum Ability of the sperm to penetrate the zona pellucida

2. Implantation Contact between the zygote and the endometrium Occurs approximately 8-10 days after fertilization Implantation occur at the upper posterior portion of the uterus, the body (Corpus) Once implanted, the zygote is called embryo

NAME Ovum Zygote


Embryo Fetus Conceptus

TIME PERIOD From ovulation to fertilization From fertilization to implantation From implantation to 5-8 weeks From 5-8 weeks until term Developing embryo or fetus and placental structures throughout pregnancy

DECIDUA
Decidua

Basalis part of the endometrium lying directly under the embryo. Together with the chorionic villi of the trophoblast cells, make up the placenta. Decidua Capsularis portion of the endometrium that stretches or encapsulates the surface of the trophoblast. Decidua Vera the remaining portion of the endometrial lining

CHORIONIC VILLI
Develops

as early as 11th-12th day Central core of connective tissue containing fetal capillaries Composed of two (2) layers. a. Syncytiotrophoblast (Syncytial) Layer Outer layer. Produces several placental hormones: HPL, HCG, Estrogen, & Progesterone b. Cytotrophoblast (Langhans) Layer Protection of the growing fetus aginst infxn; present as early as 12th week AOG & disappears 20th-24th week AOG.

PLACENTA
Latin

for Pancake because of the shape Starts to develop @ 2nd wk & functions @ 3rd wk AOG 15-20cm in diameter and 2-3cm in depth in term Covers about half of the internal uterus Functions as the fetal lungs, kidneys, and gastro-intestinal tract and as a separate endocrine throughout the pregnancy Secretes HPL, HCG, Estrogen & Progesterone

UMBILICAL CORD Formed at the chorion and amnion Provide circulatory pathway connecting the embryo to the chorionic villi Carries oxygen & nutrients from the placenta and waste products from fetus back to the placenta Approximately 53cm (21in) in length & 2cm in diameter @ term Covered exteriorly with amnion membrane A-V-A blood vessels found in the umbilicus & protected by Whartons Jelly

MEMBRANES
These

membranes cover the fetal side of the of the placenta and gives the typical shiny appearance. Two (2) Layers: 1. Chorionic Membrane Outer membrane of the sac. Gives support to the amniotic sac as fetus grows and fills with fluid. 2. Amniotic Membrane Innermost membrane. Contains and produces the amniotic fluid.

AMNIOTIC FLUID
At

term, the fluid ranges from 800-1200mL More than 2000mL of Amniotic fluid: Hydramnios (Polyhydramnios) Less than 300mL: Oligohydramnios Functions: Shields fetus against pressure and direct blows Thermoregulator Fetal muscular development Protects the cord from pressure, protecting fetal oxygenation

GREEN

TINGES OR MECONIUM STAINED SIGNIFIES FETAL DISTRESS GOLD OR YELLOW SIGNIFIES HEMOLYTIC DISEASE SUCH AS Rh OR ABO INCOMPATIBILITY GRAY INDICATES INFECTION

AOG 1 2 3 6 8 10-12 12 16 18

Presumptive
Breast changes; N&V; Amenorrhea Frequent urination

Probable
Serum Lab Tests

Positive

Chadwicks, Goodells, Hegars Signs; UTZ evidence of Gestational Sac UTZ evidence of fetal outline Audible FHT Fatigue & Uterine enlargement Ballottement Quickening

20
24
Linea nigra; Melasma; Striae Gravidarum

Braxton Hicks; Fetal outline felt by an examiner

Fetal Movement felt by an examiner

CIRCULATORY / CARDIOVASCULAR:
BEGINNING

THE END OF THE FIRST TRIMESTER, THERE IS A GRADUAL INCREASE OF ABOUT 30%-50% IN TOTAL CARDIAC VOLUME. THIS CAUSES A DROP IN HgB & HcT VALUES SINCE THE INCREASE IS ONLY IN PLASMA.PHYSIOLOGIC ANEMIA OF PREGNANCY

CONSENQUENCES OF INCREASED CARDIAC VOLUME:


** EASY FATIGABILITY & SOB DUE TO INCREASED WORKLOAD OF THE HEART

MX: REST
** SLIGHT HYPERTHOPHY OF THE HEART CAUSING IT TO BE DISPLACED TO THE LEFT

** SYSTOLIC MURMURS DUE TO LOWERED BLOOD VISCOSITY


** NOSEBLEEDS MAY OCCUR DUE TO MARKED CONGESTION OF THE NASOPHARYNX

**

PALPITATIONS DUE TO INCREASED PRESSURE ON THE DIAGPHRAGM ** EDEMA OF LOWER EXTERMITIES OCCURS DUE TO POOR CIRCULATION RESULTING FROM PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS

MX; > RAISE LEGS ABOVE HIP LEVEL


> AVOID PROLONGED STANDING & SITTING

NOTE:

EDEMA OF THE LEG IS NOT A SIGN OF TOXEMIA.

**

VARICOSITIES COULD OCCUR DUE TO PRESSURE OF THE GRAVID UTERUS ON THE BLOOD VESSELS OF THE LEGs
> DO NOT CROSS LEGS WHEN SITTING

MX:

> WEAR SUPPORT HOSE TO PROMOTE VENOUS FLOW THUS PREVENTING STASIS IN THE LOWER EXTREMITIES > APPLY ELASTIC BANDAGE START AT THE DISTAL END TOWARDS THE TRUNK TO AVOID CONGESTION & IMPAIRED CIRCULATION IN THE DISTAL PART > AVOID USE OF KNEE HIGH SOCKS

**

VARICOSITIES OF THE VULVA & RECTUM

MX:

> SIDE LYING POSITION WITH HIPS ELEVATED ON PILLOWS > MODIFIED KNEE CHEST POSITION ** THERE IS INCREASED CIRCULATING FIBRINOGEN ( CLOTTING FACTOR) THAT IS WHY PREGNANT WOMEN ARE NORMALLY SAFEGUARDED AGAINST UNDUE BLEEDING. HOWEVER THIS ALSO PREDISPOSES THEM TO CLOT FORMATION ( THROMBI)

IMPLICATION:

PREGNANT WOMEN SHOULD NOT BE MASSAGED SINCE BLOOD CLOTS CAN BE RELEASED & CAUSE THROMBOEMBOLISM.
** DURING DELIVERY, THE ALLOWABLE BLOOD LOSS IS 250450 ML (MAXIMUM 500 ML) FOR A SINGLE FETUS, 1000 ML FOR VAGINAL DELIVERY OF TWINS OR CESARIAN SECTION.

** SUPINE HYPOTENSION SYNDROME OR VENA CAVA SYNDROME = THE WEIGHT OF THE GRAVID UTERUS PRESSES ON THE VENA CAVA OBSTRUCTING BLOOD FLOW. THE WOMAN EXPERIENCES LIGHTHEADEDNESS, FAINTNESS & HEART PALPITATIONS.
MX: LEFT SIDE LYING OR LEFT LATERAL SO AS NOT TO COMPRESS THE VENA CAVA. NO SUPINE POSITION AFTER 20 WEEKS AOG

** PSEUDOANEMIA AS THE BLOOD VOL. INCREASES, THE CONCENTRATION OF HGB MAY DECLINE MX: iron supplement

RESPIRATORY SYSTEM:

** SLIGHT DYSPNEA MAY OCCUR UNTIL LIGHTENING CAUSED BY INCREASED O2 CONSUMPTION & PRODUCTION OF CO2

GASTROINTESTINAL SYSTEM:

** MORNING SICKNESS EAT DRY CRACKERS 30 MINUTES BEFORE ARISING IN THE MORNING. AVOID SPICY, FATTY FOODS

MX:

HYPEREMESIS GRAVIDARUM = EXCESSIVE NAUSEA & VOMITING WHICH PERSISTS BEYOND 3 MONTHS THAT COULD RESULT TO DEHYDRATION, STARVATION, MALNUTRITION AND F & E IMBALANCE

MX: D10NSS 3000 ML IN 24 HOURS IS THE PRIORITY OF TREATMENT > REST

> ANTI- EMETICS (EX. PLASIL)

CONSTIPATION = DUE TO DISPLACEMENT OF THE STOMACH & INTESTINES AND DUE TO INCREASED PROGESTERONE DURING PREGNANCY ( DECREASED PERISTALSIS)

MX:

> INCREASE FLUID INTAKE > HI - FIBER DIET


ESTABLISH REGULAR ELIMINATION PATTERN EXERCISE MINERAL OIL SHOULD NOT BE USED BECAUSE IT INTERFERES WITH ABSORPTION OF FAT SOLUBLE VITAMINS ( ADEK)

HEARTBURN = REFLUX OF STOMACH CONTENT INTO THE ESOPHAGUS DUE TO INCREASED PROGESTERONE WHICH DECREASES GASTRIC MOTILITY MX: > PATS OF BUTTER BEFORE MEALS
> AVOID FRIED, FATTY FOODS > BEND AT THE KNEES NOT AT THE WAIST > TAKE ANTACIDS EX. MILK OF MAGNESIA BUT NEVER SODIUM NHCO3

PICA = **ABNORMAL CRAVING FOR NON NUTRITIOUS SUBSTANCES. THE MOST COMMON IS CRAVING FOR ICE CUBES. THERE COULD ALSO BE CRAVING FOR PAPER, ETC.,
**OFTEN ACCOMPANIES

IRON

DEFICIENCY ANEMIA
**ENCOURAGE

TO TAKE IRON

SUPPLEMENTS

MUSCULOSKELETAL SYSTEM
GRADUAL

SOFTENING OF PELVIC LIGAMENTS AND JOINTS TO FACILITATE PASSAGE OF THE BABY. FORWARD CURVATURE OF THE LUMBAR SPINE . THE PRIDE OF PREGNANCY CRAMPS MAY OCCUR FROM AN IMBALANCE OF CALCIUM PHOSPHORUS RATIO IN THE BODY AND FROM PRESSURE OF THE UTERUS ON LOWER EXTREMITIES; FATIGUE; CHILLS MUSCLE TENSENESS; LOW CALCIUM AND HIGH PHOSPHOROUS INTAKE

LORDOSIS=

LEG

MANAGEMENT:
**FREQUENT

REST PERIODS WITH FEET ELEVATED **WEAR WARM, COMFORTABLE CLOTHING **INCREASE CALCIUM INTAKE (CALCIUM TABLETS AND DIET)

**DO

NOT MASSAGE= BLOOD CLOTS CAN CAUSE EMBOLISM


EFFECTIVE RELIEF: PRESS KNEE OF THE AFFECTED LEG AND DORSIFLEX THE FOOT.

**MOST

WEIGHT
*DURING

THE FIRST TRIMESTER, WEIGHT GAIN OF 1.5-3LBS. THE 2ND AND 3RD TRIMESTERS, WEIGHT GAIN OF 10-11 POUNDS PER TRIMESTER IS RECOMMENDED. WEIGHT GAIN DURING THE ENTIRE PERIOD OF PREGNANCY IS 20-25 LBS. 10-12 KGS.). MORE THAN 30 LBS OF WEIGHT GAIN IS A DANGER SIGN = POSSIBLE PREECLAMPSIA.

*ON

*TOTAL ALLOWABLE

RECOMMENDED EXERCISES:

CHIEF AIM: STRENGTHEN MUSCLES USED IN LABOR & DELIVERY.

1.

TAILOR SITTING ( INDIAN SIT)

= STRENGTHENS THE THIGH & STRETCHES THE PERINEAL MUSCLES. THE WOMAN SHOULD NOT PUT ONE ANKLE ON TOP OF THE OTHER BUT SHOULD PLACE ONE LEG IN FRONT OF THE OTHER GENTLY PUSHING HER KNEES ( PUSHING THEM TOWARDS THE FLOOR) UNTIL SHE FEELS HER PERINEUM STRETCH

2.

SQUATTING = HELPS TO STRETCH THE MUSCLES OF THE PELVIC FLOOR. IT SHOULD BE DONE FOR 15 MINUTES A DAY. THE WOMAN MUST KEEP HER FEET FLAT ON THE FLOOR TO BENEFIT FROM THE EXERCISE.
PELVIC FLOOR CONTRACTIONS ( KEGELS EXERCISE) = STRENGTHENS PERINEAL MUSCLES FOR LABOR & DELIVERY; PROMOTES PERINEAL HEALING; INCREASES SEXUAL RESPONSIVENESS AND PREVENTS STRESS INCONTINENCE.

3.

3. PELVIC ROCKING = HELPS RELIEVE BACKACHE DURING PREGNANCY. IT CAN BE DONE ON HANDS AND KNEES, LYING DOWN, SITTING OR STANDING. IF THE WOMAN LIES SUPINE, SHE TIGHTENS HER BUTTOCKS & FLATTENS HER LOWER BACK AGAINST THE FLOOR TRYING TO LENGTHEN HER SPINE. SHE HOLDS THE POSITION FOR 1 MINUTE THEN HALLOWS HER BACK OR RAISES THE LUMBAR SPINE IN THE FLOOR.

4. ABDOMINAL MUSCLE CONTRACTIONS =

HELPS STRENGHTEN ABDOMINAL MUSCLES DURING PREGNANCY & PREVENTS CONSTIPATION IN THE POSTPARTAL PERIOD. IT CAN BE DONE IN A STANDINGOR LYING POSITION.

1.

NAEGELES RULE = CALCULATION OF EXPECTED DATE OF CONFINEMENT ( EDC )


FORMULA: COUNT BACK 3 MONTHS FROM THE LAST DAY OF THE MENSTRUAL PERIOD (LMP) THEN ADD 7 DAYS PLUS 1 YEAR.

EXAMPLE: LMP APRIL 22, 1995


-3 JAN +7 +1

29, 1996

2. MC DONALDS RULE = ( ESTIMATION OF AOG IN MONTHS & WEEKS BY FUNDIC HEIGHT MEASUREMENT)=
FORMULA :

FUNDIC HEIGHT IN CMS X 2/7 OR 8/7


EXAMPLE: FUNDIC HEIGHT IS 21 CMS 21 CMS X 2 =42 42/ 7 = 6 ( AOG IN MONTHS) 6 MONTHS X 4 = 24 ( AOG IN WEEKS)

HAASES RULE = ESTIMATION OF FETAL LENGTH


RULE: **DURING THE FIRST HALF OF PREGNANCY, SQUARE THE NUMBER OF THE MONTH ( EX. FIRST LUNAR MONTH: 1X1 = 1CM. **DURING THE SECOND HALF OF PREGNANCY, MULTIPLY THE MONTH BY 5 ( EX. 6TH LUNAR MONTH: 6X5 = 30 CM.) FORMULA: 1 TO 5 MONTHS = MONTHS SQUARED

BARTHOLOMEWS RULE = ESTIMATION OF AOG BY THE RELATIVE POSITION OF THE UTERUS IN THE ABDOMINAL CAVITY.

** BY THE 3RD LUNAR MONTH, THE FUNDUS IS PALPABLE SLIGHTLY ABOVE THE SYMPHYSIS PUBIS ** ON THE 5TH LUNAR MONTH, THE FUNDUS IS AT THE LEVEL OF THE UMBILICUS ** ON THE 9TH LUNAR MONTH , THE FUNDUS IS BELOW THE LEVEL OF THE XIPHOID PROCESS

A SYSTEMATIC METHOD OF OBSERVATION & PALPATION TO DETERMINE THE PRESENTATION, FETAL POSITION, ATTITUDE, FETAL LIE & DEGREE OF ENGAGEMENT. THE WOMAN SHOULD BE IN SUPINE POSITION WITH HER KNEES FLEXED SLIGHTLY SO AS TO RELAX THE ABDOMINAL MUSCLES. INSTRUCT THE CLIENT TO VOID
PALPATE WITH WARM HANDS. COLD HANDS CAUSE ABDOMINAL MUSCLES TO CONTRACT.

PREPARATORY STEPS:

LABOR

= PHYSICAL & MECHANICAL PROCESS IN WHICH THE BABY, THE PLACENTA & FETAL MEMBRANES ARE PROPELLED THROUGH THE PELVIS & ARE EXPELLED FROM THE BIRTH CANAL.
= ACTUAL EVENT OF

DELIVERY

BIRTH

1.

THE PASSENGER ( FETUS) =

THE FETAL SKULL = FROM AN OBSTETRICAL POINT OF VIEW, THE FETAL SKULL IS THE MOST IMPORTANT PART OF THE FETUS BECAUSE: A. IT IS THE LARGEST PART OF THE BODY

B. IT IS THE MOST FREQUENT PRESENTING PART


C. IT IS THE LEAST COMPRESSIBLE OF ALL PARTS

SUTURE LINES ARE IMPORTANT BECAUSE THEY ALLOW THE BONES TO MOVE AND OVERLAP, CHANGING THE SHAPE OF THE FETAL HEAD IN ORDER TO FIT THROUGH THE BIRTH CANAL, A PROCESS CALLED MOLDING.
1. SAGITTAL SUTURE LINE = THE MEMBRANOUS INTERSPACE WHICH JOINS THE 2 PARIETAL BONES. 2. CORONAL SUTURE LINE = THE MEMBRANOUS INTERSPACE WHICH JOINS THE FRONTAL BONE AND THE PARIETAL BONES.

3. LAMBDOIDAL SUTURE LINE


FONTANELLES = MEMBRANE COVERED SPACES AT THE JUNCTION OF THE MAIN SUTURE LINES: 1. ANTERIOR FONTANEL = THE LARGER, DIAMOND SHAPED FONTANEL WHICH CLOSES BETWEEN 12 TO 18 MONTHS IN AN INFANT

2. POSTERIOR FONTANEL = THE SMALLER TRIANGULAR SHAPED FONTANEL WHICH CLOSES BETWEEN 2-3 MONTHS IN THE INFANT. THE SPACE BETWEEN THE TWO FONTANELLES IS REFERRED TO AS THE VERTEX. D. MEASUREMENTS THE SHAPE OF THE FETAL SKULL CAUSES IT TO BE WIDER IN ITS ANTEROPOSTERIOR (AP) DIAMETER THAN IN ITS TRANSVERSE DIAMETER.

2. THE PASSAGEWAY (Birth Canal) =

THE PELVIS

a.

PELVIC INLET = ENTRANCE TO THE TRUE PELVIS, OR THE UPPER RING OF BONE THROUGH WHICH THE FETUS MUST FIRST PASS TO BE BORN VAGINALLY. ITS TRANSVERSE DIAMETER IS WIDER THAN ITS AP DIAMETER. THUS: TRANSVERSE DIAMETER = 13.5 CM
AP DIAMETER = 11 CM

b.

MIDPELVIS/ PELVIC CAVITY = THE SPACE BETWEEN THE INLET & THE OUTLET. THIS IS NOT A STRAIGHT BUT A CURVED PASSAGE.
PELVIC OUTLET = THE INFERIOR PORTION OF THE PELVIS. THE MOST IMPORTANT DIAMETER OF THE OUTLET IS ITS TRANSVERSE OR BI-ISCHIAL DIAMETER( DISTANCE BET THE TWO ISCHIAL TUBEROSITIES) WHICH IS ABOUT 11.5 CM DIAMETER 9.5 TO 11.5 CM

c.

AP

a.

DIAGONAL CONJUGATE = DISTANCE BETWEEN THE MIDPOINT OF THE SACRAL PROMONTORY TO THE LOWER MARGIN OF THE SYMPHYSIS PUBIS. ( MEASURED BY INTERNAL EXAMINATION) AVERAGE = 12.5 TO 13 CMS

B.

TRUE CONJUGATE/ CONJUGATA VERA = THE DISTANCE BETWEEN THE MIDPOINT OF THE SACRAL PROMONTORY TO THE UPPER MARGIN OF THE SYMPHYSIS PUBIS.
IMPORTANT MEASUREMENT BECAUSE IT IS THE DIAMETER OF THE PELVIC INLET. AVERAGE = 11.5 CM.

VERY

C.

OBSTETRIC CONJUGATE = DISTANCE BETWEEN THE MIDPOINT OF SACRAL PROMONTORY TO THE MIDLINE OF THE SYMPHYSIS PUBIS WHICH IS ASCERTAINED BY SUBTRACTING 1 TO 1.5 CM FROM THE DIAGONAL CONJUGATE.. AVERAGE = 11 CM

3. THE POWER (Uterine Contraction) = Phases:

INCREMENT = WHEN THE INTENSITY OF THE CONTRACTIONS INCREASES ACME = WHEN THE CONTRACTIONS ARE AT ITS STRONGEST DECREMENT = WHEN THE INTENSITY DECREASES

DURATION

refers to the length of the contraction starting from the beginning of the contraction to the end of the same contraction FREQUENCY starts from the beginning of one contraction to the beginning of another contraction INTERVAL regularity of contractions. Starts from the end of one contraction to the beginning of the next contraction

INTENSITY

refers to the strength of the uterine contractions a. Mild the fundus is slightly tense and easy to indent with fingertips b. Moderate the fundus is firm and difficult to indent with fingertips c. Strong fundus is hard & rigid and almost impossible to indent

Oxytocin
Uterine

Theory

Stretch Theory Deprivation Theory

Progesterone Placental

Age Theory

STAGE
1ST STAGE 2ND STAGE

PRIMIS
10-12 HRS 30MIN-2 HRS

MULTIS
6-8 HRS 20 TO 90 MIN

AVE. 50 MIN
3RD STAGE 5 TO 20 MIN

AVE. 20 MIN
5 TO 20 MIN

4TH STAGE

2 TO 4 HRS

2 TO 4 HRS

1st

Stage (Stage of Dilatation) begins from true labor and ends in full cervical dilatation 2nd Stage (Stage of Expulsion) begins from full cervical dilatation until the baby is delivered 3rd Stage (Placental Stage) from the delivery of the baby until the placenta is entirely expelled 4th Stage (Recovery Stage) starts immediately once the fetus is delvered up to 4 hours and is completed once the reproductive tract has returned to its non-pregnant state

1. MEDIAN - FROM MIDDLE PORTION OF THE LOWER VAGINAL BORDER (FOURCHETTE) DIRECTED TOWARDS THE ANUS.
2. MEDIOLATERAL BEGINS IN THE MIDLINE BUT DIRECTED LATERALLY AWAY FROM THE ANUS.

OBSTETRICAL FORCEPS ARE DOUBLE BLADED INSTRUMENTS DESIGNED TO GRASP THE FETAL HEAD TO:
1. HASTEN DELIVERY WHEN THE LIFE OF THE MOTHER IS THREATENED. 2. TO SHORTEN THE SECOND STAGE OF LABOR 3. INTERVENE WHEN REGIONAL OR GENERAL ANESTHESIA HAS AFFECTED THE WOMANS ABILITY TO PUSH.

1. OUTLET FORCEP - USED WHEN THE HEAD IS VISIBLE IN THE PERINEUM. THIS IS ADVOCATED FOR DELIVERY OF PRETERM INFANTS.
2. MID FORCEP USED WHEN THE FETAL HEAD IS ABOVE THE ISCHIAL SPINES ( RARELY USED BECAUSE IT IS ASSOCIATED WITH CEREBRAL DAMAGE & NEONATAL DEPRESSION.)

THE

USE OF FORCEPS REQUIRES A FULLY DILATED CERVIX ( 10 CM)


MEMBRANES

RUPTURED

VERTEX

OR FACE PRESENTATION

ENGAGED

HEAD ( PREFERABLY IN THE PERINEUM THE PHYSICIAN MUST KNOW THE EXACT POSITION & STATION OF THE FETAL HEAD.)

ENCOURAGE WOMAN TO MAINTAIN BREATHING TECHNIQUES & ASK NOT TO PUSH DURING APPLICATION OF FORCEPS.
MONITOR FHR CONTINUOUSLY UNTIL DELIVERY. FETAL BRADYCARDIA MAY OCCUR TEMPORARILY FROM HEAD COMPRESSION AS TRACTION IS APPLIED TO THE FORCEPS.

THE

INFANT MAY HAVE A SCALP BRUISE FROM THE BLADES OF THE FORCEPS. PARENTS ARE TOLD OF THE BRUISE & ASSURED THAT IT WILL DISAPPEAR IN A FEW DAYS.
NEONATES FOR ERBS PALSY OR CEREBRAL TRAUMA.

OBSERVE

DELIVERY

OF THE BABY THROUGH AN ABDOMINAL & UTERINE INCISION

Indications

FETAL DISTRESS BREECH PRESENTATION DYSTOCIA CEPHALOPELVIC DISPROPORTION

PRIOR CESARIAN SURGERY CORD PROLAPSE ABRUPTIO PLACENTA PLACENTA PREVIA

COMPLICATIONS

INFECTIONS

HEMORRHAGE
BLOOD CLOTS

SURGICAL INJURY TO THE BLADDER


SURGICAL INJURY TO THE FETUS

Cesarian

Hysterectomy Operation Removal of the uterus is performed after delivery of the baby INDICATIONS Intrauterine infection Uterine rupture that cannot be repaired Placenta Accreta Presence of large uterine myoma Hypotonic uterus that doesnt respond to oxytoxic stimulation Laceration of major uterine blood vessels Grossly deffective scar

PUERPERIUM

/ POSTPARTUM = REFERS TO THE SIX TO EIGHT WEEK PERIOD AFTER THE DELIVERY OF THE BABY.
= THE RETURN OF THE REPRODUCTIVE ORGANS TO THEIR PRE-PREGNANT STATE.( 6 WEEKS)

INVOLUTION

FUNDUS - SHOULD BE CHECKED EVERY 15 MINUTES FOR 1ST HOUR THEN EVERY 30 MINUTES FOR THE NEXT 4 HOURS. FUNDUS SHOULD BE FIRM, IN THE MIDLINE, & DURING THE FIRST 12 HOURS POST PARTUM, IS A LITTLE ABOVE THE UMBILICUS. LOCHIA UTERINE DISCHARGE CONSISTING OF BLOOD, DECIDUAS, WBC & MUCUS. SHOULD BE MODERATE IN AMOUNT.

RUBRA = 0-3 DAYS , DARK RED & MODERATE IN AMOUNT, SMALL CLOTS, FLESHY STALE ODOR.
SEROSA = 4 -7 DAYS ; PINK OR BROWNISH IN COLOR, NO CLOTS, NO ODOR ( UNLESS POOR HYGIENE)

ALBA = 1 3 WEEKS; CREAM TO YELLOWISH IN COLOR; MINIMAL IN AMOUNT; NO ODOR; NO CLOTS

PATTERN SHOULD NOT REVERSE


IT SHOULD APPROXIMATE MENSTRUAL FLOW

IT HAS THE SAME FLESHY ODOR AS MENSTRUAL BLOOD.


IT SHOULD NEVER BE ABSENT, REGARDLESS OF THE METHOD OF DELIVERY. ( NSD OR CS)

BLADDER

= A FULL BLADDER IS EVIDENCED BY A FUNDUS WHICH IS RIGHT TO THE MIDLINE


IS NORMALLY TENDER , DISCOLORED ( ECCHYMOTIC) & EDEMATOUS. ( APPLY ICE BAG TO THE PERINEUM IMMEDIATELY). IT SHOULD BE CLEAN WITH INTACT SUTURES.

PERINEUM

ROOMING

IN CONCEPT ( PRIMARILY TO PROMOTE BONDING) PRESSURE TAKEN EVERY 15 MINUTES FOR 1ST HR; THEN EVERY 30 MINUTES DURING THE 2ND HOUR

BLOOD

TAKING- IN PHASE = 1 3 DAYS POSTPARTUM WHEN MOTHER RELIES ON OTHERS TO CARE FOR HER & HER NEWBORN PREOCCUPIED WITH SELF & OWN NEEDS ( FOOD & SLEEP) CLIENT MAY VERBALIZE HER FEELINGS REGARDING RECENT DELIVERY HESITANT ABOUT MAKING DECISIONS NEEDS TO BE MOTHERED

TAKING HOLD PHASE = 4 7 DAYS POSTPARTUM WHEN MOTHER BEGINS TO INITIATE ACTIONS & DECISIONS READY FOR MOTHERING ROLE POST-PARTUM BLUES (AN OVERWHELMING FEELING OF SADNESS THAT CANNOT BE ACCOUNTED FOR) MAY BE OBSERVED. COULD BE DUE TO HORMONAL CHANGES, FATIGUE OR FEELINGS OF INADEQUACY IN TAKING CARE OF A NEW BABY.

LETTING GO PHASE = 10 DAYS


WOMAN ATTAINS

COMPLETE

INDEPENDENCE
ASSUMING

NEW ROLES AND RESPONSIBILITIES


INCORPORATES THE NEW BABY INTO THE FAMILY UNIT.

MOTHER