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Anatomy of The Female Pelvis Final
Anatomy of The Female Pelvis Final
Anatomy of The Female Pelvis Final
pelvis
The part of the trunk inferoposterior to the abdomen. The area of transition between the trunk and the lower limbs. Part of the appendicular skeleton of the lower limb. The space or compartment surrounded by the pelvic girdle(bony pelvis).
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Function of pelvis
Adapted for child bearing Allow movement of the body Permits the person to sit and stand Transmits the weight of the trunk to the leg Affords protection to pelvic organs and a lesser extent to the abdominal contents
Fun..
Provide attachment for the powerful muscles of locomotion and posture. Provide attachment for the erectile bodies of the external genitalia. Provide attachment for the muscles and membranes that assist in these functions by forming the pelvic floor and filling gaps that exist in or around it.
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The ilium
Is the large flared out part of the innominate bone Is made up of a relatively flat of bone above and part of acetabulum below.
iliac crest
The superior margin of ileum . the fourth lumbar vertebra. Used as a surface marking when performing lumbar puncture. Ends interiorly in a rounded anterior superior iliac spine and posterior in a sharp posterior superior iliac spine.
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The ilium
Anteriorly the crest ends in the anterior superior iliac spine, a bony prominence which can be palpated under the skin. Posteriorly iliac crest ends in the posterior superior iliac spine. Below the anterior superior iliac spine is an other bony prominence the anterior inferior iliac spine, while posteriorly, there is posterior inferior iliac spine. At its lower most part the ileum forms the upper two- fifths of the acetabulum, where it fuses with ischium and pubis.
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The ilium
Behind the acetabulum, the ileum forms the upper part of a large notch, the greater sciatic notch, through which pass the piriforms muscles and the nerves of the sacral plexus, on their way from the front of the sacrum in to the thigh. On the inner aspect of the bone, the iliac fossa is bounded below by a prominent ridge, which is the iliac part of the ilio pectineal line. Anteriorly the ilio pectineal line swells into a bony prominence, at the point where the ileum fuses with superior ramus of the pubis, to form the ilio-pectineal eminence. Posterior to the ilio pectineal line and above the greater sciatic notch, is a roughened area , where the ileum articulate with the sacrum to form the sacro -iliac 12 joint.
The ischium
The lowest constituent bones of the innominate bone Formed by the following parts; The head forms the lowest two-fifths of the acetabulum, where it fuses with the ileum and pubis. Below the acetabulum a thick buttress of bone pass down and terminates in ischial tuberosity the part which the weight of the body rest on when sitting.
Passing up wards and in ward from the ischial tuberosity a small shaft of the ischium becomes continuous with the inferior ramus of the pubis so forming the public arch.
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The ischium
The ischium forms the lower boundary of the large foramen, the obturator foramen or foramen ovale. On its internal aspect the ischium forms the side wall of the true pelvis. Protruding in wards from its posterior edge, about 5cm above the tuberosity, is a conspicuous projection known as the ischial spine which is use to estimate the station of fetal head. Lesser sciatic notch is situated between the ischial spine above and ischial tuberosity below.
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The pubis
The smallest of the three bones forming the innominate bone and form the lower one fifth of the acetabulum. The right and left pubic bones unite with each other anteriorly at the square shaped pubic bodies. They are fused by a pad of cartilage, the symphysis pubis. The upper surface of the body forms a crest, the pubic crest, which ends laterally in the 15 pubic tubercle.
The pubis
Extending upwards from each pubic body, the superior ramus unites with ilium at iliopectineal eminence. Below the body of the pubic, the inferior ramus passes down wards and out wards to join the ischium, so forming the upper part of pubic arch
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The sacrum
Is situated in the posterior part of the pelvis and consists of five fused sacral vertebrae. The anterior surface is smooth, and is concave from above down wards and slightly so from side to side forming the hollow of the sacrum. The sacral alae are the widened out wings of bone on each side of the 1st sacral vertebra. Promontory of the sacrum is the center point of the upper border of the 1st sacral vertebrae which with the base of the 5th lumbar vertebra, protrudes over the hollow of the sacrum.
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The sacrum
Sacral canal runs longitudinally through the center of the sacrum and opens at the level of the 5th sacral vertebra. The posterior surface for the sacrum is rough and irregular and serves for the attachment of the ligaments and muscles of the back. The sacrum articulates laterally with the ileum at sacroiliac joint and lower margin of it articulate with coccyx at sacro18 coccygeal joint.
The coccyx
Consists of four fused coccygeal vertebrae. It is triangular in shape with its base uppermost. The 1st coccygeal vertebra articulates with lower end of the sacrum at the sacro-coccygeal joint. The remaining three vertebrae mere rudimentary nodules of bone; they are smooth in their inner surface where they support the rectum, while their lowest most tip are attached to the external anal sphincter and ano-coccygeal body.
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Pelvic joints
There are four pelvic joints Two sacro-iliac joints One symphysis pubis One sacro-coccygeal joints
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The sacro- tuberous ligament and sacrospinous ligaments cross the sciatic notch and form the posterior wall of the pelvic out let.
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6. Inner border of the superior ramus of pubic bone. 7. Upper inner border of the body of pubic bone 8. upper inner border of symphysis pubis
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Dimensions.
The diagonal conjugate is measured anteriorposteriorly from the lower border of the symphysis pubis to sacral promontory and measures 12-13cm.
It may be estimated pervaginum as a part of pelvic assessment. The oblique diameter passes from the sacro-iliac joints to the opposite ilio- pectineal eminence. It measures12cm. The transverse diameters is a line between the points farther most a part on the ilio- pectineal lines and measures 13 cm. The sacro- cotyloid diameter is a line passing from the promontary of the sacrum to the ilio- pectineal eminence and it measures 9.5 cm on each side.
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Dimensions
The diameters of the cavity - The cavity is circular in shape and all diameter are equal in length. Anterior- posterior diameters posses from the mid point of symphysis pubis to the junction of the 2nd and 3rd sacral vertebrae and measures 12cm. The oblique diameter- pass obliquely in the plane of the cavity parallel to the oblique diameters of the brim. It measures 12cm. The Transverse diameter- passes in the plane of the cavity between the points far most apart in the lateral pelvic walls and measures 12cm.
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Dimensions
The diameters of out let
The anterior-posterior diameter passes from the lower border of the symphysis pubis to the sacrococcygeal joint and measures 13cm. There are two transverse diameters;
The 1st is a line passes between the two ischial spines. It measure 11 cm. The 2nd is a line passing between the inner borders of the two ischial tuberosities and measures 11cm
Types of pelvis
Based on the shape of the brim, there are four main groups of pelvis Gyneacoid Android Platypelloid Anthropoid
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Gynaecoid pelvis(50%)
It is the normal female type. Inlet is slightly transverse oval. Sacrum is wide with average concavity and inclination. Side walls are straight with blunt ischial spines. Sacro-sciatic notch is wide. Subpubic angle is 90-1000.
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Robert pelvis
Has no wings (alae) of the sacrum and there fore contracted in all diameters It is a type very rarely seen and is the result of congenital abnormality . Caesarean section is always necessary for delivery
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Gynaecoid
Anthropoid
Android
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Function
Supports the weight of the abdominal and pelvic organs. Its muscles are responsible for the voluntary control of micturition, defecation and play a role in sexual inter course. Maintenance of intra- abdominal pressure. It influences the passive movement of the fetus through the birth canal.
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Muscles
Bulbo-cavernous muscles arise from the
central point of the perineum and pass forwards around the vagina lying superficial to bartholins glands and the vestibular bulbs, and deep to the labia. They are inserted into the corpora cavernous of the clitoris in the upper part of the pubic arch. Its action is to diminish the size of the vaginal orifice and to cause engorgement of clitoris during sexual activity.
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Muscles
Ischio cavernous muscles pass from the
ischial tuberosity a long the pubic arch to the corpora cavernous of the clitoris. Their function is to cause engorgement of the clitoris.
canal, lying below the internal sphincter and the levator ani. Anteriorly it enters in to the formation of the perineal body and posteriorly some of its fibers are attached 58 to the tip of the coccyx.
Muscles
The membranous sphincter of the urethra is
composed of muscle fibers passing above and below the urethra and attached to the pubic bones.
Muscles
Ischiococcygeus muscles
arise from the ischial spine and pass to the upper part of the coccyx and lower border of the sacrum, in front of the sacro-spinous ligament. It helps to stabilize the sacroiliac and sacro-coccygeal joints.
the body of pubic bones. Its fibers sweep posteriorly below the bladder on either side of the urethra and the lowest third of the vagina, to enter the perineal body. The longest fibers gain insertions into ano-cocygeal body and the coccyx. They surround and support the urethra, vagina and rectum. It helps in controlling micturition and defection, as well as 60 normal sexual function.
Is a combination of connective tissue, blood vessels and voluntary and involuntary muscle fibers. It lines the walls and floor of the pelvic cavity and fills the area between the organs, thus giving additional support. The fascia thickens to form pelvic ligaments. These are Two lateral ligaments extend from the white line of the of fascia to the lateral walls of the bladder . Two pubovesical ligaments extend from the neck of bladder to the inner surface of each pubic body. 63 They form part of the pubo-cervical ligaments.
Pelvic fascia
Pelvic fascia
Two pubovesical ligaments are attached to the inner surface of each pubic body; they run posteriorly and become attached to the neck of bladder, the vault of the vagina and the supra vaginal cervix. Transverse cervical ligaments (cardinal or mackenrodts) - are attached to the vaginal vault and supravaginal cervix. Run transversely across the pelvic floor and run out until they reach the white line of the fasciae. They are the strongest of the pelvic ligaments. 64
Pelvic fascia
Uterosacral ligaments are attached to the vaginal vault and supravaginal cervix. They pass posteriorly and attach to the lateral border of the 1st sacral body. Round ligaments arise anteriorly from just below the cornu of the uterus and fallopian tubes then take a V, shaped canal before inserting in to each labia major. The cardinal, uterosacral and round ligaments all contribute to the support of the uterus and maintenance of its position
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External Genitalia
External Genitalia
Labia minora are two smaller folds of pink
skin lying longitudinally with the labia majora. The area they in close is known as the vestibule Anteriorly they divided in to two folds. The upper folds surround the clitoris and unite to form the prepuce. The two lower folds are attached to undersurface of the clitoris and are known as the frenulum. Posteriorly, the labia minora unite to form a thin fold of skin, the fourchette.
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External Genitalia
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External Genitalia
vestibules:- is a triangular space bounded
anteriorly by the clitoris, posterior by the fourchette and on either said by labia minus. There are four openings in to the vestibule. 1.The urethral meatus lies 2.5 cm below the clitoris. 2.The vaginal orifice (introitus) occupies the lower two thirds of the vestibule lying between the labia minora.
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External Genitalia
3.The bartholins ducts and glands:- are situated in the superficial perineal pouch posterior to the vestibular bulb.
It secretes abundant alkaline mucus during sexual excitement which helps in lubrication. 4.Vestibuler bulb:- are bilateral masses of erectile tissues situated beneath the mucus membrane called vestibule. Each bulb lies on either side of the vaginal orifice deep to the labia majora and minora and anterior to bartholins glands.
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External Genitalia
Blood supply:- The vulva is supplied with blood from two main arteries The femoral artery in the upper part of the thigh. The internal pudendal arfery running along the pubic arch. The veins drain to corresponding veins. Lymphatic drainage: - some drainage in to the inguinal glands and some is in to the external iliac glands. Never supply:- is from the branches of pudendal nerve and the perineal nerve.
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Internal genitalia
The vagina
Is a tube (canal) which extends from the vulva to the uterine cervix. It is longer in posterior wall (9cm) than anterior (7cm). The vault of the vagina is divided in to four fornices by the projection of the cervix. Anterior Posterior Two lateral fornices The posterior for nix is the largest. The vaginal walls are pink in appearance and thrown in to small folds known as rugae.
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The vagina
Structures
Vaginal wall is composed of four layers. The layers from in to out wards are : 1. Mucus coat lined by stratified squamous epithelium. 2. Sub mucous layer 3. muscular layer inner circular and outer longitudinal 4. fibrous coat
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The vagina
Contents
There are no glands situated in the wall of the vagina. The vagina contains a small amount of fluid which is derived from two sources; Alkaline mucus which secrete from the glands of the cervix, The vaginal blood vessels which allow serous fluid to transude through the vaginal wall into its lumen. The vaginal fluid is acidic in reaction having a PH of about 4.5 during reproductive life.
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The vagina
Relations
Anterior the bladder and the urethra Posterior lowest 2/3 perineal body -Middle third rectum -Upper third pouch of Douglas. Lateral upper 2/3 pelvic fascia at the base of the brood ligament. - Lowest third two levator ani muscles - bulbo-cavernosus muscles. Superior Uterine cervix Inferior hymen and the structures of the vulva
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The vagina
Blood supply Arterial supply from the vaginal, the uterine (descending branch), the middle haemorrodial, the inferior vesical and pedundial arteries The vain drains in a corresponding manner. Lymphatic drainage The lowest 2/3 drain to the horizontal inguinal groups along with those of the vulva. Upper 1/3 drain to the internal iliac and sacral glands. Nerve supply is from the sympathetic and pelvic splanchnics nerves 80
The vagina
Functions Entrance for spermatozoa Exit for menstrual flow and products of conception Helps to support the uterus Organs for sexual intercourse Helps to prevent infection
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The Uterus
Is a hollow, flattened, muscular peer shaped organ situated between the bladder and rectum in non pregnant state. It is normally anteverted and anteflaxed It measures 8cm in length 5cm width and 2-3 cm thick. Its weight is approximately 57gm.
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The Uterus
It consists of the following parts. Body or corpus Comprise the upper 2/3 of the uterus Lies between the isthmus and the opening of the fallopian tubes. Cervix Forms the lower third of the uterus and measures about 2.5 cm in length. It is conical in shape The cervix projects through the anterior wall of the vaginal which divides it in to an upper supra vaginal portion and lower vaginal portion.
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The Uterus
SUPRA VAGINAL CERVIX
and above the vagina Superiorly it meets the border of the uterus at the isthmus. Is separated in front from the bladder by parametrium. Posteriorly it is covered by the peritoneum.
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The Uterus
INFRAVAGINAL CERVIX- is the part which projects in to the anterior vaginal wall between the anterior and posterior fornices. The internal os-opens in to the cavity of the uterus It dilates during labor. In competence of the cervix at this level results in spontaneous abortion. The external os opens in to the vagina at the lower end of the cervical canal. The cervical canal lies between the internal and external os It is fusiform in shape.
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The Uterus
FUNCTIONS OF THE CERVIX It helps to prevent infection entering the uterus. It dilates and withdraws during labor to enable vaginal delivery of the fetus and placenta.
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The Uterus
The funds- is the domed upper wall between
the insertions of the fallopian tubes. The cornu- are the upper outer angles of the uterus where the fallopian tubes join. The cavity- is a potential space between the anterior and posterior walls It is triangular in shape the base of the triangle being upper most. The isthmus- is a narrow area between the cavity and the cervix which is 7 mm long. It enlarges during pregnancy to form the lower 87 uterine segment.
The Uterus
STRUCTURES
1. The mucous membrane (tunica mucosa) Endometrium Forms a lining of ciliated epithelium on a base of connective tissue or stroma. The epithelial cells are cubical in shape and dip down to form glands which secrete alkaline mucus.
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The Uterus
The cervical endometrium is thinner than that of the body and is folded in to a pattern known as the arborvitae (tree of life), this assist the passage of the sperm. Here the epithelial cells are tall and columnar in shape.
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The Uterus
2.The muscular coat (tunica muscularis)Myometrium.
It is thick in the upper part of the uterus and is more sparse in the isthmus and cervix. Its fibers are outer longitudinal, middle interlacing oblique and inner circular. Its muscle fibers are embedded in collagen fibers which enable to stretch in the labor.
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The Uterus
3.The serous coat (tunica serosa)Perimetrium. Is derived from the peritoneum; it invests the fundus and the whole of the intestinal surface of the uterus, covers the vesical surface as only far as the junction of the body and cervix.
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The Uterus
The form, size and situation of the uterus vary at different periods of life and under different circumstances. In the fetus:- the uterus is contained in the abdominal cavity projecting beyond the superior aperture of the pelvis. The cervix is considerably larger than the body. At puberty- it is pyriform in shape and weights from 14 to 17 gm.
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The Uterus
In the adults- the position of the uterus
depends on the condition of the bladder and rectum. When the bladder is empty the entire uterus is directed forward and is at the same time bent on itself at the junction of the body and cervix, so that the body lies up on the bladder. as the bladder fills the uterus gradually becomes more and more erect until with a fully distended bladder the fundus may be directed back ward 93 toward the sacrum.
The Uterus
During menstruation:-the uterus is enlarged, more vascular, and its surface rounder; the external orifice is rounded, its labia swollen, and the lining membrane of the body thickened, softer, and of a darker color.
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The Uterus
After parturition-the uterus nearly
regains its usual size, weighinig about 42gm; but the cavity is larger than in the virgins state, its vessels are tortuous, and its muscular layers are more defined; the external orifice is more marked, and its edges present one or more fissures.
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The Uterus
In old age - the uterus becomes
atrophied, and denser in texture, a more distinct separates the body and cervix. The internal orifice is frequently, and the external orifice occasionally, obliterated, while the lips almost entirely disappear.
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The Uterus
RELATIONS ANTERIOR uterovesical pouch and bladder. POSTERIOR- recto uterine pouch of Douglas and the rectum. LATERAL broad ligaments, the fallopian tubes and ovaries. SUPERIOR- the intestines INFERIOR the vagina. 98
The Uterus
UTERINE SUPPORTS (ligaments) Transverse cervical ligaments and (mackenrodts) Uterosacral ligaments Pubocervical ligaments Broad ligaments Pass from the sides of the uterus to the lateral walls of the pelvis. Together with the uterus it forms a septum across the female pelvis dividing the cavity in to two portions.
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The Uterus
Between the two layers of each broad ligament are contained; Uterine tube The round ligament of the uterus The ovary and its ligament The epoophoron and paraoophoron Connective tissue Unstriped muscular fibers Blood vessels and nerves Round ligaments
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The Uterus
BLOOD SUPPLY From the uterine artery, a branch of the hypo gastric artery. Veins drains to the corresponding manner. LYMPHATIC DRAINAGE- lymph is drained from uterine body to the internal illiac glands and also from the cervical area to many other pelvic lymph glands. Nerve supply -from autonomic nervous system, sympathetic and parasympathetic via sacral plexus 101
The Uterus
FUNCTION OF THE UTERUS To prepare a bed for the fertilized ovum. To nourish the fertilized ovum for the gestation period To expel the product of conception at full term. To involutes following child birth
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FALLOPIAN TUBES
Are paired structures which are attached with the lateral angle of uterine cavity. They run along the upper margin of the broad ligament and 10 cm in length. It has four portions 1.The interstitial portion- is 1.25 cm long and lies within the wall of the uterus. Its lumen is 1mm wide
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FALLOPIAN TUBES
2.The isthmus is another narrow part which extends for 2.5 cm from the uterus. It acts as reservoir for spermatozoa because its temperatures is lower than other. 3.The ampulla- is the wider portion where fertilization usually occurs & it is 5 cm in length. 4.The infundibulum- is the funnel shaped fingered end which is composed of many processes know as fimbriae.
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FALLOPIAN TUBES
RELATIONS
Anterior posterior and superior the peritoneal cavity and the intestine Lateral the side walls of the pelvis. Inferior the broad ligaments and ovaries. Medial the uterus.
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FALLOPIAN TUBES
LAYERS OF THE TUBE It consists of three coats 1.The external or serous coat is the peritoneum. 2.Middle or muscular coat- consists of inner circular and outer longitudinal layer of smooth muscles which helps for peristaltic movement of the fallopian tube. 3.The internal or mucous coat-is line by columnar and ciliated epithelium. Beneath the lining is a layer of vascular connective tissue.
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FALLOPIAN TUBES
SUPPORT - by the infundibulo pelvic ligaments. These ligaments are formed from folds of the broad ligament and run from the infundibulum of the tube to the side walls of the pelvis. Blood supply:- is via the uterine and ovarian arteries; venous return is by the corresponding veins. Lymphatic drainage- is in to the lumbar gland. NERVE SUPPLY is from the ovarian plexus.
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FALLOPIAN TUBES
FUNCTIONS
Propels the ovum towards the uterus. Receives the spermatozoa as they travel up wards Provides a site for fertilization Supplies the fertilized ovum with nutrition during its continued journey to the uterus.
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THE OVARIES
Are two nodular bodies which produce ova and hormones estrogen and progesterone. POSITION They are attached to the back of the broad ligament within the peritoneal cavity Size 3 cm in length, 2 cm in width and about 1 cm in thickness and weight from about 6gm.
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THE OVARIES
RELATIONS
Anterior the broad ligament. Posterior the intestine. Lateral the infudibulopelvic ligaments and the side walls of the pelvis. Superior the fallopian tubes. Medial the uterus and ovarian ligaments.
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THE OVARIES
SUPPORTS From above by the ovarian ligament medially, and the infundibulo pelvic ligaments laterally. Attachment of ovary- infundibulo pelvic ligament to the pelvic wall. Ovarian ligament- to the uterus. Mesooverium to the broad ligament
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THE OVARIES
Structures
The ovary is composed of medulla and cortex covered with germinal epithelium. The medulla- is the central portion and point of entry for blood vessels, lymphatic and nerves. The hilum where these vessels enter lies just where the ovary is attached to the broad ligament and this area is called the mesovarium. 113
THE OVARIES
It contains the ovarian follicles in different stage of development surrounded by stroma. The outer layer is formed of fibrous tissue known as tunica albuginea. Germinal epithelium lies over the tuinica albuginea.
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THE OVARIES
Blood supply
Is from the ovarian arteries and drains by the ovarian veins. Lymphatic drainage- is to the lumbar glands. Nerve supply- is from the ovarian plexus.
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Hormones
2.Prolactin inhibitory factor/ hormones
3.Thyrotrophin releasing hormone
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Hormones
PITUITARY HORMONES
Anterior pituitary (Adenohypothesis) Gonadotropins hormones - FSH and LH. Prolactin hormones- milk production. Others hormones - TSH,ACTH,GH Posterior pituitary Oxytocin and ADH.
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Hormones
Ovarian hormones 1.Estrogen - is produced by granulosa cells under the influence of FSH. Function (actions) Responsible for secondary sexual characteristics. Inhibition of FSH secretion from ovary (negative feedback mechanism). Growth of myomentrium, endometrium, alveoli and ducts of the breast. 120
Hormones
Myometrial stimulation (increase myometrial contractility). Promotion of female fat distribution. Stimulation of protein synthesis in the liver. Promotion of calcifications of the bone. Angiogenesis (new blood formation). Na and H20 retention by the kindney. Influences the production of cervical mucus and the structure of the vaginal epithelium.
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Hormones
2.Progestrone-produced by the corpus luteum
under the influence of LH.
Actions Growth of ducts and lobules of the breast, inhibition of prolactin synthesis. Relaxation of smooth muscles of the uterus, blood vessels, GI and urinary tract. Secretary changes and decasualization of the endometrium.
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Hormones
Vasodilatation. Termogenic (increase BBT). Hyperventilation (decrease concentration of co2 . 3.Androgens - produced by the theca interna cells. They are source for estrogen synthesis. 4.Inhibin and Relaxin
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PUBERTY
Is the stage of life at which secondary sexual characteristics appear: It is marked by neuro-endocrine changes. Pulsative releases of GnRh seen at this time. Ovarian steroid hormones start to be secreted. The H-P-O axis becomes coordinated.
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PUBERTY
Notable changes at this time are: Breast development. Marked physical growth. Increase in the transverse diameter of the pelvis. Growth of pubic and auxiliary hair. Menarche the 1st menses.
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menstruation
Ovarian follicular development The number of oocytes are 6-7 million by 20 weeks of gestation. 1-2 million oocytes remain in the ovary at birth. At puberty only 300,000 oocytes remains. Only 400-500 will ultimately ovulate and they will end up at the time of menopause.
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1.Follicular phase:- hormonal feedback promote the development of single dominant follicle. Its average length is 10-14 days.
menstrual phase the basal layer of the endometrium (decidua basalis) under the influence of estrogen; proliferate to regenerate the superficial layer that is shaded during menses. At the beginning of this phase endometrium is relatively thin (1-2mm)
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IV. EMBRYOLOGY
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IV. EMBRYOLOGY Is a science that deals with the origin and development of individual organism. FERTILIAZATION- is the union of the ovum and spermatozoa. Following ovulation as the ovum is extruded from the graafian follicle it is surrounded by a ring of mucoploysaccharide fluid (the zone pellucid) and a circle of cells (the corona radiate.) Fertilization usually takes place at the ampulla.
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Mr.SPERM
Mrs. EGG
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EMBRYOLOGY cont..
Immediately after penetration of the ovum the chromosomal material of the ovum and the spermatozoa fuse. The resulting structure is called a zygote. The occurrence of fertilization depends on: Maturation of both sperm and ovum. Ability of the sperm to reach the ovum Ability of the sperm to penetrate the zonapellucida and cell membrane and achieve fertilization. 144
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EMBRAYOLOGY cont..
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EMBRYOLOGY cont..
It takes 3 to 4 days for the zygote to reach the body of the uterus. This time the zygote undergoes mitotic division and consists 16 to 50 cells and is termed as a morula. When fluid filled cavity appears in the morula a blastocyt is formed, these is after 3 or 4 days. The cells of a blastocyst are arranged in to layers the outer layer is called the trophoblast which eventually develops in to the placenta and membrane. The inner layer is called the embryoblast which later gives rise to the embryo 147 (fetus).
EMBRYOLOGY cont..
All tissue products of conception (embryo, fetus, fetal membranes and placenta) are called conceptus. On day 4 after fertilization the blastocyst enters in to the uterine cavity. By day 7 starts embedding it self in to the prepared endometrium which is now called the deciduas. This process is called implantation. Once implanted the zygote is an embryo (the period from the end of ovum stage until measurement reaches approximately 3cm, 54-56 days). Fetus- period end of embryo stage until birth.
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EMBRYOLOGY cont..
First trimester (0-12 wks) Susceptible to teratogens. Heart function at 3-4 weeks. Eye formation at 4-5 weeks Arm and leg buds at 4-5 weeks Recognizable face at 8 weeks
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EMBRYOLOGY cont..
Brain rapid grows. External genitalia at 8 weeks. Placenta formed at 12 weeks. Bone ossification at 12 weeks. Fetal circulation function properly at 8-12 weeks.
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EMBRYOLOGY cont..
2nd trimester (13-27 weeks)
Less danger from teratogens after 12 week. Facial features formed at 16 week. Fetal heart beat heard by 16 to 20 week with fetoscope. Lanugo appears (hair over the body). Vernix present. Length 10 inches (2.5 cm), weight (05-0.6 Ib) (0.23-0.27 kg). Most organs become capable of functioning.
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EMBRYOLOGY cont..
EMBRYOLOGY cont..
Reflexes present at 28-32 week. Subcutaneous fat deposits at 36 week. Lanugo disappears from the body Average size 18-22 inch, 7.5-8.5 Ib at 38-40 weeks. Term is reached and birth is due at 38-40 weeks.
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EMBRYOLOGY cont..
EMBRYOLOGY cont..
CHORIONIC VILLI
As early as the 11th or 12th day after conception the tropoblastic cells have sent out processes in to the endometrium. The outgrowths becomes finger like and termed chorionic villi. The chorionic villi have a central core of loose connective tissue surrounded by a double layer of trophoblastic cells. 155
THE PLACENTA
Is formed from the traphoblast and deciduas basalis. The placental barrier is formed by the syncitiotrophoblast, cytotrophoblast, the basement membrane and fetal vascular endothelial cells. The placenta on overage has a diameter of 18 cm, a thickness of 23 mm, a volume of 497ml, a weight of 508 grams and villous surface area of 15m2.
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THE PLACENTA
It has two surfaces; maternal and fetal surface. The maternal surface is made of deciduas basalis and dark red in color. The fetal surface is smooth, white and is covered by amnion. The branching fetal vessels are visible under the amnion.
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THE PLACENTA
FUNCTIONS OF PLACENTA
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THE PLACENTA
THE PLACENTA
Its purpose is to act as fail-safe measure to ensure that the corpus luteum of the ovary continues to produce progesterone and estrogen. Forms the basis for pregnancy test. Estrogens is produced as a 2nd product of the syncitial cells of the placenta. It contributes to the mothers mammary gland development in preparation for lactation and stimulates the uterus to growth to accommodate 161 the developing fetus.
THE PLACENTA
Progesterone- maintain endometrial
lining of the uterus during pregnancy. It reduces contractility of the uterine musculature during pregnancy which prevents abortion and premature labor.
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THE PLACENTA
Human placental lactogen (HPL) (chorionic somatomamotropin): Is produce by placental trophoblasts (as early as 3rd week) and detected in serum by 4th week after ovulation. Its main action is resetting of CHO and fat metabolism of mother so as to ensure adequate supply of glucose and energy to the fetus.
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THE PLACENTA
Other action includes. Gluconeogenesis inhibition. Inhibitions of peripheral uptake of cellular glucose and insulin hyper insulinism maintain maternal blood glucose level. Increase uptake of amino acid and ketones by placenta.
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THE PLACENTA
ANATOMICAL VARATION OF THE PLECENTA AND CORD 1.Succenturiata lobe of placenta A small extra lobe is present, separate from the main placenta and joined to it by blood vessels which run through the membrane. Danger the small lobe may be retained in the utero after delivery and if it is not removed it may lead to hemorrhage and infection. Identification- on inspection the placenta will appear torn at edge or torn bold vessels may extend beyond the edge of the placenta.
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THE PLACENTA
2.Circumvallate placenta- in this situation an opaque ring is seen on the fetal surface. It is formed by a doubling back of the chorion and amnion.
separate lobes are present each with a cord leaving it. The bipartite cord joins a short distance from the two parts of the placenta. Danger- the extra lobe may be retained during 166 delivery.
THE PLACENTA
4.A tripartite placenta is similar to bipartite but with three distinct lobes. 5.Battledore insertion of the cord- the cord is attached at the very edge of the placenta Danger- likely it is detached up on applying traction during active management of 3rd stage of labor. 6.Velamentous insertion of the cord- it is inserted in to the membrane some distance from the edge of the placenta. The umbilical vessels run through the membranous from the cord to the placenta. Danger- the vessels may tear with cervical 167 dilatation and would result in sudden blood loss.
To transport oxygen and nutrients from placenta to the fetus. To return waste products from the fetus to the placenta Allows fetal mobility.
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The membranes (sac) it has two layers: 1.Chorion - is the smooth opaque outer most fetal
membrane. Purpose support the sac that contains amniotic fluid.
Offers support to amniotic fluids. It produce the amniotic fluids. It produce phospholipids that initiates the formation of prostaglandins.
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Maternal vessels in the decidua. Fetal vessels in the placenta. Fetal urine. APPEARANCE: Its normal color is clear fluid. Meconium stained- sign of fetal distress except in cases of breech presentation. Golden- sign of hemolytic disease. Milky appearance because of vernix caseosa.
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UTERINE MALFORMATION
Various types of structural abnormality can result from failure of fusion of the mullerian ducts. Double uterus and double vagina- develop when there is complete failure of fusion of the duct. A single vagina with a double uterus- is the result of fusion at the lower end of the ducts only.
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UTERINE MALFORMATION
A bicornuate uterus (one with two horns)- is the result of incomplete fusion at the upper portion of the urogenital area. Unicornuate uterus -with one horn. Agenesis- complete absence of the uterus and vagina Imperforate hymen.
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UTERINE MALFORMATION
EFFECTS OF THE UTERINE ABNORMALITY
Abortion Premature labor abnormal lie of the fetus Poor uterine contraction Obstructed labor
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V. Fetal circulation
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V. Fetal circulation
As the placenta acts as the intermiditary organ of transfer between the mother and fetus, fetal circulation differs from that required for extra uterine existence. The fetus receives oxygen through the placenta because the lungs do not function as organs of respiration in the uterus. To meet this situation the fetal circulation contains certain special vessels that shunt the blood around the lungs, with only a small amount circulating through them for nutrition. 182
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forehead or
sinciput. Their ossification centers are named frontal eminence or frontal bosses. Fuse in to a single bone by 8 years 191
Types of sutures Lambdoidal suture separate the occipital bone from the two parietal
bones. It is shaped like the Greek letter Lambda
Sagital suture- runs between the two parietal bones and runs
from the anterior fontanel in front to the posterior fontanel behind.
occurs at the junction of the lambdoidal and sagital sutures. It is very small and triangular in shape It is normally closes by 6 weeks of age
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1.Caput succedaneum is an
edematous swelling of the subcutaneous tissues of the fetal skull. It occurs in early rupture of membranes in the 1st stage of labor, because there is no bag of fore waters to take the pressure of dilating cervix off the fetal 202 head.
to bleeding between the skull bone and periosteum which covers it. The bleeding occurs because of friction between the skull bones and the periosteum. Characteristics It is not present at birth, but appears 2-3 days after wards . The swellings is limited by the periosteum and can there fore only occur over the bone , although it may be bilateral . It can not lie over a suture.
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Excessive molding
Occurs when labor is prolonged or where the skull bones are not completely ossified ( as in prematurity ). Upward molding Occurs when the baby delivers in the persistent occipito posterior position and the after coming head of the breech passes through the pelvis. It can result in intracranial hemorrhage . 207
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